Food Neglect and Infant Language Acquisition: A National Study of Maltreated Children

Background: Inadequate food can be a particularly damaging form of child neglect, since hunger can impair cognitive development, including language development. But it is not clear whether it has unique effects in children involved with child welfare over and above other forms of maltreatment and other risk factors associated with child welfare involvement.  Highlighting the specific role of food inadequacy on the development of children involved in child protection investigations may promote a more effective child welfare response to the problem. This study evaluates whether young children who experienced food inadequacy as part of neglect allegations are more likely to have impaired language than children who did not have neglect allegations involving food inadequacy.

Methods: Data from the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II) study were used.  NSCAW sampled closed maltreatment investigations in 83 counties nationwide (n = 5873). Our sample included infants ages 3 through 12 months of age (n =1695).  The key predictor variable was the most serious type of maltreatment allegation, as determined by the child welfare investigator. Food inadequacy as the most serious type was compared to other forms of maltreatment as the most serious type. Food inadequacy included a range of severity, from children not being provided regular meals to poor nourishment to the point the child fails to gain weight. Language was assessed by the Preschool Language Scale-3, a standardized measure of receptive and expressive communication, with scores 2 standard deviations or more below the mean operationalized as impairment.  All percentages were weighted for sample probabilities.  Bivariate contingency table analysis using the Pearson χ² test tested the relationship between food inadequacy and language impairment. Multivariable logistic regressions also tested this relationship while controlling for potential confounding variables: child race, age, and gender; prior maltreatment investigation; parental mental health problems; and substantiation.   

Results: Food inadequacy was the most serious type of maltreatment alleged in 4% of investigations, and 12% of infants had either an expressive or receptive language impairment.  There were no bivariate associations between food insecurity and language impairment.  However, once confounding factors were controlled for in the logistic regression, food inadequacy was highly correlated with language impairment.  Compared to infants experiencing food inadequacy, children who experienced supervision neglect were at decreased odds of language impairment (OR=.19; p<.03), as was infants with substance abusing parents (OR=.20; p<.04) and infants experiencing other forms of physical neglect (OR=.10; p<.02).   

Conclusion: After controlling for confounding variables, food neglect had a greater effect on infant language acquisition than other forms of maltreatment.  Although food neglect is only a small proportion of allegations overall, it has a significant and negative impact on infant development.  It is therefore important that child welfare workers assess the availability of food in all risk assessments and service planning and then connect families in need with food assistance programs.  Increase food assistance participation may decrease the number and severity of children suffering this form of neglect.