The Boston Globe By Deborah A. Frank and Joseph P. Kennedy II The all-too-thin baby on the pediatric exam table does not know that oil prices recently topped $80 a barrel. With almost no fat on his malnourished body, he is unable to tolerate for even a brief period being undressed by his doctor. His mother wonders how she will keep the house warm, food cooked, and lights on through the coming winter for the boy and his sister, while making sure that they have enough to eat. She is not alone in her anxiety. The price of heating oil is projected to exceed $3 per gallon this winter, and electricity and natural gas costs remain high. Last week, heating oil prices in Massachusetts reached their highest levels ever at $2.72 per gallon, according to the Massachusetts Department of Energy Resources. Between March and May, 1.2 million households had their electricity shut off due to last winter’s overdue energy bills. A new report by the Children’s Sentinel Nutrition Assessment Program demonstrates that this “heat or eat dilemma” was depressingly familiar to America’s poor and near-poor families and their doctors. Federal research shows that while both rich and poor families increase their expenditures on home fuel during the winter, poor families offset this cost through decreasing food purchases, with an average 10 percent decrease in caloric intake. Parents know that children can freeze to death more quickly than they starve to death, and so most decrease food purchases first to pay for heat. Many inevitably sacrifice on both fronts, living with food scarcity while heating their homes with cooking stoves and space heaters, both of which dramatically increase the risk of fires, burns, and carbon monoxide poisoning. These untenable choices wreak havoc on the health of children. Babies and toddlers lose body heat more rapidly than older children and adults because of their higher surface area-to-mass ratio. When babies’ bodies have to divert already-scarce calories to maintain body heat, cold and hunger intertwine to jeopardize their health and growth as well as their future ability to learn and relate to others. The health effects of energy insecurity surface in emergency rooms at hospitals like Boston Medical Center during the cold of winter. Medical researchers found a 30 percent increase in the number of underweight infants and toddlers in the BMC emergency room in the three months after the coldest months compared with the rest of the year. Pediatric researchers have identified a preventive medicine that works to soften the blow of this annual epidemic. Young children in poor families who receive energy assistance through the federal Low Income Home Energy Assistance Program are 32 percent less likely to require admission to the hospital on the day of their visit to the emergency room than eligible families who do not receive LIHEAP. Unfortunately, despite LIHEAP’s effectiveness in helping keep children warm and healthy, it is unavailable to most who need it. Inadequate funding, skyrocketing energy costs, and a growing number of eligible families have shrunk the proportion receiving assistance to 16 percent. Even for those who receive help, the size of the average grant is steadily decreasing each year. A 250-gallon tank of heating oil lasts for approximately four to six weeks when temperatures are freezing and costs about $600 to fill. The national average yearly LIHEAP assistance grant is about $314. So why aren’t policy makers following the doctor’s orders? Some tell us there is no money in the till; the Bush administration’s proposed budget this year would cut LIHEAP by 44 percent compared with funding just two years ago. And yet, the federal government collected $10 billion dollars in royalties from oil and gas companies in fiscal 2006 - a small fraction of the $77 billion that oil and gas companies received from the sale of oil and gas produced from federal lands and waters. In addition, with crude oil prices lingering around $80 a barrel, the federal government takes in billions more in tax revenues on the sale of oil, as well as revenues from the sale of oil and gas leases on federal lands and in federal waters. Earlier this month, a Department of the Interior sale of offshore oil and natural gas leases in the Central Gulf of Mexico netted another $2.9 billion, the second highest sale in US offshore leasing history. A portion of all of these federal oil and gas revenues could fully fund programs that help children stay warm and healthy. Policy makers should pledge to fully fund LIHEAP, at the $5.1 billion level for which it is authorized, support additional consumer shut-off protections, and avoid unnecessary budgetary trade-offs that put already disadvantaged children at risk. These steps would help ensure that America’s children do not suffer through the freezing temperatures of winter. Energy insecurity compromises a child’s health and development. With more resources than any other nation on earth, we owe it to all our children to provide fuel for a healthy future. Our children should not run on empty. Dr. Deborah A. Frank is director of the Grow Clinic for Children and principal investigator of the Children’s Sentinel Nutrition Assessment Program at Boston Medical Center. Joseph P. Kennedy II is chairman and president of Citizens Energy Corp.