Who's Hungry - You Can't Tell by Looking Project



A photo education project designed to promote awareness and to provide information about the prevalence of childhood hunger in northern California for pediatricians and other health care professionals, as well as to the general public. Produced by pediatrician members of northern California Chapter 1 of the American Academy of Pediatrics in collaboration with local photographer Karen Ande, the project promotes screening and referral for hunger/food insecurity in our community. Working with the Food Security Task Force of SF DPH, the SF Food Bank, SF School District, and other local community organizations to provide information about access to food and nutrition resources in the San Francisco Bay Area, we have the following goals, which can be replicated in other communities:

  • Promote awareness of the prevalence of child hunger/food insecurity to pediatricians, other child health professionals, and the general public
  • Encourage routine screening using the 2 item HFSS screen
  • Collaborate with local Food Banks, Public Health, School District, and other community based organizations to improve referral and access to nutrition resources for food insecure families and plans to develop an app for these
  • Influence policy to help find solutions for food insecurity/hunger

One in four San Francisco Bay Area children goes to bed hungry each night due to lack of food. This and the family’s lack of money to buy adequate food to feed their families defines food insecurity. Pediatricians know that child hunger contributes to learning and behavior problems and a myriad of growth and developmental issues. We also recognize that parents, especially mothers, routinely go hungry to provide food for their children.

We might not realize the prevalence of food insecurity or hunger within our own communities and our own patient populations. In fact, you cannot tell by looking if a child is hungry or food insecure, as Ms. Ande’s photographs demonstrate. Photos of children whose consenting parents completed the screening questionnaire were taken at a local health fair and at other city venues last fall and winter.

We encourage all pediatric and adult primary health care professionals to routinely screen for food insecurity/hunger using the following 2 questions and to refer those screening positive to appropriate community resources:

  • Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.
  • Within the past 12 months we worried whether our food would run out before we got money to buy more.

*In 2010, Hager and associates confirmed (Pediatrics 2010:126: e26-e32) the validity of a 2 item screen for food insecurity risk, having analyzed the USDA survey of 30,098 families which used the 18 item Household Food Security Survey (HFSS)*. That multi-site survey found 23.7% families food insecure. Working to develop a more succinct screening instrument applicable to routine use, they found the above 2 item screen brief, valid, sensitive and specific.

Lucy S. Crain, MD, MPH, FAAP

PDF icon whoshungryposter.pdf16.37 MB