THE IMPORTANCE OF THE FEDERAL NUTRITION PROGRAMS

Poverty, food insecurity,

and poor nutrition have

serious detrimental

impacts on the health,

development, and

well-being of infants and

young children in the

short and long terms.

One essential strategy to

address these issues is connecting vulnerable young

children and their families to the federal nutrition programs,

speciﬁcally the Supplemental Nutrition Assistance Program

(SNAP, formerly called “food stamps”), the Special

Supplemental Nutrition Program for Women, Infants, and

Children (WIC), and the Child and Adult Care Food Program

(CACFP). These profoundly important programs support

healthy growth and development during the early childhood

period and beyond. The programs are especially important

to the 19.9 percent of U.S. children 0 to 3 years of age who

live in poverty.

Infants and toddlers living in poverty —

particularly Black and Hispanic children who experience

disproportionately higher rates of poverty than White

children — face multiple risks and challenges during the

critical early childhood window.

This paper will provide a brief overview of the importance

of early nutrition; brieﬂy summarize the harmful impacts

of food insecurity on infants and young children; and

highlight research demonstrating the eective role of

the federal nutrition programs during early childhood in

improving food and economic security, dietary intake,

health, and development.

Early Nutrition is Critical

for a Healthy Start in Life

It is widely accepted that the early childhood period sets the

foundation for physical, social, and emotional health, as well

as establishes dietary patterns and food preferences that

can last a lifetime. This period also is a time of rapid brain

growth with more than 1 million new neural connections

being formed every second.

These neural connections

are stimulated and strengthened when infants and toddlers

have nurturing relationships, early learning experiences,

and good nutrition.

While good nutrition supports healthy growth and

development, poor nutrition in early childhood can

negatively impact child health and development in the

short and long terms and hinder adult achievement and

productivity.

5, 6

And unfortunately, too many infants and

toddlers consume diets that fall short of key nutrients.

This includes iron, for example, a micronutrient critical for

brain development. Inadequate dietary intake during early

childhood can lead to iron deﬁciency anemia, which is

associated with socioemotional diculties, poor motor

development, and cognitive impairments that can be

long-lasting.

Nutrient inadequacies and deﬁciencies

are a concern for this population, and so too is the

overconsumption of calories, sugar, salt, and saturated

fat, which can contribute to rapid weight gain and the

establishment of preferences for foods of poor nutritional

quality.

9, 10, 11, 12

In short, poor nutrition in early childhood —

including the prenatal period — can have substantial, long-

lasting impacts, especially for the developing brain.

Revised WIC Food Packages

Speciﬁc WIC food packages are prescribed for dierent groups of participants (e.g., pregnant

women, infants, young children) to supplement their diets based on their nutritional needs. The WIC

food packages were revised in 2007 to align the authorized foods with the latest nutrition science

and guidance. All WIC state agencies were required to implement the new food packages by Octo-

ber 2009.

THE IMPORTANCE OF

THE FEDERAL NUTRITION

PROGRAMS FOR INFANTS

AND TODDLERS

Federal Nutrition Programs for Infants and Toddlers n Food Research & Action Center n October 2018 n www.FRAC.org n 1

Food Insecurity has Harmful

Impacts on the Health and

Well-Being of Young Children

Adequate calories and nutrients are required to support

healthy growth and development, but food insecurity can

compromise this. Food insecurity is a term deﬁned by the

U.S. Department of Agriculture (USDA) that indicates that

the availability of nutritionally adequate and safe food, or

the ability to acquire such food, is limited or uncertain for a

household.

Food insecurity is a signiﬁcant public health concern,

especially among young children, given the high prevalence

and negative consequences for nutrition, health, and well-

being. USDA estimates that 1 in 6 U.S. households with

children under 6 years of age experienced food insecurity in

2017.

In about half of these households, one child or more

was food insecure.* Research shows that certain households

with children face higher rates of food insecurity, including

those headed by a single female, Black or Hispanic, and

households with incomes under 185 percent of the federal

poverty line.

While food insecurity has direct and indirect consequences

across the lifespan, food insecurity — and even marginal

food security (a less severe level of food insecurity)

15, 16

—

is especially detrimental to the health, development, and

well-being of children.

17, 18, 19, 20

For instance, young children

in food-insecure households are more likely to have poorer

overall health, iron deﬁciency anemia, and developmental

problems, and to have been hospitalized, compared to

young children in food-secure households.

21, 22

These and

other consequences have short-term implications, but food

insecurity also can put young children at a disadvantage

later in childhood, and beyond, in terms of unfavorable

health and education outcomes. For example, living in

a food-insecure household at 2 years of age is a strong

predictor of low academic scores and high problem

behaviors at kindergarten entry.

Research also links food insecurity in households with young

children to unfavorable outcomes related to family health

and well-being, including increased maternal depressive

symptoms and parental arguing.

These ﬁndings are not

surprising given the incredible stress and pressure facing

low-income parents who struggle to feed their families.

Furthermore, because of limited ﬁnancial resources, families

who are food insecure may use coping strategies to stretch

budgets that are harmful for health and nutrition, such as

diluting or rationing infant formula

or making trade-os

between food and other basic necessities (e.g., housing,

medicine).

The Federal Nutrition Programs

Support Strong Physical Health and

Nutrition During Early Childhood

There is considerable evidence about the eective role

that participation in the federal nutrition programs plays in

reducing food insecurity and poverty, and in providing the

nutrients children need for growth, development, and overall

health. This is especially true for SNAP, WIC, and CACFP,

which are critical nutrition and health supports for vulnerable

infants and young children.

Federal Nutrition Programs for Infants and Toddlers n Food Research & Action Center n October 2018 n www.FRAC.org n 2

*USDA measures food insecurity at the household level. In some food-insecure households with children, the children are themselves food insecure.

In other food-insecure households with children, only the adults are food insecure, yet, even then, harm can trickle down to the children.

Supplemental Nutrition Assistance

Program (SNAP)

SNAP serves as the ﬁrst line of the nation’s public policy

defense against hunger and undernutrition, as well as an

eective anti-poverty initiative. Over 39 million Americans

participate in SNAP in a given month,

and researchers

estimate that half of all of American children will receive

SNAP at some point during childhood.

The program has

a substantial reach and also touches a large proportion of

young children and their families. According to an analysis

by the Food Research & Action Center, 29.8 percent of

children 0 to 3 years of age lived in a household that

participated in SNAP at some point over the period of

2012 to 2016.

The monthly beneﬁts provided by SNAP enhance the food-

purchasing power of eligible low-income families. In addition,

research demonstrates the eectiveness of SNAP in

alleviating poverty, reducing food insecurity, and improving

the health, nutrition, and well-being of children, adults, and

seniors.* The selected studies below illustrate some of the

short- and long-term impacts of program participation during

childhood generally and in the early childhood period.

n Nationally, 3.4 million people — including more than 1.4

million children — were lifted above the poverty line by

SNAP in 2017 under the alternative poverty computation

that counts government beneﬁts as income, based on

Census Bureau data on poverty and income in the U.S.

However, these estimates understate SNAP’s anti-poverty

eects due to the underreporting of program participation

in Census surveys. According to leading economists and

poverty scholars, “SNAP is our nation’s most eective

anti-poverty program for the nonelderly when adjusted for

underreporting, one that is especially good at reducing

extreme poverty — by over 50 percent — and also

especially eective for poor families with children.”

n Children in households that participated in SNAP for six

months are approximately one-third less likely to be food

insecure than children in households recently approved

for SNAP but not yet receiving it, based on a national

sample of SNAP households with children.

n Access to SNAP in utero and in early childhood (through

the age of 5) reduces the incidence of metabolic

syndrome (obesity, hypertension, diabetes, heart

disease, heart attack) in adulthood, reduces the risk of

stunting, and, for women, increases reports of being

in good health in adulthood.

Program access during

these critical time periods in early life also increases

economic self-suciency later in life for women in terms

of increased educational attainment, earnings, and

income, and reduces poverty and public assistance

program participation in adulthood.

n Children under the age of 4 in food-insecure households

who receive SNAP beneﬁts are less likely to be

overweight, at developmental risk, and in fair or

poor health, compared to children in food-insecure

households who are not receiving SNAP beneﬁts.

35, 36

In addition, food-insecure children 3 years of age

or younger who participate in SNAP have fewer

hospitalizations than comparable nonparticipants.

Federal Nutrition Programs for Infants and Toddlers n Food Research & Action Center n October 2018 n www.FRAC.org n 3

* For more information on the beneﬁts of SNAP, see FRAC’s SNAP and Public Health: The Role of the Supplemental Nutrition Assistance Program in Improving the

Health and Well-Being of Americans at www.frac.org.

n Mothers of children under 4 years of age in food-insecure

households receiving SNAP beneﬁts are less likely to

experience maternal depressive symptoms and less

likely to be in fair or poor health, compared to mothers in

food-insecure households who are not receiving SNAP

beneﬁts.

38, 39

n Conversely, a loss or reduction in SNAP beneﬁts has

detrimental health impacts on children and families.

Young children under the age of 4 in families whose

SNAP beneﬁts were recently lost or reduced due to an

increase in income are more likely to be in fair or poor

health and at risk for developmental delays, compared

to young children in families who consistently received

SNAP beneﬁts.

Families with SNAP beneﬁt loss or

reductions also are more likely to forgo medical care

for the child or other family members due to cost, or to

make health care trade-os.

41, 42

n Families receiving housing subsidies, SNAP, and

WIC beneﬁts are 72 percent more likely to be housing

secure (i.e., deﬁned as living without overcrowding or

frequent moves within the last year), compared to those

families receiving housing subsidies alone, based on a

study of low-income caregivers of children younger than

3 years old.

Special Supplemental Nutrition

Program for Women, Infants, and

Children (WIC)

WIC provides low-income pregnant

women, breastfeeding women, non-

breastfeeding postpartum mothers,

infants, and children up to the age

of 5 with nutritious foods, nutrition

education and counseling, and

referrals to health care and social

services. In addition to being income-eligible, applicants

must be at nutritional risk (e.g., underweight, overweight,

anemic, poor dietary intake) as determined through a

nutrition assessment conducted by a health professional.

In ﬁscal year 2017, WIC provided services to approximately

1.7 million women, 1.8 million infants, and 3.8 million children

in the average month.

In the latest year (2015) for which

USDA has published a WIC coverage rate, WIC reached 76.9

percent of eligible infants, but just 44.4 percent of eligible

children ages 1 to 4 years old.

A large body of research spanning decades shows that WIC

is a profoundly important program with well-documented

beneﬁts to the health, development, and well-being of young

children and their families, as demonstrated in the selection

of studies below.*

n WIC reduces the prevalence of household food

insecurity by at least 20 percent, based on a national

sample of children under the age of 5 who lived in

households that were income-eligible for WIC.

n Prenatal WIC participation is associated with improved

birth outcomes, including lower infant mortality rates

(especially for African-Americans)

and a lower risk

of preterm birth, perinatal death, low birth weight, and

neonatal intensive care unit admission.

48, 49

n Multiple studies link the revised WIC food packages with

improvements in overall dietary quality, healthful food

purchases, and the consumption of fruits, vegetables,

whole-grains, and lower-fat milk.

50, 51

Research also

ﬁnds improvements in infant-feeding practices in terms

of the appropriate introduction of solid foods, as well as

increases in breastfeeding initiation.

n Overweight and obesity rates declined modestly among

young children 1 to 4 years of age enrolled in New York

state’s WIC program within three years of introducing the

revised WIC food packages.

Federal Nutrition Programs for Infants and Toddlers n Food Research & Action Center n October 2018 n www.FRAC.org n 4

*For more information on the beneﬁts of WIC, see FRAC’s Child Nutrition Programs and Public Health: The Role of the Federal Child Nutrition Programs in

Improving Health and Well-Being and FRAC’s WIC is a Critical Economic, Nutrition, and Health Support for Children and Families at www.frac.org.

n Young children participating in WIC, SNAP, or both

programs have lower rates of failure to thrive, anemia,

and nutritional deﬁciency, and lower risk of abuse and

neglect, when compared to low-income nonparticipants.

n Even in the face of family stressors, such as household

food insecurity and maternal depressive symptoms,

children younger than 36 months who receive WIC,

compared to those who do not, are less likely to be

in fair or poor health, and more likely to meet well-

child criteria.

(For this particular study, children met

“well-child” criteria if they were in good or excellent

health per parent report, were developing normally,

were not overweight or underweight, and had not been

hospitalized.)

n Prenatal and early childhood participation in WIC is

associated with stronger cognitive development at age

2, and better performance on reading assessments in

elementary school, leading researchers to conclude that

“these ﬁndings suggest that WIC meaningfully contributes

to children’s educational prospects.”

Child and Adult Care Food Program

(CACFP)

CACFP provides reimbursement to Head Start programs,

family child care, child care centers, afterschool programs,

homeless shelters, domestic violence shelters, and senior

day care centers for nutritious meals and snacks served

to children and seniors. Young children attending CACFP-

participating family child homes, child care centers, or

Head Start programs can receive up to two meals and a

snack per day that meet USDA nutrition standards. In ﬁscal

year 2017, CACFP served 4.4 million children, 2 billion

healthy meals and snacks, and distributed over $3 billion in

reimbursements to child care providers.

While much of the research on CACFP focuses on program

implementation, there are several studies — mostly focused

on preschoolers — that evaluate the impact of participation

on household food insecurity, the child care food

environment, and child nutrition and health, as highlighted

below.* (More research is needed on CACFP’s impacts for

infants and toddlers.) In addition, multiple studies conclude

that CACFP plays an important role in improving the quality

of child care programs and making them more aordable for

low-income families.

57, 58

n Attending a CACFP-participating child care program

is associated with a modest reduction in the risk of

household food insecurity, according to a study using

national data on 4-year-olds.

Speciﬁc WIC food packages are prescribed for

dierent groups of participants (e.g., pregnant women,

infants, young children) to supplement their diets based

on their nutritional needs. The WIC food packages

were revised in 2007 to align the authorized foods with

the latest nutrition science and guidance. All WIC state

agencies were required to implement the new food

packages by October 2009.

Overall, the revised WIC food packages improve

the health and nutritional quality of the foods in the

program, increase participants’ choices, and expand

cultural food options. More speciﬁcally, the revised

packages retain the basic WIC foods, including milk,

cheese, eggs, fruit juice, iron-fortiﬁed cereal, beans,

peanut butter, infant formula, and (for breastfeeding

women) tuna. However, the amount of milk, cheese,

eggs, fruit juice, and, in some cases, infant formula was

reduced in the new packages. In addition, the new

packages move to low-fat or non-fat milk; oer fruits,

vegetables, and whole-grain bread (with the option

to substitute whole-grain tortillas, pasta, rice, or other

grains); and allow the substitution of soymilk, tofu, and

(in 2015) yogurt for milk and cheese.

Revised WIC Food Packages

Federal Nutrition Programs for Infants and Toddlers n Food Research & Action Center n October 2018 n www.FRAC.org n 5

*For more information on the beneﬁts of CACFP, see FRAC’s Child Nutrition Programs and Public Health: The Role of the Federal Child Nutrition Programs in

Improving Health and Well-Being at www.frac.org.

n Child care sites participating in CACFP, especially

Head Start centers, serve more fruits, vegetables, and

low-fat or skim milk, and fewer sweetened beverages,

sweets, and snack foods than nonparticipating child

care sites.

60, 61

n Participating in CACFP is associated with greater fruit,

vegetable, and milk consumption among low-income

preschoolers.

62, 63

Children in CACFP centers also

consume less saturated fat and total fat, likely a result

of the provision of low-fat milk by CACFP-participating

centers.

n CACFP-participating centers report more supportive

nutrition practices than nonparticipating centers.

65, 66

(Supportive nutrition practices include oering whole

grains daily, teaching about the food groups, and serving

foods family style.) For example, 53 percent of CACFP

sites report that sta always eat the same foods that the

children are oered, compared to 35 percent of non-

CACFP sites.

n Child care centers participating in CACFP also

have higher-quality nutrition and physical activity

environments than nonparticipating centers.

n Low-income preschoolers attending CACFP-participating

child care centers are slightly less likely to be obese than

similar children attending nonparticipating centers.

Also, preschool children with an unhealthy weight status

(i.e., obese, overweight, or underweight) who participate

in Head Start have healthier body mass indexes by

kindergarten than nonparticipants — children are less

obese, less overweight, and less underweight.

This may

be due, in part, to the program’s adherence to CACFP

nutrition coverage and guidelines for meals and snacks.

n Toddlers (between 13 months and 3 years old) in

subsidized child care whose meals are supplied by their

child care provider — and, therefore, highly likely to be

participating in CACFP — are less likely to be in fair or

poor health, less likely to be hospitalized, and more

likely to be at a healthy weight than similar children

whose meals are supplied from home.

Conclusion

Young children in this country are experiencing high levels

of poverty, food insecurity, and inadequate dietary intake,

which can contribute to poor health and development in the

short and long terms. Research shows that SNAP, WIC, and

CACFP can alleviate these problems during early childhood,

and improve overall health and well-being. Strengthening

and increasing access to and participation in these critical

programs would further their role in supporting the physical

health, development, and nutrition of our nation’s children.

This paper was prepared by FRAC’s Heather Hartline-Grafton,

DrPH, RD, Senior Nutrition Policy and Research Analyst. FRAC

wishes to thank the Think Babies™ campaign for their generous

support of this research brief. ZERO TO THREE created the

Think Babies™ campaign to make the potential of every baby a

national priority. Funding partners for Think Babies™ include

the Robert Wood Johnson Foundation, which supports the

campaign’s public education aspects, and the Perigee Fund,

which supports the campaign’s public education and advocacy

aspects. Learn more at www.thinkbabies.org.

Federal Nutrition Programs for Infants and Toddlers n Food Research & Action Center n October 2018 n www.FRAC.org n 6

Federal Nutrition Programs for Infants and Toddlers n Food Research & Action Center n October 2018 n www.FRAC.org n 7

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