Introduction: Food insecurity—the limited or uncertain access to enough food—is a critical child health issue impacting millions of families in the United States and across the world and has significant negative physical and mental health effects on children and their families.¹  The American Academy of Pediatrics recommends using a two question Hunger Vital Sign^TM screening tool, developed and validated by Children’s HealthWatch, to be used in routine medical care as an efficient way to screen for food insecurity.^2,3 Children with transplant are often closely followed by their transplant team, giving the transplant team an opportunity to identify patients at risk for food insecurity and connect families with available federal and local resources. We aim to incorporate universal food insecurity screening in our kidney transplant clinic.
Methods: We implemented a pilot project to screen patients in a large, academic pediatric kidney transplant clinic in the US, utilizing the Hunger Vital Sign.^TM Input was obtained from multidisciplinary team members (including renal nutritionists, nurses, social workers, and providers) prior to implementation, and team members were educated about the health impacts of food insecurity, the screening process, and available food resources.  Patients were given a written, two question Hunger Vital Sign^TM survey during the intake process at the start of the visit and completed surveys were collected at the time of triage. Providers were notified of positive results to facilitate further discussion with families. All patients were provided with a food resource handout and information on how to apply for federal food programs and find local food assistance.
Results: Since screening implementation, 97 patients have been approached resulting in 75 completed questionnaires (77%).  A positive screen for food insecurity was identified in 22 patients (29.3%). We plan to continue to screen the entire cohort of pediatric kidney transplant patients at our center, optimize screening process, and implement targeted interventions to address food insecurity.
Conclusion: Our pilot project shows a high prevalence of food insecurity in children with kidney transplant. Screening for food insecurity can be readily implemented using the Hunger Vital Sign^TM screening tool as part of routine care with the goal to identify and support families experiencing food insecurity. Further work is needed to determine the impact of screening and resource referral on access to food.