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When temperatures drop and winter winds start blowing, Ketline Leonard feels not just cold, but fear.

Her son Cory, 3, already weak from sickle cell anemia, risks getting even sicker. Keeping the thermostat above 65 degrees is not a matter of comfort — it’s a medical necessity.

Paying for that heat on a $9-an-hour salary while putting food on the table for Cory and her 2-year-old daughter Kayla nearly breaks Leonard’s budget during the winter months — and with oil trading at over $90 a barrel, she fears it will only get worse.

“When it’s cold, I’m so afraid,” said Leonard as Kayla, crawling on her lap, reached up to wipe away her mother’s tears. “It’s heartbreaking. Nobody wants to see a child live like this.”

Leonard’s dilemma, and that of millions of parents like her, took center stage at a hearing last week where Dr. Deborah Frank, chief of the Growth Clinic at Boston Medical Center, released a study showing the impact of rising fuel costs on the health of children from low-income families.

Testifying before a panel of elected officials and fuel assistance advocates, Frank called the “heat or eat” dilemma “an epidemic of energy insecurity” for poor families barely scraping by in today’s economy.

According to the report, a dramatic increase of over 50 percent in heating costs in the last six years poses serious threats to children’s health and well-being, particularly for low-income families who have seen their earnings stagnate or decrease during the same period.

“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,” said Frank in the report by the Children’s Sentinel Nutrition Assessment Program (C-SNAP).

“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.”

The effects of skyrocketing fuel costs have shown up in emergency rooms, where researchers found a 30 percent increase in the number of underweight toddlers and infants in the cold winter months.

Showing the broad impact of rising energy costs, Rachel Jordan, an Iraq war veteran whose husband is still serving in the Persian Gulf, testified about the difficulty of buying enough food for her family while cranking the heat to protect the health of her 5-year-old daughter and her son John, just three months old, who was born frail and sickly.

Though John is now up to 12 pounds, “he’s still low in the percentile,” said Jordan, who lives in Quincy. “He gets chilled very easily and has to be well clothed and kept in blankets.”

Jordan’s testimony sparked an impassioned response from former Congressman Joseph P. Kennedy II, whose company, Citizens Energy, sponsored the C-SNAP report and convened the hearing.

“I can’t tell you how deeply disturbing it is to hear that a mother who served our country in war and whose husband continues to put his life at risk to protect us all is suffering here at home,” said Kennedy.

Congressmen Michael Capuano, D-Mass., and Bill Delahunt, D-Mass., and former Congressman Marty Meehan, now chancellor of the University of Massachusetts at Lowell, vowed to push for increases in the federal fuel assistance budget in order to help families like the Leonards and the Jordans get through winter.

In spite of record price spikes in the cost of oil, the Bush administration proposed a 44 percent cut to the Low Income Home Energy Assistance Program (LIHEAP) for the current fiscal year. Meanwhile, over 11,000 families in Boston alone had their heat shut off because of outstanding fuel bills.

At today’s prices, the average LIHEAP grant of $314 will fill just half a household fuel tank — barely enough to get through two weeks in winter.

As the gap between the number of households eligible for fuel assistance and those who receive it continues to widen, Frank pointed out that LIHEAP has a clear positive impact on children’s health, citing statistics showing that children from poor families getting the aid are significantly more likely to avoid hospitalizations, be at risk for developmental problems and suffer from poor nutrition.

Doctors from local teaching hospitals and panelists signed a letter to President Bush urging full funding of LIHEAP — $5.1 billion, a $3 billion increase above current funding — during the coming year.

As the doctors and panelists put their signatures on the letter, Jordan sat in her witness chair, shaking her head.

“I can’t understand how people could not know there’s a struggle out there,” she said. “There are million of families like mine. I just hope others don’t have to go through what we do.”