Jade Hunter is used to her pupils coming to school without breakfast but she has never seen them as hungry as they have been over the past year. “We’ve got children with bowed legs because they’re so deficient in vitamins. We’ve had children so malnourished they’ve had heart murmurs,” said Hunter, a headteacher at West Earlham infant and nursery school in Norwich. “It’s heartbreaking. It’s not how it should be. It’s the worst I’ve ever seen it. We’ve got two-year-olds coming in and trying to eat sand because they’re hungry. ” It’s just after 8.30am on a cold Monday morning and the pouring rain outside means they’re expecting some children to stay off. “If their parents can’t afford to buy them a coat some of them don’t come in,” she said. Hunter grew up on the housing estate in Earlham where her pupils live. It’s ranked in the 10% most deprived areas in England, and about 50% of her students receive free school meals. High unemployment and poverty have been part of life here for generations but the cost of living crisis has sharpened the effects in recent months. “We’re seeing it with parents; they’re wearing old trainers with holes in the winter. The standard of their living is really declining,” she said. “Children will talk about it being dark at home because there’s no electric, or having to keep their coat on at home because it’s cold.” The most alarming impact has been the effect on pupils’ physical health, with many school absences thought to be linked to sickness caused by poor living conditions and diet. “We do get a lot of bad chests because they’re in damp homes that are maybe mouldy, and we get a lot of sickness and diarrhoea because the quality of the food they’re eating isn’t great,” said Hunter. “I’ve had one child who came in so malnourished and ill I had to carry them to the doctor myself.” Malnutrition is increasing nationwide but Norfolk is thought to be one of the worst-affected areas – the Norfolk and Waveney Integrated Care Board (ICB) has recorded a malnutrition rate of 6.7%, the highest of any ICB in the country, according to a report from Future Health research centre. Hunter’s school works with the national charity Magic Breakfast to provide all pupils with free food at the start of each day, regardless of whether they’re eligible for free school meals. With a growing number of pupils coming into school hungry, concentration levels were dropping and behaviour getting worse. Now all pupils are offered a bagel or cereal before lessons begin, which helps to set them up for the day. “Pupils are coming into school, and they haven’t eaten properly since lunchtime the day before,” said Jan Jemson, an engagement partner for Magic Breakfast. “If they don’t have a breakfast at school, they’re then having to go right back through to lunch to wait, and most of the learning is happening in the morning. So you can see why they would be struggling.” The charity says it has heard reports from headteachers around the country that an increasing number of children appear physically small for their age, and are wearing clothes designed for younger year groups, prompting concerns that poor diet is stunting children’s growth. “It’s really difficult to sit and hear what’s happening to families at the moment. Children are coming in and their lunch boxes are virtually empty, or they’ve got a couple of cheap sugary snacks,” said Jemson. “Children with teeth falling out, children with bowed legs, in current society – this isn’t the Victorian era. Parents are doing their absolute best, but they’re being marketed deliberately cheap, unhealthy food.” “It’s really dire at the moment and the health impacts are really wide,” said Dr Sarah Hanson, an associate professor in community health at the University of East Anglia. “There’s evidence that not getting enough to eat causes low mood and anxiety, and often leads to stricter discipline in households. For children, their behaviour worsens and it has been linked to increased asthma diagnoses, as well as significantly higher use of emergency care.” She said the health effects of malnutrition needed to be considered “systemically” as it often led to people becoming immunocompromised. “It’s quite astonishing how nutrition cuts across all aspects of health. GP surgeries are all seeing the products of this, that’s why a lot of surgeries are so busy,” Hanson said. The eastern region where Norfolk sits – known as “Britain’s breadbasket” – still produces nearly 30% of all edible crops in England, and almost half of all homegrown vegetables. “The irony is that Norfolk is such a massive food producer, but people here are going without,” she said.