The Toll on Children’s Health during COVID-19

Originally posted on Bostonia.

Slammed by Twin Pandemics

For caregivers at the Grow Clinic at Boston Medical Center (BMC) treating children identified as “failure to thrive” for lack of adequate nutrition, the pandemic has been a wrenching period without precedent. The clinic’s caseload soared 40 percent, with new referrals arriving in a more dire state than usual—some requiring emergency hospitalization—and with many “graduated” patients returning after falling off the growth curve again.

“During COVID more so than ever, it was like the kids who came to us were so sick that it brought us to tears,” says clinic codirector Soukaina Adolphe, a School of Medicine clinical associate professor of pediatrics. Parents were trying so hard to sustain their young children but were slammed by the “twin pandemics” of COVID and entrenched racism and inequality, says Adolphe’s codirector, Megan Sandel, a MED associate professor of pediatrics.

Early on, with supermarkets ransacked and supply chains upended, even families who were able to get out to stores had to visit four or five of them to find prescribed items, like high-fat yogurt and cheese, rendering tested solutions—gift cards to stretch family budgets, for example—inadequate. Many parents lost their jobs, through layoffs of in-person service workers and the closure of childcare centers, which left parents whose lower-wage jobs couldn’t be done remotely with no choice but to stay home. (“Childcare is infrastructure,” Sandel says.)

Deborah Frank, the Grow Clinic’s semiretired founder, says public policy “is written on the bodies of babies,” in a country with the resources, but not the political will, to end child hunger. Frank, a MED professor of pediatrics, and her colleagues were heartened by certain state and federal measures—P-EBT (pandemic electronic benefits transfer) cards to replace lost school meals, extended unemployment benefits, eviction moratoria, stimulus checks. But they found even well-meaning programs could miss the mark, with families trapped in the margins struggling to access them or unaware of their eligibility. Temporary measures merely delay the pain, they warn, like a feared eviction crisis for families in arrears when that protection lifts.

her child’s weight plunged.

That’s more than a matter of anguish—for developing bodies and brains, even brief episodes of food deprivation can contribute to emotional-
behavioral problems, learning loss, and a host of later physical ailments. Frank likens it to a union construction job: “If you don’t deliver the bricks when the crew is on site, under contract, you can deliver them all you like two years later; you’re not going to get the same building.”

For the donation-sustained Grow Clinic, whose team of pediatricians, dieticians, social workers, and multilingual outreach workers were already serving families far beyond the limitations of insurance-reimbursable medical care, even that multifaceted approach fell short amid the new pandemic urgencies. Where home visits had been kitchen-focused—making sure families had high chairs and booster seats, as well as food—the staff was scrambling to procure desks, school supplies, and internet connections in a world where “home became everything,” Sandel says. The clinic team became bilingual advocates, negotiating with landlords, teachers, and school administrators, addressing macro problems at the micro level, family by family.

At the same time, BMC-affiliated pediatricians—and peers at lower-income clinics in Baltimore, Little Rock, Philadelphia, and Minneapolis—continued to gather family surveys for Children’s HealthWatch, the data and policy network that Frank cofounded in the 1990s and Sandel helps oversee today. Food insecurity among those families jumped from 21 percent to 35 percent during the pandemic, and housing instability, a measure of the struggle to keep up with rent, spiked from 27 percent to 43 percent, although the moratorium drove the actual eviction rate down for those patients from 4.6 percent to 1.5 percent for the time being.