In a recently released article in Pediatrics, Dr. Heather Hamner and colleagues (10.1542/peds.2018-2274) examine differences in food and beverage intake among children ages 12-23 months by WIC (Special Supplemental Nutrition Program for Women, Infants and Children) enrollment status. Over the past decade, WIC has revised its food packages to align better with best nutritional practices such as those promoted by the AAP. We can applaud the changes, which include less juice, more vouchers for fresh fruits and vegetables, more whole grain products, and low fat (rather than full fat) milk for expectant women and children over 2 years in age. Since almost half of United States (US) children are WIC-eligible, small changes in foods covered and promoted by WIC have potential for a major impact on child health in the US. The authors asked whether children are eating better after the food package changes, and specifically whether WIC status, defined as WIC participation vs. WIC eligibility without participation vs. WIC non-eligibility, made a difference in diet.
The authors used the NHANES (National Health and Nutrition Examination Survey) 2011-2014 data to answer their research question. I did not realize that this national survey includes a household interview, a physical exam in a “Mobile Examination Center” and both an in-person 24 hour dietary recall and a second dietary recall by phone 3-10 days later. The authors included a final total sample of 418 children ages 12-23 months old, and defined food groups according to the US Department of Agriculture’s “What we eat in America” categories. I think you will find that the study results are good news, and support the value of WIC as a key federally funded program that makes a difference in the lives of Americans afflicted by poverty. I encourage you explore for yourself the details which are clearly presented in text and tables.
The finding that most grabbed my attention beyond the main results was the astonishing proportion of children who were WIC-eligible but not participating: while 38.1% of children ages 12-23 months receive WIC, 19.6% are WIC-eligible but do not participate. What are the obstacles to participation in this beneficial program? Anecdotally, in our practice, we see parents who (1) do not have needed documentation, (2) are fathers with new custody of their children, (3) are single mothers who have not organized themselves to obtain this benefit, and (4) occasional parents who seek major brand formulas that are not WIC-covered. Among pregnant women, WIC receipt was associated with younger age and lower educational level, and was negatively associated with non-Hispanic White and Asian race and ethnicity.  WIC receipt for eligible women with children was not significantly associated with health literacy, marital status or number of children, but was negatively associated with child age and positively associated with being unemployed or not fully employed.  The authors speculated that following prenatal enrollment, and as the index child grew older, WIC documentation requirements might outweigh the benefits of the food package. I was not able to identify more studies on this topic, and given what Dr. Hamner and colleagues have reported, such research efforts might be fruitful.
1. Driscoll AK, Osterman MJK. Maternal Characteristics of Prenatal WIC Receipt in the United States, 2016. NCHS Data Brief. 2018 Jan;(298):1-8.
2. Pati S, Siewert E, Wong AT, Bhatt SK, Calixte RE, Cnaan A. The influence of maternal health literacy and child's age on participation in social welfare programs. Matern Child Health J. 2014;18(5):1176-89.