The Food Journal and Food, Nutrition & Science

An alliance between The Lempert Report and The Center for Food Integrity

Child-Care Nutrition

Child-Care Nutrition

Health and Wellness

September 24, 2013

Nutrition at child-care centers needs improvement, according to a study from the University of North Carolina at Chapel Hill and published in the Journal of the Academy of Nutrition and Dietetics. The study found that child-care centers are not serving enough vegetables or whole grains, and serving too many high fat, high sugar items.

Preschool nutrition is of public health significance. Preschool-aged children spend about 25 hours a week in a child-care setting, and therefore consume a substantial amount of their food in these settings. There are a variety of standards for foods offered in child-care settings, ranging from the Child and Adult Care Food Program (CACFP) Meal Pattern Requirements to the Academy of Nutrition and Dietetics’ Benchmarks for Child-Care Programs to the Healthy Eating Index-2005 (HEI-2005).

“Children develop food preferences in early childhood. During this period, many children are in child-care programs where they are introduced to different types of foods and beverages. The food habits they develop at this stage are likely to continue into adolescence and adulthood where it may influence their risk for developing obesity and other chronic diseases,” says Dr. Temitope Erinosho, study co-author. 

For this study, researchers applied the Healthy Eating Index-2005 to assess the quality of foods and beverages offered to 120 preschool children ages 3 to 5 years old in 20 child-care centers in North Carolina between July 2005 and January 2006. The HEI-2005 consists of 12 food components, and each is assigned a score, with total scores ranging from 0-100. For saturated fat, sodium, alcohol and sugars, higher scores indicate lower intakes, which is preferred. For components like fruit, vegetables, milk, and whole grains, high scores indicate higher intakes, which is preferred for those healthier components. The mean total HEI-2005 score was 59.12 – much lower than the optimal score of 100, and indicating a need for better quality of foods offered to children.

While all child-care centers met the maximum scores for milk, and most met the maximum scores for total fruit and whole fruit, mean scores for vegetables, grains, meat/beans and oils were lower than the recommended scores. Mean scores for saturated fat and calories from solid fats and added sugars were higher than they should be.

This study is consistent with prior studies on the topic, which also found that child-care nutrition is not living up to recommended standards. One Journal study in particular by Briley and colleagues (1999) found that child-care centers typically serve milk, cheese, bread, fruits, crackers, cookies and cold cereal, and that they rarely serve vegetables or provide a variety of foods. Unfortunately, this current study reveals that not a lot has changed. 

“While there have been a few studies that have examined foods and beverages offered and consumed in child care centers, efforts to intervene to promote healthy food environments in child-care settings have only been within the past decade or so. Micronutrients, such as iron and vitamin A are needed for cognitive function. If foods offered to children do not supply the recommended amounts of these micronutrients, and children are not making up for these deficiencies in foods consumed at home, their cognitive development and learning skills may be impacted negatively. Such children may be at risk for not reaching their full academic potential in the long-term,” says Erinosho.

Erinosho suggests that child-care centers make environmental changes to improve the quality of the food they offering to preschoolers. For example, child-care centers should provide a variety of dark green and orange vegetables and legumes, increase whole grains by substituting brown rice for white rice, and offer more whole wheat options. Centers can also increase access to lean meats and fish, provide more beans (like black beans and chickpeas), and cook with nonhydrogenated vegetable oils. 

There is also the need to improve the meal requirements for child care centers, as indicated in a recent report by the Institute of Medicine (IOM). The CACFP, which is the federally-funded food program that reimburses centers for providing meals/snacks to children, does not prevent centers from providing additional non-nutritious meals and snacks for which they do not seek reimbursement. The IOM report therefore recommended, among other things, increased emphasis on limiting foods high in solid fats and added sugars (like cake and cookies). Actual changes to the CACFP requirements are expected to be released soon.

Another helpful way to get kids on board with improving their nutrition is to encourage the caretakers at child-care centers to eat healthier foods with the children. Modeling, both at child-care centers, and in the home, by parents, can go a long way toward helping children develop healthy eating patterns to last a lifetime. 

“Children learn from their caregivers (parents, and child care providers) and also tend to copy what they see their caregivers doing. Studies have shown that modeling healthy eating behaviors is associated with increased intake of healthful foods such as fruits and vegetables in young children,” adds Erinosho.

Lastly, nutrition professionals can work with child-care centers to develop programs for parents and staff to educate them about the importance of healthful eating behaviors and, most importantly, how to encourage and model such behaviors. They can also work with policy makers to develop policies for child-care centers that promote healthy behaviors and prevent the marketing of unhealthy foods to children in child-care settings.