Housing insecurity, food insecurity and child health — formative SAQs

SAQ 1 (10 marks)

A 20-month-old attends for a well-child visit. Caregivers answer “sometimes true” to both Hunger Vital Sign items. BMI is on the 85th centile. Growth velocity is steady. [5]

1. Interpret the screen and state why body size does not exclude the problem. (3) [1] [5]
2. List four medical or developmental sequelae you will still review today. (3) [1] [8]
3. Outline a closed-loop management plan for the next two weeks. (4) [1]

Model answer

Positive Hunger Vital Sign: either item affirmative is enough. Food insecurity can coexist with overweight because cheap energy-dense foods may fill hunger without dietary quality. Do not wait for thinness. [1] [5]

Review iron/diet risk, dental health, development/behaviour, immunisation status, caregiver mental health and housing trade-offs (rent vs food). Marginal/low food security still associates with adverse outcomes. [1] [8]

Validate without shame; offer concrete food access this week (food bank/school/community programme as locally available); name a referral owner and timeframe; document needs; book early follow-up to confirm connection and recheck growth/symptoms; ask about housing stress driving food shortfalls. [1]

SAQ 2 (10 marks)

A family with a 3-month-old receives an eviction notice. The infant is well. They are couch-surfing tonight. [4] [12]

1. Name the housing-insecurity domains illustrated. (2) [4]
2. What are the same-day paediatric priorities? (4) [4] [12]
3. How do you distinguish poverty-driven need from neglect in this scenario? (4) [4]

Model answer

Stability threat (eviction), possible overcrowding/doubled-up arrangements, and risk of homelessness/no fixed safe home. Affordability is the usual driver. [4]

Same day: confirm a safe sleep plan for tonight; activate social work/housing pathway; supply feeding/nappy essentials if needed; document medical vulnerability of a young infant for priority advocacy; plan medical-home continuity after moves; review safe sleep in temporary settings. [4] [12]

If caregivers are seeking help and barriers are structural, advocate and support. Escalate safeguarding if the infant is left without a workable safe plan, help is refused without reason, or intentional harm/withholding is evident — poverty alone is not neglect. [4]