Objective: The authors assess seasonal variations in the prevalence of low weight-for-age among young children visiting the pediatric emergency room of a city hospital.
Methods: We analyzed data on 11,118 children ages 6 to 24 months who visited the Boston City Hospital Pediatric Emergency Department between July 1989 and June 1992. Medical diagnoses were documented on a randomly selected subsample of 1,569 children. In addition, a questionnaire about food insecurity was administered to a convenience subsample of 269 families with children under 3 years of age.
Results: The percentage of children visiting the emergency room with weight-for-age below the fifth percentile was significantly higher for the three months following the coldest months than for the remaining months of the year, controlling for year of measurement. In the subsample, gastrointestinal illness was correlated with both season of measurement and weight-for-age, but the seasonal effect remained for the entire sample after controlling for dehydration. The questionnaire data suggested a relationship between economic stress and food insecurity that might help explain the seasonal effect. Families who were without heat or who were threatened with utility turnoff in the previous winter were twice as likely as other families to report that their children were hungry or at risk for hunger.
Conclusions: Winter and early spring constituted periods of increased nutritional risk in the in this sample of predominantly low-income children, probably because of the increased caloric associated with cold stress and infections. Further research is needed to assess whether decreased caloric availability due to high heating costs, a "heat or eat" effect, also contributes to this phenomenon.