Skipping a nutritional lunch can lead to more than just negative effects in the classroom.

A hungry child between the age of 6 and 12 is more likely to receive special education services, repeat a grade in school or receive mental health counseling, than a child who is not hungry, according to the American Psychological Association.

The APA explains children may also feel isolated, ashamed or embarrassed by their lack of food.

School districts across the nation work to combat hunger with meal policies and by working with the United States Department of Agriculture (USDA) to provide discounted and free lunch to students who qualify.

School districts can rack up substantial unpaid student-meal debt and need to find a way to balance a gap. A national survey of more than 1,000 school nutrition directors working in public school districts found nearly 71 percent of districts reported unpaid meal debt at the end of the 2012-13 school year, according to The Atlantic. School lunch debt ranged from $2 million to $4.7 million.

Many schools struggle to afford healthy foods to students, according to the American Federation of Teachers. This makes it especially hard to provide food for students who have unpaid meal balances. Many districts opt to provide an alternative or 'emergency lunch' that is less nutritious than a full hot lunch to students with lunch debt. However, some school district meal policies can be controversial.

Many schools use the 'cheese sandwich' meal as an alternative meal, where a child receives a cold cheese and bread sandwich instead of a hot meal. This practice receives backlash from parents and educators, claiming it's not a satisfying meal and can make a child feel ashamed for being singled out.

A Pennsylvania cafeteria worker recently made headlines for quitting her job after being forced to take a hot lunch away from a first grader with an unpaid balance. The woman posted on her Facebook page, that she'd never forget “the look on his face” or the tears that “welled up” in his eyes.

The incident doesn't stand alone. In 2014, an elementary school in Salt Lake City seized and threw away the meals of 40 students over unpaid balances creating a national firestorm of criticism. In 2013, a 12-year-old Texas boy's lunch was tossed over a 30 cent debt.

So just how does the experience of 'lunch shame' affect a child?

"That would be of a great concern to me," said Ann Moylan, a professor of Family and Consumer Sciences at Sacramento State University. "What we're saying to that child is 'you don't belong here'"

When you have anything with a stigma attached to it, children are affected, explained Moylan.

One of the most painful human experiences is the feeling of being ostracized, shamed or not included, according to Moylan.

If a child feels singled out for having unpaid meal debt, or for receiving an alternative lunch, it could have major long-term effects and goes 'to the core', Moylan said.

Some children don't have the support of parents at home, which means just getting to school is a task. If a student feels ashamed in school, they may choose to not come to class, which can lead to truancy problems, according to Moylan.

Lunch shaming can make a child feel insecure and affect how safe they feel in school.

"Feeling safe is so critical to learning," Moylan said. "I see this policy as attacking a child's feeling of safety."

Kristin Lagattuta, a professor of psychology at UCDavis, said a child also may not fully understand what is happening to them, depending on their age.

"A child may feel they're unfairly blamed for something out of their control," Lagattuta said.

Children are not the ones putting money in the account, so it's not their fault, according to Lagatutta.

The combination of being hungry, having your food taken away and feeling ashamed can make a situation even more stressful.

"Psychologically, if they're hungry and have the food in their hand and it's taken away, it makes it far worse," said Lagattuta.

Many local school districts work to avoid causing this type of damage to students.

Davis Joint Unified School District makes sure students are lined up to receive their lunch in a way that is sensitive to potentially causing them emotional harm.

Instead of a cheese sandwich alternative lunch, DJUSD offers a salad, fruit and veggies and milk as an emergency lunch, according to the school district's Director of Student Nutrition Services, Dominic Machi.

All students line up and receive their option of salad, fruit and veggies and milk before being charged. If a student has unpaid debt, they can walk away with their food and not face having their entree taken away. If they are up to date in payment, they can grab their entree after going through the POS system.

"Taking the food out of their hands – that’s where the emotional side comes in," Machi said. "To food service staff, it can be an extremely grueling emotionally [too]"

DJUSD uses the meal charge policy. Students have a dollar threshold that's equivalent to five lunches. Schools are in constant communication with parents regarding student meal balances, according to Machi.

"We send email notifications daily," Machi said. "When accounts are low or negative, we've notified parents every step of the way."

If a parent fails to acknowledge their child's needs, the school takes it up to administrators or the district because of the possibility of a child neglect case, Machi explained.

School districts are not allowed to give free or discounted lunches to students who do not qualify but Machi said in rare and extreme cases the school can petition to override the rule and put a child on a free lunch program.

DJUSD also provides “share baskets,” Machi said. Under USDA rules, school districts can provide a 'share basket' where students can place untouched food they may not like or want to eat, so that other students can pick it up if they want.

"It's to make sure food doesn't go to waste," Machi said.

In the Sacramento City Unified School District, about two-thirds of the students qualify for a free lunch by federal guidelines, according to SCUSD spokesperson Gabe Ross.

Ross said they just want kids to eat, and at many schools, all the students are able to receive a free meal, so he's never heard of a student having their meal taken away.

School officials will reach out to parents directly if there's a payment due, according to Ross.

The Elk Grove Unified School District's alternative lunch consists of a cheese sandwich, fruit and either milk or juice, according to EGUSD spokesperson, Xanthi Pinkerton.

Some EGUSD schools also offer breakfast. Students with exhausted funds receive cereal, fruit and milk.

Typically, students enter their lunch codes or pay for their food before receiving any food, according to Pinkerton.