What It's Really Like When You Can't Feed Your Family

Amy Bardwell never expected to be picking up free groceries at her neighborhood food pantry. But she worries every month about how to scrape together the money needed to pay her family's rent and utility bills and still have enough left over for food.

A few years ago, Amy and her husband, Otis, who are parents of Edmund, 3, and Lydia, 7, were living comfortably in the Los Angeles suburbs. When Otis decided to go back to school for a master's degree, the college-educated couple felt sure it would make him even more employable as a college art instructor. "He wanted to shift away from office administration," explains Bardwell, who now works part-time as a nanny, bringing Edmund with her. "We heard that lots of teachers were approaching retirement age, which would create all these new opportunities." But by the time Otis graduated in 2008, the recession had hit and the job market dried up. "He cobbles together work as best he can, picking up one class here, one class there, but he's been underemployed for more than two years now and we're just barely making it," Bardwell confesses.

In order to put dinner on the table, the family has cut back on every expense they can. They've deferred student loans and they pay cash for everything to avoid credit-card debt. "It can feel surreal because we live in a pretty affluent neighborhood -- I see other moms getting together for coffee at Starbucks, which I can't do now," says Bardwell. "One of the most discouraging things is not being able to afford the piano lessons and gymnastics classes that our kids see their friends taking. I hate for them to miss out." Bardwell tries to put a positive spin on their situation when she talks about it with Lydia and Edmund. "I try to say that everybody needs help sometimes, and right now we're getting help from some nice people," she explains. "I also talk about how it's important for us to help others. I'll hand them a quarter to put in the Salvation Army bucket, for example, so they get a sense of what it feels like to give as well as receive."

She admits that she's worried about other people's reactions when she's reached out for help. "I've had to get over my own preconceptions, where I'd think, 'Oh, you just need to work harder,' or 'Don't waste your money on the nonessential stuff,'" Bardwell admits, getting teary-eyed. "Because now it's my son's birthday and I really want to buy some frosting to put on the cake mix we got at the food pantry. And that's nonessential. But it just doesn't feel that way when it's your child."

The family hasn't missed a meal yet, but Bardwell isn't sure where they'd be without regular trips to the food pantry. Many nights, they eat rice and beans, sometimes with a canned vegetable on the side. "We're so thankful for the help, but it can be frustrating because it's not, 'What do I feel like cooking tonight?' anymore," Bardwell adds. "It's, 'What did we get, and will it be enough to keep everyone well fed?'"

The Bardwells are four of the more than 50 million Americans who worry about having enough to eat today, a number that has climbed nearly 40 percent since the start of the recession in 2007. It's a group that now includes more than 17 million children, meaning one in four American kids are what the United States Department of Agriculture classifies as "food insecure," or living in a household that has difficulty providing enough food for all of its members. The states with the highest food-insecurity rates are, in order: Arkansas, Mississippi, Georgia, Texas, and North Carolina. Households with children report food insecurity at almost double the rate of childless households, and Feeding America, the nation's largest network of food pantries, says the number of children using its services has jumped 50 percent in the past four years. Nearly half of its clients are now in suburban and rural areas, an increase of 58 percent from 2006.

Families with babies and young kids are the ones who are least likely to be getting enough to eat -- and these children are also the group that suffers the most from being malnourished. Though hunger gets the most media attention around the holidays, summertime is actually the roughest stretch for many children because they can't rely on free or low-cost school-provided breakfasts and lunches to get them through the week. "Before the recession, we had a lot of families living very close to the edge," says Parents advisor Irwin Redlener, M.D., president of the Children's Health Fund. "Now, they have fallen off the cliff."

How Hunger Impacts Health

In a third of food-insecure homes, one or more family members sometimes go hungry. Tangela Fedrick's household, which includes her children, 2-year-old Tasir and 3-year-old Asyiah, plus Fedrick's own teenage brother and sister, falls into this category. "There's never enough food," says Fedrick, 22, a single mom in West Philadelphia. She wants her family to be well-nourished, but there are weeks every month when that's not possible. "By the time I buy diapers, pay for day care and get my transit pass so I can go to work and school, and pay co-pays on my kids' asthma medication, there's nothing left," she explains. "So if all we have is cereal or toast, that's what we have for dinner. A lot of the time, that's what we eat for breakfast and dinner."

The person most likely to go hungry in homes like hers? Mom. "As long as I know my babies ate something, I'll be fine," insists Fedrick, who regularly skips meals. "I can drink some water and wait it out." But experts agree that children can still suffer even when they're not the ones who are hungry. "Parents deprive themselves to feed their children, and now you have an irritable, exhausted mother who can't cope as well," says Deborah Frank, M.D., professor of pediatrics at Boston University School of Medicine. "When we hear yelling in the waiting room, it's usually because the mom, child, or both is really, really hungry," says Dr. Frank, who keeps graham crackers and milk on hand to give to children and mothers who come to her clinic.

Mothers in food-insecure households are also three times more likely to report depressive symptoms than mothers who get enough to eat, according to a policy action brief from Children's HealthWatch, which studies how economic conditions affect children under age 3. Depressed moms are less likely to show affection, read stories, play games, and offer other forms of interaction, which are so critical to a young child's developing brain. Breastfeeding can help buffer infants against the negative effects of food insecurity, but only when Mom gets enough to eat: A malnourished nursing mom will have trouble producing enough breast milk, and studies show it often lacks critical nutrients like vitamins D, B12, and A.

When the situation is so dire that children do miss meals, the consequences continue to snowball. "The scary thing is that a child's mental development will be impacted long before you see an effect on growth," notes Dr. Frank, founding principal investigator of Children's HealthWatch. When babies and toddlers don't eat enough, their body tries to conserve heat for physical needs, so they become less active. "They sleep more and explore less, which means they miss out on the crucial learning that a normal child experiences," she explains. "Once this ground is lost, it's very hard to get it back."

Hungry infants and toddlers are also more likely to catch infections, have anemia or other health problems, and be hospitalized than children who are well-nourished. Dr. Frank sees a handful of cases each year where desperate parents overdilute infant formula to make the cans last longer. "This causes low blood salt, which can lead to seizures," she notes. "Parents might also give their baby cow's milk or even soda, both of which are cheaper than formula but can lead to growth failure and other health problems. Once a child becomes malnourished, she needs 50 percent more quality nutrition than a typical child does in order to regain her health."

While it may seem paradoxical, hunger also plays a key role in another major public health issue: childhood obesity. "Parents may buy fruits and vegetables until their disposable income is drastically reduced, but then they have to turn to very low-cost foods that are higher in fat and calories," explains Dr. Redlener. Poor neighborhoods are more likely to lack grocery stores, farmers' markets, and other affordable sources of healthy foods. Even if you can find products for sale in your neighborhood, you might not be able to afford it: A study from the University of Washington found that junk food can cost an average of $3.32 per 1,000 calories, compared with a whopping $27.20 per 1,000 calories for nutritious foods. "I often hear things like, 'Those people can't be hungry -- they're fat!'" says Janet Poppendieck, Ph.D., author of Free for All: Fixing School Food in America. "But the least healthy, most obesity-inducing calories in our society are often the cheapest."

Falling Through the Gap

Despite the rise in unemployment and stereotypes about out-of-work welfare moms, most adults on food stamps (and 36 percent of food-pantry users) are working but unable to find jobs that pay a living wage. Things actually got harder for Fedrick when she received a pay raise at her part-time job. "I went from $7.50 to $7.75 an hour, so my cash assistance stopped," Fedrick explains. She now has a full-time job in a day-care center but still doesn't make enough to cover her expenses.

Many families don't realize they could qualify for more help (such as food stamps), or they fall through a gap in the system where they can't pay their own bills but aren't poor enough to qualify for aid. In one 2008 study, 21 percent of children going hungry lived in households with an income higher than the cutoff needed to get the reduced-price lunch and breakfast program at school, says Dr. Poppendieck.

Even when families do qualify for help, obtaining assistance can be difficult. "Our safety net is completely broken," says Mariana Chilton, Ph.D., associate professor of public health at Drexel University and director of Witnesses to Hunger, a research and advocacy project working with families who have experienced hunger. "It's rare to talk to someone receiving assistance who hasn't been mistreated or had critical documents lost. It's so frustrating."

A Hunger-Free Future

Our economy may be slowly improving, but it will take a long time for food-insecure families to bounce back. "This recession will be permanently inscribed in the bodies and the brains of children growing up today," says Dr. Chilton. President Obama has pledged to end childhood hunger in America by 2015. The most concrete action to come from that pledge to date is the Healthy, Hunger-Free Kids Act of 2010, which will expand the federal school-lunch program to provide healthy free or reduced-priced breakfasts, lunches, and suppers to more low-income students.

The Bardwells and Fedrick continue to try to improve their circumstances. Fedrick attends a culinary job-training program that she hopes will enable her to land a better-paying full-time job in a restaurant kitchen. "All I want is to be able to work hard and earn enough to take care of my children," she says. In the meantime, her daughter, Asyiah, has reached the "Why?" stage, which means Fedrick must face questions like "Why did they turn out the lights?" and "Why can't we get pizza for dinner?" "There aren't any simple answers, so I find myself saying 'Just because' or 'Maybe next time,'" Fedrick says. "And she just gives me that look, like she already knows what 'next time' means."

Help For the Hungry

If you're struggling, or know someone who is, get assistance. "Don't try to hide it, because you're not alone -- food stamps help feed one in seven people today," says Dr. Mariana Chilton. Now called the Supplemental Nutrition Assistance Program (SNAP), the government-funded program provides qualifying households with a card, accepted at most grocery stores, to purchase food (www.snap-step1.usda.gov/fns). More useful programs:

• CHILD AND ADULT CARE FOOD PROGRAM (CACFP) A federally funded program that feeds 3.2 million children and 112,000 adults daily at day-care programs and shelters across the country.
• THE SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC) Provides federal grants for supplemental food, infant formula, health-care referrals, and nutrition education to low-income pregnant women, new moms, and kids up to age 5. www.fns.usda.gov/wic/howtoapply/
• SCHOOL BREAKFAST AND LUNCH PROGRAM A federal program that provides children with nutritionally balanced, free, or reduced-price breakfasts and lunches in schools. www.fns.usda.gov/cnd/
• FOOD PANTRIES offer canned and dry goods and sometimes even fresh produce, meat, dairy, and staples including diapers. feedingamerica.org

What You Can Do

GET INVOLVED For $25, Feeding America will help provide meals to feed a family of four for two weeks. You can also register with its Hunger Action Center to become a hunger-relief advocate (feedingamerica.org). Share Our Strength is a national nonprofit that works with community organizations and creates partnerships that provide food to children at risk of hunger. A $25 donation will help feed a child three meals a day for more than a month (strength.org). Wholesome Wave works to improve access to healthy foods in neighborhoods without adequate grocery stores. It needs donations and volunteers to facilitate programs (wholesomewave.org).

SUPPORT SUMMER PROGRAMS "Ask your school or recreation center if it's participating in the federally funded summer feeding programs," suggests Dr. Mariana Chilton. "Many communities don't take advantage. You can help organize volunteers to host distributions at parks and playgrounds."

WRITE LETTERS "Tell your senators and representatives that you want to see an end to childhood hunger," says Dr. Chilton. You can also push your congresspeople to support an expansion of food-stamp benefits in the Farm Bill, which will be rewritten in 2012.

DONATE THOUGHTFULLY Advocates recommend asking food pantries and soup kitchens what is needed before cleaning out your kitchen cupboards. "Think of what you would want your kids to eat," says Dr. Deborah Frank. Canned produce, infant foods, diapers, and supermarket gift cards often top the list of needs.

Healthy Eating on a Budget

This grocery list of affordable, kid-friendly foods, from Vivien Morris, R.D., director of community initiatives for the Nutrition and Fitness for Life Program at Boston Medical Center, offers maximum nutritional bang for every buck.

• Cabbage, broccoli, and carrots
• Dried beans
• Ground turkey
• Whole chickens (as long as your family will eat all parts)
• Bulk whole grains like oatmeal and brown rice
• Quart-size low-fat yogurt
• Thin-crust frozen pizza dough (add tomato sauce, vegetables, ground turkey, and cheese)

Originally published in the July 2011 issue of Parents magazine.

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