Social determinants of health have increasingly become a part of the discussion during well-child visits conducted by Pediatric primary care providers. While this has helped providers to identify the needs that families have, many patients primarily followed by subspecialists may not have similar evaluations by the physicians that they see most often. Pediatric patients with chronic medical conditions, such as those with chronic kidney disease, often see their subspecialist provider every few months, many times more often than they see their primary care provider. Social determinants of health have an impact on a child’s growth and general well-being, but, just as importantly, they can also impact the progression of chronic conditions such as hypertension or diabetes that require access to nutritious foods, safe exercise spaces, and medications. Nephrologists recommend specific diets, consistent physical activity, and regimented adherence to medications for their patients. While these are historically common recommendations for these patients, patients are not often equipped with the resources, skillset, or knowledge to achieve those goals.

In the United States, 1 in 7 children live in households with food insecurity. (1) In the District of Columbia (DC), 11% of the area is considered a food desert.(2) Proximity to grocery stores is one of the key risk factors of food insecurity. However, food insecurity involves issues beyond access to grocery stores and is intensified by household income, education, and race. Communities considered in the minority and populations in lower levels of education are disproportionately affected by food accessibility. Food insecurity is notably more prevalent in children who suffer from chronic conditions and obesity. I joined a project at Children’s National’s Nephrology clinics where patients are screened for food insecurity and, if positive, are then connected with a group of students volunteering as FLiP (The Family Lifestyle Program) navigators. FLiP is a collaboration between the YMCA of Metropolitan Washington, Children’s National Hospital, and the American Heart Association that works to connect patients with family-centered lifestyle programs that promote physical activity, nutrition education, and links residents to local community resources. (3) Patients with hypertension who screen positive for food insecurity at the Nephrology clinics are also referred to a food pharmacy housed at Children’s National Hospital’s main campus. This food pharmacy was initially created as a part of the Endocrinology Department’s Diabetes Clinic as a way for patients with diabetes to receive bags of healthy food during their clinic visits. In partnering with this food pharmacy, Nephrology patients with hypertension and food insecurity can use their referral to also pick up bags of nutritious foods. This referral is an example of holistic and equitable care where a subspecialist’s recommendations to patients are aligned with the resources and effort the clinic provides the patients.

Pediatric subspecialists can improve the health outcomes of their patients by bridging gaps in care that are largely impacted by social determinants of health. Community organizations and subspecialty groups have made efforts to assist subspecialists in achieving this by creating resources and handouts for providers to reference, learn from, and provide to families. For example, the Kidney Kitchen in coordination with the American Kidney Fund has made a guide titled “Guide for Professionals: Supporting patients with chronic kidney disease facing food insecurity” that providers can refer to to better understand the specific needs their patients have. (4) Subspecialists can continue to expand the care they provide and breadth of concerns they identify at patient visits by broadening their own knowledge of social determinants of health and how they impact their unique patient population and by connecting with primary care providers, existing community efforts, and other subspecialists to ensure patients are adequately and equitably equipped to optimize their health.