Tackling infant malnutrition in Shenandoah County, Virginia.
Good nutrition, beginning in utero and continuing throughout the first years of life, is critical for ensuring optimal health, growth and development. Children and society pay a heavy price when nutrition is inadequate. Children pay with compromised development and attainment, and our society funds the ongoing services needed to deal with the resulting health, schooling and behavioral problems.
Poor nutrition takes many forms. Hunger is the most obvious, with mothers delaying feeds and watering down formula to stretch the food they have on hand. But poverty also leads to the inappropriate substitution of foods. Eating in the earliest years of life provides the foundation for a child's future food tastes and eating habits. Poor nutrition in infancy can place the child at risk for long-term obesity and related health problems.
A letter in the journal Pediatrics summarizes how poverty in the US is linked to food insecurity and child malnutrition. Malnutrition takes many forms. Poor children go hungry when money is especially short, as pay day approaches, when food stamps are exhausted and when school is out and school meals are unavailable. Malnutrition is seen in the excessive consumption of calorie-dense foods - foods that provide the most energy at the cheapest price - those rich in sugars and fat. Such food choices are seen as an adaptation to poverty and an economic imperative. But such choices also establish food preferences and patterns of eating that place poor children at risk for future obesity and diabetes.
SNAP (Food Stamps) and WIC are vital programs for poor families, but both were designed to supplement nutrition, not as measures to eliminate food insecurity. Families living in long-term poverty never accumulate the reserves needed to weather shortages. As with any family, emergencies inevitably arise - sickness, unexpected expenses, loss of a job, fewer hours of work. These place even greater strain on the family budget; and spending on food is often the area reduced. 1 Our goal is to assist families through emergencies, and provide a buffer for them to avoid future food insecurity.
A Small Hand will provide families with access to a week's supply of food to ensure that infants do not go hungry and mothers are not forced to make inappropriate substitutions.
Recent studies have highlighted the troubling state of general infant nutrition in the U.S. Contrary to expert guidelines, almost a third of babies were found to be eating solids before they were 4 months old, 17% were drinking juice before six months, and 29% were drinking cow's milk before 12 months.  A separate study  showed that up to a third of babies consume no fruit or vegetable on any given day, and that French Fries is the most common choice of vegetable. Ten percent of infants 9-11 months of age eat French Fries every day. Over half of infants are eating candy or dessert every day by the time they are one year old.
A Small Hand will provide only high-quality age-appropriate foods, following best practice guidelines.
We also do not want infants to be left in wet and dirty disposable diapers because mothers lack the money to buy an adequate supply. This places infants at risk for skin rashes and secondary infections. Disposable diapers are a major expense; and one not covered by WIC or SNAP. For most mothers, disposable diapers are not an optional expense. Most child-care facilities will not accept an infant in cloth diapers, and mothers often lack the facilities needed to maintain a supply of freshly-laundered diapers.
A Small Hand will supply mothers with a week's supply of disposable diapers and a pack of wet-wipes.
The other way in which we will help parents, is by giving mothers access to gently-used infant clothing and selected new baby items at no cost. Doing so, will satisfy these needs and free up money for other uses, including reducing food insecurity.
A Small Hand will supply gently used clothing, selected hygiene and other items for infants at no cost.
The goal of A Small Hand is to safeguard good nutrition for infants in need in Shenandoah County. We are beginning with infants 0-36 months, hoping to grow with our infants and gradually extend services to 48 months.
In order to ensure that the most needy are served, we are limiting access to infants who are WIC or SNAP recipients. To be eligible for WIC, a family's income must be less than 185 percent of the Federal poverty income guidelines. To be eligible for SNAP, net monthly income must be 100 percent or less of Federal poverty guidelines. Households may have no more than $2,000 in countable resources, such as a bank account ($3,000 if at least one person in the household is age 60 or older, or is disabled).
A Small Hand will limit access to its services to those infants most at risk for food insecurity.
We will be offering a service modeled on highly successful infant programs in Oklahoma and Texas. Each of these centers has developed access rules suited to its local needs. During our first year (2010), we evaluated how often families need to access our services. Our experience is that we have a core of clients who need consistent help with diapers and non-food items; while other families need help far less frequently. We share with our families that we have limited resources and limited donations; and ask them to take only what they need. Our experience is that our trust is well-placed. If indicated, we will challenge families who appear to be misusing this trust.
A Small Hand will do everything possible to ensure that monies and goods donated to it go only to infants in need.
The most recent figures available from The Shenandoah County Department of Social Services indicate that there are some 400 infants [0-36 months] in Shenandoah County on the WIC program.
The US Census Bureau, 2006-2008 American Community Survey found that 9% of people in Shenandoah County had an income below the poverty level, and 11% of families with children less than 5 years old. A third (32%) of women raising children less than 5 years of age without a husband present were living in poverty, contrasted with 4% of women with a husband present.
Access to programs unfortunately does not eliminate food hardship. A recent survey (October-December 2009) found that 18.5% of households in the US reported times during the preceding year when they had lacked the resources to buy the food they needed. Almost a quarter (24.1%) of families with children had experienced this problem. Shenandoah County lies in the 6th Virginia Congressional District, and this ranked 237th in the nation in terms of food hardship with a rate of 17.4%. Shenandoah County is probably, therefore, very representative of the nation in respect of food hardship.
The available data suggest a pool of some 400 infants (0-36 months) in Shenandoah County eligible for services from A Small Hand, many of them live in families headed by a single mother.
Based on current figures provided by Infants in Crisis Inc.  purchasing formula, food and diapers will average about $37.50 per infant [Appendix Table 1].
We are, therefore, projecting a need for $30, 000 worth of formula, food and diapers to service 800 visits during 2011.
For every dollar of purchased material, we hope to add a dollar of donated goods and clothing; ensuring that families leave with about $75 worth of free food, clothing and baby goods. We are mindful that to deliver this program professionally and effectively will take thousands of hours of volunteered time, and we will keep a careful log indicating the monetary value of the time donated.
In Oklahoma and Texas, corporations , businesses and foundations have played a prime role in ensuring the constant supply of formula, food and diapers.
We too are looking for institutional support to underwrite the purchase of formula, food, diapers and wet-wipes. We will concentrate all our efforts on promoting the service, delivering quality help, securing donations of goods and establishing long-term financial support.
 Meyers AF, Karp RJ, Kral, JG. Poverty, Food Insecurity, and Obesity in Children. Pediatrics 2006: 118(5): 2265-2266.
 Supplemental Nutrition Assistance Program.
 Women, Infants and Children Program
 Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddler study: What foods are infants and toddlers eating? J Am Diet Assoc 2004: (1 Suppl 1)104:S22-S30.
 Koplan J, Liverman C, Kraak V. Preventing childhood obesity among US children, adolescents and adults, 1999-2002. JAMA 2004; 291:2847-2850.
 Committee to review WIC Food Packages: WIC Food Packages: Time for a Change. Washington, DC: National Academic Press, 2005. Available at www.nap.edu/catalog/11280.html.
 Infant Crisis Services, Inc., Oklahoma City, OK. http://www.infantcrisis.org/
Emergency Infant Services, Tulsa, OK https://emergencyinfantservices.org/
Local Infant Formula for Emergencies, Houston, TX. http://www.lifehouston.org/
 Food Research and Action Center Report January 2010. Food Hardship: A closer look at hunger. http://www.frac.org/pdf/food_hardship_report_2010.pdf