Food insecurity leads to behavioural problems in children

Household food insecurity appears to be associated with the manifestation of externalizing and internalizing behaviour problems in young children in Singapore through both nutritional deficits and family stress, according to a study.

Propensity-score matching analysis showed that compared with food security, food insecurity led to a moderately increase in young children’s externalizing behaviour problems (estimated average treatment effect, 0.20) and internalizing behaviour problems (estimated average treatment effect, 0.13). This effect was seen concurrently and 2 years later. [PLoS One 2024;19:e0294109]

The impact of food insecurity on children’s externalizing and internalizing behaviour problems was mediated by both the family stress pathway and nutrition pathway. Notably, the family stress pathway had a stronger influence on children's behaviour problems than the nutrition pathway.

“Food insecurity was positively correlated with parental psychological stresses, which disrupted family relationships and effective parenting by reducing parental warmth and increasing harsh disciplines. These parenting styles were associated with more externalizing and internalizing behaviour problems among children,” the investigators explained.

Meanwhile, the effect of food insecurity on children’s behaviour had also been demonstrated in previous studies, wherein dietary intake of high carbohydrates and refined sugar and low fruits and vegetables contributed to children’s behavioural problems. [Lancet 2011;377:494-503; J Child Psychol Psychiatry 2014;55:416-427; Lancet 2007;370:1560-1567]

The analysis was based on two waves of data collected before and during COVID-19 from a nationally representative sample of 2,601 children in the Singapore Longitudinal Early Development Study (mean age 4.5 years at wave 1, mean age 6 years at wave 2).

At baseline, 10 percent of the children experienced household-level food insecurity. This number increased by nearly twofold to 18 percent in wave 2 during the COVID-19 pandemic. Children with food insecurity were more likely to come from Malay families than from families of other ethnic groups, have more siblings, be living with a single parent or without any parent in some cases. Parents or caregivers of children in food-insecure household tended to have attained a secondary or below education, be unemployed, and have a household income in the lowest quartile.

In both waves, children in food-insecure households exhibited significantly higher externalizing and internalizing behaviour problems compared with their food-secure peers. Food-insecure children were approximately twice as likely in both waves to have diets that are low in vegetables and high in sugary drinks and were 1.7–2.7 times more likely to consume more carbohydrates. Additionally, food-insecure families were more than 10 times more likely to struggle financially, with the primary caregivers consistently exhibiting higher depressive affect across both waves and using less warm parenting.

“The COVID-19 pandemic introduced unprecedented economic challenges and exacerbated food insecurity, hitting disadvantaged households particularly hard. Although food assistance can be obtained in Singapore from charities, it is found that only a small proportion of food insecure households have sought help probably due to social embarrassment and unawareness of food support. This social embarrassment adds another layer of stress to these food-insecure households,” the investigators said.

Given that family stress pathway had a larger impact than the biological factors (ie, nutrition) on children’s behaviour problems, the investigators emphasized that interventions targeting food insecurity must go beyond providing immediate nutritional sustenance and address the full spectrum of challenges faced by these families in food-insecure households, including the emotional and mental strain.