As a community pediatrician with firsthand experience, I’ve observed an enduring curiosity among parents and caretakers about food, nutrition and health. I have also sadly met families who struggle to access the very food they need to stave off hunger and optimize their growing child’s health. A child is a core member in the household, vulnerable to stress and environmental changes, yet they are often a missing piece in our “Food as Medicine” conversations.
Food as Medicine (FAM) consists of the strategies and interventions that work as part of healthcare to improve access to nutritious food to prevent, manage or even treat disease. Within FAM, adult food/nutrition insecurity- and diet-related chronic conditions are often prioritized. Unfortunately, children and families are considered an afterthought. When considering a more expansive approach including children within FAM, we encounter several significant considerations, including:
Investing in household health
FAM efforts could focus on children in two different ways: actively, directly for children and adolescents; or passively, designed for another household member yet also supporting children in the household. Let’s focus on the latter. Data show the over 37 million U.S. households with children often face higher poverty and food insecurity rates, leading to a greater prevalence of diet-related conditions like heart disease, diabetes and obesity. Adult caretakers often sacrifice their own nutritional needs, skipping meals or stretching resources, to ensure their children do not go hungry. This creates significant risk of reducing effectiveness by diminishing the food supply intended for the adult.
We need FAM strategies that revolve around the entire family. While it’s essential to supply more substantial amounts of food to households under FAM programs, it comes with challenges such as increased costs and the need for more storage space. These issues may discourage potential backers such as insurers, health systems, service providers and employers. However, supporting the entire household with enough food can likely lower stress levels for adult caretakers. Reducing food insecurity, often a toxic household stressor, can potentially transform household behaviors and create a more positive environment.
Assessing the impact of pediatric FAM interventions through data
Children do not typically carry the same disease burden, cost of care or risk of poor health outcomes as adults do. So, questioning the prioritization on children makes sense. But this doesn’t tell the entire story. Adult-centered FAM intervention research is further along than pediatric research. We have seen rigorous studies (PDF) with adults showing the burden of cost as a result of food insecurity, cost savings appreciated with FAM and significant improvement in disease outcomes. While the greatest potential for reducing the lifelong impact of diet-related diseases lies in children, FAM has not been as extensively researched in pediatric settings.
Medically Tailored Meals have proven to be some of the most promising interventions in adult settings, however, the value for pediatric populations has not yet been proven. There is limited evidence in children showing consistent disease improvement with typical FAM strategies incorporating medically tailored meals/groceries, produce prescriptions or even nutrition education. This may be due to the lack of sustainable funding for pediatric FAM programs and research. This should not deter us from the need to focus on strategies and programs for children. It should encourage us to push for more aggressive analysis of potential novel short-term and long-term benefits.
It is also important to look at the years of data that do show the power of FAM within children. Looking at federal nutrition programs like the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Program for Women, Infants and Children (WIC), or school meals we see their long track record of improving children’s health outcomes (PDF)—through decreasing infant mortality, improving growth or even preventing disease onset. We also see a multitude of other institutions and charitable organizations such as Feeding America leaning into multigenerational FAM programs and showing promising results. It’s crucial to continue to utilize and measure FAM interventions as a tool to manage and prevent future disease and turn the tide of family health.
Adapting food interventions for children’s diverse dietary needs and stages
FAM interventions should be adapted to the varying dietary needs and preferences of children in different stages of development. The diversity in food needed for different children based on their stage of development, age and preferences must be considered. Many adults and children display picky eating tendencies beginning earlier than you might expect. A child begins to adapt, taste and smell flavors of food in the womb during the second and third trimesters as well as during the early months post-delivery based on whether the child is breast or formula feeding. The continued introduction of diverse solid food is also a contributor to later eating patterns.
Children do not need to be raised on fish sticks or other modern meal categories marketed to families. It is beneficial to support families early on with FAM strategies that expose pregnant individuals, infants and toddlers to whole foods that are developmentally appropriate, cost-effective and tasteful. This would support caretakers not being isolated with what they eat and let children enjoy the families’ traditional meals at a younger age.
That said, it is important to recognize the nutritional needs of a 2-year-old are different from the needs of a 13-year-old. To enable children to thrive using FAM interventions, nutrition-related medical education needs to be broadened to support families and meet culturally appropriate developmental needs. These situations present a challenge for FAM for children yet can be overcome for the greater good of improving the health of the next generation.
Future scope
The potential for implementing FAM for pediatric settings is promising, with growing support from stakeholders, lawmakers and health agencies. By promoting FAM as a tool for reducing stress, disease management and prevention among children, we can ensure healthier future generations.
Kofi Essel, M.D., M.P.H. serves as Food as Medicine director at Elevance Health and is board-certified community pediatrician at Children’s National Hospital (CNH) and Clinical Associate Professor of Pediatrics at the George Washington University School of Medicine & Health Sciences in Washington, D.C.
(Editor’s note: Feeding America has collaborated with the Elevance Health Foundation as a program partner and grant recipient.)