A Hungry Child's First Thousand Days

 

By David K. Shipler 

                Dr. Megan Sandel, a pediatrician, experiences a troubling revelation whenever she sees a patient in the Boston Medical Center’s Grow Clinic. The clinic seems like a normal health-care facility in an advanced country, she notes: a waiting room, a medical assistant taking a child to be weighed and measured and then into an examining room.

“But that’s where, in some ways, the picture changes,” said Dr. Sandel, the clinic’s co-director, “because when you walk into the room you see this really cute, what you think is a twelve-month old, but it turns out it’s a two-year old. It’s a two-year old who hasn’t outgrown their twelve-month-old clothes yet.” [Listen to Sandel here.]

Even more serious than what you see is what you do not see: the brain of the child during a critical window of cognitive development. And in that largely invisible universe of neurons and synapses, of myelin sheaths and the neurological connections that are supposed to be generating the abundant future of every small person, lifelong damage is being done. The medical diagnoses are “stunting” and “failure to thrive.”

 That is malnutrition in America, which is chronic among the poor and has soared during the pandemic. Its long-term harm will be one of the most severe legacies of Covid-19.

 The usual incidence of what the government calls “food insecurity” ranges from 13 to 21 percent of American households with children, varying with the state of the economy. Most of them are white, although Black and Hispanic families suffer at higher rates. As school meals ended and vulnerable parents lost jobs during the Covid-19 outbreak, the Grow Clinic’s caseload jumped 40 percent. Nationwide, the rate of food insecurity in families with children rose to 29.3 percent last spring and summer from 13.6 percent in 2019, before the pandemic. With the return of some jobs and bursts of government assistance, the level has gradually declined to 17.8 percent, according to a large sample of adults with children in their households, surveyed by the Census Bureau in April. Seven out of ten who reported that they “sometimes” or “often” did not have enough to eat said they simply couldn’t afford to buy more food.

The recent $1.9-trillion American Rescue Plan will help, but not sufficiently or indefinitely. It raises grants by what used to be called food stamps--the Supplemental Nutrition Assistance Program (SNAP)—by up to $100 a month per family. More significantly, the plan’s $3000 to $3600-per-child stipend for one year would re-conceptualize governmental aid if made permanent, evading bureaucratic red tape by providing direct cash payments. Medical professionals say that getting money into parents’ pockets is the best way to treat children’s malnutrition.

Without broader policy overhauls, though, food insecurity seems likely to remain both a result and a cause of hardship, a key link in the middle of a complex chain reaction. For poor families without government housing subsidies, for example, rent on the private market can soak up 40 to 60 percent of income. Paying rent is not optional. The bills for electricity, water, heat, phone, and car loans cannot be ignored. The part of the budget that can be squeezed is the part for food. And that’s what happens.

Empathy vs. Self-Interest

By David K. Shipler

Making America Cruel Again: Part 1 of an occasional series

            It was sadly appropriate for Attorney General Jeff Sessions to use a biblical verse once cited by some slave owners to justify cruelty to other human beings who were considered less than human: by Sessions about separating children from parents who enter the US illegally and “infest” the country (President Trump’s word, reducing them to insects and rodents), and by planters about returning fugitive slaves to their rightful place in bondage. It was the law, after all. Romans 13:1.

            Not that ripping weeping children from their parents’ arms is slavery—although slavers did so when profit and efficiency dictated. And not that the US is perpetrating “genocide” or acting like Nazis, as some critics have said, reaching for the most dreadful terms to harness their disgust and shame at the behavior of their beloved country.

But the outrages being perpetrated on the Mexican border signify the resurrection of practices and hatreds that might have seemed long buried in history if you were one of those citizens who believed America was destined to become better and better: more welcoming of difference, more just, more decent, more humane. How naïve of those of us who fostered such faith in their beloved country.

Nasty attitudes and impulses from the worst dimensions of America’s past are resurfacing as if they had merely hibernated waiting for the oxygen and sunlight of demagoguery to nurture them back into thorny bloom. And our past is replete with unsavory precedents: slavery, of course, and racist law in the form of Jim Crow; Native American families torn apart as authorities tried to stamp out tribal culture; citizens of Japanese descent interned during World War II; explicit anti-Semitism and white supremacy.

Food Stamps: The Chain Reaction

By David K. Shipler

            Let’s give the Republicans in Congress the benefit of the doubt. (Yes, I hear the groans, boos, and catcalls.) But let’s be charitable for a moment and assume that they had no idea, when they allowed severe cuts in food stamps to take effect today, that they were damaging the brain development, lifelong cognitive capacity, and therefore the future earning power of untold numbers of American children. If they had known, surely the legislators would not have done what they did.

            That may sound like an overstatement until you look at the science or, more broadly, the interaction between economics and biology.

            The chain reaction between early malnutrition and various intellectual and behavioral deficits has been well established by neuroscience. Extensive documentation, in readable form, can be found in a thick digest of studies published in 2000 by the National Academy of Sciences, with the provocative title From Neurons to Neighborhoods. The research has been updated since in scholarly papers and conferences.

            Inadequate iron and other nutrients during the critical periods of brain development—especially the second and third trimesters of pregnancy and the first two years after birth—damages the complex, overlapping processes of growth.