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Household food insecurity (FI) is a widespread public health issue with significant implications for health.1 Sociocultural factors, including high food prices amid declining support from federal nutrition programs, continue to worsen food access and place additional strain on household finances among already vulnerable populations.2 Unexpected adverse health events, such as hospitalizations, also create new financial burdens from job disruptions, lost wages, and additional expenses.3 Thus, hospitalization can exacerbate FI among those with baseline financial strains and introduce new stressors for those who were previously stable. This additional strain can manifest as hospital-based FI (HBFI), or the inability of caregivers to obtain adequate and nutritious food for themselves during their child’s hospital admission. Prior studies have consistently demonstrated a higher prevalence of HBFI than household FI among the same population.4–6 Hunger caused by HBFI can reduce families’ abilities to process information and appropriately respond during hospitalization, which can potentially hinder preparations for effective care after being discharged from the hospital.7 Addressing HBFI is essential to helping families fully engage in their child’s care.In the current issue of Hospital Pediatrics, Hardy et al aimed to alleviate HBFI by increasing the percentage of caregivers of hospitalized children who endorsed reduced hospital-related food costs through a quality improvement (QI) initiative in a Canadian general pediatric inpatient unit.8 They achieved their primary SMART aim by demonstrating that the percentage of caregivers reporting reduced hospital-related food costs increased from 0% to 92.9% over the 16-month study period. Through staged interventions—meal cards for at-risk families followed by universally provided snack bags—they increased the intervention’s accessibility for caregivers reporting HBFI from 0% at baseline to 55% and 93.1%, respectively. This change in approach was driven by persistently low screening rates for social determinants of health (SDOH) despite multiple interventions, leaving a large portion of the eligible population unscreened. This prompted the study team to thoughtfully move away from targeting specific families and instead develop an intervention that could be universally offered to all hospitalized families. Despite this transition, the cost analysis for meal cards and snack bags was similar, whereas snack bags provided greater accessibility for a broader range of caregivers, improved convenience, and offered surplus food in the unit that families could use. Caregivers also reported higher satisfaction with snack bags (100%) compared with meal cards (80%).A key strength of this study is its shift from a screening-based approach to a universal intervention, following recognition that improving screening rates within an acceptable time frame proved challenging. The authors pivoted from a targeted meal card strategy to one serving all families, reflecting both awareness of well-documented limitations with SDOH screening and, more importantly, the recognition that HBFI likely extends beyond reported household FI rates, as shown in their prior local research and across other academic children’s hospitals in the United States.4–6,9,10 A universal approach can support caregivers who are experiencing HFBI regardless of household FI screening results. The volatile nature of food access, combined with limited financial reserves or competing budgetary demands, can quickly push families into HBFI, making a universal approach a vital lifeline for families whose food security status may worsen during a hospital admission, as the authors noted. Additionally, a universal initiative can ease concerns among caregivers who fear that disclosing FI or other health-related social needs could lead to negative consequences including stigma, discrimination, and loss of dignity, particularly for those who speak languages other than English.11,12Although a universal intervention strategy may offer broad benefits, such interventions risk disproportionately aiding advantaged groups and potentially widening disparities among vulnerable, at-risk populations most in need of the intervention.13 For example, this study assumes caregiver presence at the child’s bedside throughout hospitalization, a factor that is significantly lower among marginalized groups who often experience high rates of household FI.14,15 A limited presence, especially during key interactions with the care team or, within the scope of this study, the Caregiver Wellness Wagon, may reduce awareness and use of the program by caregivers who would receive the most benefit. The authors decided not to collect sociodemographic information, possibly to avoid exacerbating stigma or affecting intervention use. However, this limits the ability to determine whether the QI initiative impacted disparities in HFBI and reduces the generalizability of the findings to other pediatric hospital populations, such as those across the United States including families from diverse racial backgrounds or those who speak languages other than English. Prioritizing intentional engagement with key stakeholder populations, especially those facing inequities or experiencing social needs, is essential to ensure that QI efforts have the intended impact for those groups, even if an intervention is universally applied.13,16In addition to the universal approach, the study introduces a novel strategy of providing snack bags through an existing hospital-based volunteer navigation team. Compared with meal cards, this approach offers greater availability, convenience, and caregiver satisfaction at a similar cost, which aligns with prior caregivers’ reports that increasing the availability of food options is an effective way to improve hospital-based food access.6 Direct delivery of snack bags to patient rooms with leftover snack bags readily available on the unit could help reduce stigma associated with food support programs. A comparable example is subsidizing school meals for low-income families, which normalizes assistance by making it universally accessible.17 Additionally, there is an opportunity to promote nutritious foods to combat diet-related health conditions, which is increasingly a priority across the United States.18 The authors note a rotating menu of healthy food items selected primarily based on availability and costs. Although the single example snack bag includes a generous amount of fruit, it is high in carbohydrates, contains some processed foods that may have added sugars, and offers limited protein-rich food options. Although it can adequately address short-term hunger, the lack of balanced nutrition limits its ability to fully meet caregivers’ dietary needs, especially considering families’ experiencing HBFI over prolonged admissions. The inclusion of patient caregivers in the Food for Families working group creates a meaningful opportunity to incorporate their preferences into food selection and choice, ensuring representation of diverse demographic groups. As hospital-based food assistance programs grow and evolve, it is crucial to prioritize food dignity by ensuring inclusive, low-barrier access that respects individuals’ choices and provides fresh, culturally appropriate food, reinforcing a family-centered approach.19The interventions in this study were provided using hospital funds, similar to a US-based QI initiative to address hospital-based caregiver hunger.4 Although these programs address an urgent need, their long-term sustainability depends on continued institutional support or other philanthropic contributions. In the United States, we are facing an uncertain future for health care funding, particularly for Medicaid and other financial supports.20 As children’s hospitals rely heavily on Medicaid, significant changes could deprioritize, or even eliminate, ancillary programs such as hospital-based meal programs in favor of services aligning with clinical priorities. As inpatient efforts to address health-related social needs such as HBFI continue, rigorous evaluation of outcomes, including patient-centered outcomes, health care use, and cost-effectiveness, must be prioritized to ensure their longevity and sustainability. The authors’ incorporation of cost analysis as a balancing measure is a valuable approach for guiding resource allocation and optimizing resource accessibility while also providing crucial information to hospital administration for strategic resource planning and evidence for long-term program inclusion.This QI initiative successfully reduced hospital-based food costs through a universally applied intervention. Presumably, these interventions helped address HBFI among families; however, uncertainty remains about whether they entirely alleviated HBFI, given the study’s measures. As considerations of universally applied food interventions progress, inpatient SDOH screening remains vital because it helps identify households that need care plan adjustments or additional assistance. Identifying these families through screening has significant implications for discharge planning and connecting to outpatient food resources, whereas universally provided food interventions can offer immediate relief to HBFI. Thus, it may be prudent for hospitals to prioritize a multipronged approach that combines universally available, easily accessible nutritious food options with screening-based resources for high-risk families who desire additional assistance. The specific solution will likely differ across institutions based on existing infrastructures, resources, and connections to community-based partners. Creatively working within existing systems to identify cost-effective resources that meet families’ needs and monitoring process and outcome measures, with a readiness to adapt if interventions fall short of their intended effect or worsen disparities, can provide a successful blueprint for ensuring that no family is left hungry during hospitalization.