Life was not easy for Tianna Gaines-Turner before the coronavirus pandemic began. When she was out of work for six months last year after having her fourth child, the family, who lives in Northeast Philadelphia and has struggled with periodic homelessness and hunger, relied on her husband’s job as a machine operator at a pill-packing plant, as well as their monthly stipend from the Supplemental Nutrition Assistance Program, or SNAP, formerly known as food stamps. She eventually returned to her job as a housing stabilization specialist for a Philadelphia nonprofit, but her hours were only part-time and her paycheck came just once a month.
“I love my job, but that was a real bad struggle,” Gaines-Turner told me in a recent phone call. Things got even harder after her 12-year-old daughter fell into a storm drain and injured her knee, requiring a hospital trip and physical therapy. “We had out-of-pocket expenses of over $1,000 in a month,” said Gaines-Turner, 41, whose story I’ve followed for seven years, and chronicled in a book. “That wiped out anything we’d been managing to put aside.”
Then coronavirus came.
Gaines-Turner’s husband was sent home without pay for four days after two people at his workplace caught the virus, and the factory was shut down. Now he’s back and receiving hazardous pay, but fewer work hours, and since the family doesn’t have a car, they must choose between his commuting via public transportation, with its higher exposure risk, or expensive Uber rides. The family has received less than half of their expected stimulus check and has yet to see an increase to their SNAP benefits, even though the United States Department of Agriculture approved Pennsylvania’s request to increase the maximum allowed benefit to all SNAP recipients on April 2.
“They say ‘call this number,’ but you’re one of 500 people trying to get through,” Gaines-Turner said. A friend bought them groceries but she’s not sure what they’ll do when those run out — which they will, quickly, with four children stuck in the house. “I think my middle name is ‘snack,’” said Gaines-Turner, who is also still breastfeeding her baby, while trying to do her job from home. “I feel like I’m just spinning in circles, trying to make breakfast, lunch and dinner. I worry every day about food.”
The family hasn’t had to skip meals yet, but Gaines-Turner said it may be on the horizon if they don’t receive their remaining stimulus checks, which will allow her to catch up on bills. And although she has dealt with food insecurity before, most of her usual coping strategies, liking going to food pantries or sharing meals with neighbors, now feel dangerous to do without increasing the family’s risk for virus exposure. Gaines-Turner has high blood pressure and her children have asthma and epilepsy, making them all high risk for Covid-19 complications. “People who live in poverty, we already know how to navigate and do different things, because we’ve pretty much had to do it all our lives,” she said. “But then something like this comes, where everything just shuts down, people are dying.”
Low-income families across the country are facing the same dilemma. Nearly one in five children 12 and younger are not getting enough to eat — three times the rate reported during the Great Recession in 2008 — according to a survey released Wednesday by the Brookings Institution. The survey of mothers found that in homes with children, food insecurity reached almost 35 percent. This poses an enormous challenge for the government’s safety net of programs like SNAP and the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, which were already struggling to meet the needs of the 37 million Americans who met criteria for “food insecurity” in 2018. Congress has passed a short-term increase in benefits for about 60 percent of recipients but continues to squabble about how long to maintain the increase.
In a national survey by Hunger Free America, a nonprofit organization based in New York City, 37 percent of parents reported cutting the size of meals or skipping meals for their children because they did not have enough money for food between mid-March and mid-April, when the survey was released. This represents a fivefold increase since before the coronavirus crisis began. “Before all of this started, we had a bigger hunger and poverty problem in this country than any industrialized nation on the planet,” said Joel Berg, the chief executive of Hunger Free America.
Now, with more than 30 million Americans unemployed since the start of the pandemic, families who already qualified for food assistance need more help than ever, and many families are finding themselves newly in need. Advocates say the government response has not been swift or sweeping enough. Emergency increases to SNAP benefits don’t help the poorest Americans — who are disproportionately families with young children — already receiving the maximum benefits.
School districts are scrambling to distribute food to the families who qualify for free or reduced-price breakfasts and lunches, and many are now also feeding hungry parents and other adults in the community. But other districts are still struggling to get food out to all of the children who need it; the New York City Department of Education recently said it was serving around 470,000 meals per day through its 475 Meal Hub locations, and another 110,00 via home delivery — impressive figures that nevertheless fall short of the 900,000 free meals provided each day by New York City schools when they are open.
“If you have to catch the bus to go pick up your child’s school meals or go to the food pantry, you’re putting yourself at higher risk for catching Covid-19, just trying to meet your child’s food needs,” said Marisol Perez, Ph.D., an associate professor of psychology at Arizona State University who studies the health trajectories of low-income Mexican-American families in Phoenix. “And with no child care, people are wondering, do I leave my children home alone or take them with me to go get the meals? These are tough decisions with no right or wrong answer.”
Infants and toddlers in food-insecure households were at higher risk for iron deficiency, experienced more hospitalizations and were generally in worse health than children who had enough to eat, according to data collected by Children’s HealthWatch, a network of public health researchers who study how economic conditions impact young children. But along with the physical health risks of so many children going hungry, parents and anti-hunger advocates are worrying about the longer-term impact on child development and the emotional health of families. Dr. Perez said stress is “skyrocketing” among the families in her study. In addition to the effort and risk that goes into procuring enough food for their children, she said, many parents reported going all day without eating so their children wouldn’t miss meals. It’s an understandable choice with potentially dire consequences, because even when children aren’t going hungry themselves, they still suffer as their hungry grown-ups struggle to be patient, present parents.
Mothers in food-insecure households were more likely to report depressive symptoms than mothers who had enough to eat, according to a 2018 review of 31 studies. And depressed moms were less likely to read stories, show affection and offer other interactions critical to a young child’s brain development, said Dr. Deborah Frank, M.D., a founder of Children’s HealthWatch and a professor who studies child health and well-being at Boston University School of Medicine. “Everyone is more worried, irritable, headache-y and lethargic when they aren’t getting enough to eat.”
Dr. Frank’s data also shows that children who experienced household food insecurity may have higher rates of attention issues, anxiety and behavioral outbursts. By age 5, she said, children are old enough to understand the pressures parents are facing. “They’ll try to squash the younger sibling from asking for seconds because there isn’t enough, or share their school lunches with parents,” she said. “Parents try to protect the children and children try to protect their parents.”
Dr. Megan Sandel, M.D., an associate professor of pediatrics at Boston University School of Medicine, is a director of the Grow Clinic for Children at Boston Medical Center, originally founded by Dr. Frank. The clinic treats children from mostly low-income families who have been diagnosed with failure to thrive, a common consequence of household hunger. Since the pandemic started, she said, children who had previously graduated from her program have returned because their families are worried they may fall off the growth curve again in the face of new food insecurity. And many of the families she works with are reporting an increase in behavioral outbursts and regression on milestones like potty training.
“One mom kept saying her 4-year-old was being mean to her, but what it came down to is, he is really anxious,” Dr. Sandel said. “He’s internalizing what’s going on, and he’s worrying about dragons and spiders coming to get him, so he wants to sleep in the bed with her.” Dr. Sandel worked with that mother to figure out a new bedtime routine for her child, because she said getting enough sleep is crucial for all children, but especially those struggling with missed meals and increased stress. “And if he wants to sleep in her bed, right now, I’m going to say that’s OK!”
Even a temporary dip into food insecurity can be traumatic for families, but those who struggle chronically — or have seen their struggle renewed because of the pandemic — can find it permanently distorts their relationship with food. During times when food was scarce, Gaines-Turner told me she often ate nothing but lettuce sprinkled with orange juice. “I’m just not even hungry for anything else,” she said, but she was also making sure her children were fed. This kind of enforced restriction may trigger problematic cycles in some parents, said Carolyn Becker, Ph.D., a professor of psychology at Trinity University. She studied 503 food bank recipients in San Antonio, Texas, and found that those facing the most severe degree of household hunger (meaning food was scarce enough that even children were missing meals) were also the most likely to meet criteria for eating disorders.
“We saw binge eating when food was available, which we expected, but we also saw folks frequently skipping two or more meals in a row, and 20 percent of the most food insecure group reported vomiting after they ate,” said Dr. Becker, noting that further research is necessary to explain these findings. “It’s possible that restriction triggers this pathology in vulnerable people, even if it’s involuntary and has nothing to do with the body weight and shape concerns we usually associate with eating disorders.”
Even families who are currently food secure said that seeing empty grocery store shelves brings up painful memories and anxieties. Bethany Johnson, a 39-year-old doctoral student and mother of two in Charlotte, N.C., said that although her family is not struggling to access food, she has found herself doing the same kind of calculations she saw her mother do when she was growing up in a food insecure household in Syracuse, N.Y. “I remember how she would always go to two different grocery stores because they took different coupons, and she could make our food stamps stretch further that way,” Johnson said. “We ate a lot of Velveeta and cereal for breakfast and dinner.”
Johnson said she deliberately wasn’t hoarding things like toilet paper, because she worried about the families who can’t afford to stock up. “But I’m getting Instacart deliveries every couple of days, and I feel like I always need to have two or three cartons of half-and-half, and two dozen eggs in the fridge,” she said. “I’m not buying 20 but I need more than one.” She’s also stocking up on pre-shredded cheese — “it’s my new Velveeta” — pasta and oatmeal. Johnson has asthma and is considered high-risk for Covid complications, which she also attributes to her childhood: “A lot of us who grew up in really poor neighborhoods have asthma,” she said. “If I get this thing, I’ll be on a ventilator. So we’re doing Instacart and tipping extra. And I worry about the workers involved. I feel like I’m endangering people to keep their kids fed.”
Gaines-Turner and other food insecure parents I’ve interviewed reported being similarly strategic about shopping for foods with long shelf lives.
“I have what I call my ‘army pots,’ these big pots where I can make a pile of spaghetti or chicken alfredo,” said Alisha Gillespie, a 31-year-old single mother of three boys ages 12, 8 and 5, in Philadelphia, who receives SNAP to supplement her income as a hospital feeding aide, and participates in a financial empowerment program for low-income families called the Building Health and Wealth Network. “Then my boys eat that all day long or maybe for two days. That’s been holding us over.”
Gaines-Turner makes large trays of nachos for her children, and relies on the bags of free snacks their school drops off to help keep everyone fed during the day, especially her youngest who, like most toddlers, lives for cheesy crackers and fruit cups. “You’re looking for things that are shelf-stable because they can stretch,” Johnson said. “You buy those salty flavor packets because you can use half on your rice or noodles and get more meals out of them.”
But running alongside the enormous mental load these parents carry in acquiring and preparing enough food for their families is the fear of having to explain to their children that there isn’t enough to eat. For parents navigating that difficult conversation, Dr. Frank advised leading with empathy. “It’s important to acknowledge their feelings,” she said. “Try: ‘I know you’re angry with me right now because you’re hungry and your tummy hurts. I’m working and other helpers are working to try to get you more.’” And make sure to reassure them that the lack of certain foods isn’t a punishment or somehow their fault. If children are missing favorite snacks or meals because of grocery store shortages or budget limitations, you can also encourage them to think creatively about a Plan B and C in terms of other foods or meals they might enjoy. “One of my families is doing a lot of breakfast for dinner because those foods are more affordable and their kids get really excited about it,” Dr. Sandel said.
Keeping other parts of children’s lives as consistent and stable as possible won’t blunt hunger pangs, but it may help manage the anxiety and emotional instability they are experiencing. “As much as possible, include your kids in planning meals and schedules,” Dr. Sandel advised. “This can give them some sense of control in a time when they’re feeling really out of control.” Gaines-Turner said a schedule was helping her find some time for herself too. “I’m trying to wake up half an hour early in the morning just to pray,” she said. “We need that time to ourselves to meditate, or read a book, just something where we can work out that energy.” Gillespie said she journals, and also schedules times for family meetings so she can talk through issues with her kids.
But Dr. Frank was quick to warn that the consequences of childhood hunger cannot be mitigated by parental ingenuity alone. “You cannot make people feel like if only they were better parents, their kids could survive this,” she said. “We’re talking about a base level of nutritional deprivation that is very difficult to compensate for. We need communities to reach out to these families and help them cope.”
— source nytimes.com | Virginia Sole-Smith | May 7, 2020