Child Care Center Staff Readiness to Change in an Early Childhood Obesity Prevention Program.

CONTEXT: The childcare center (CCC) setting has the potential to be a strong foundation that supports the introduction of sustainable healthy lifestyle behaviors to prevent childhood obesity. It is important to assess barriers and facilitators to healthy weight development initiatives via program evaluation, including measuring CCC staff readiness to change. OBJECTIVE: The overall goal of this study was to assess the readiness level over 1 school year among CCC staff who participated in "Healthy Caregivers-Healthy Children" (HC2), a cluster randomized controlled trial that evaluated the effectiveness of a childhood obesity prevention program from 2015 to 2018 in 24 low-income, racially/ethnically diverse centers. A secondary outcome was to assess how a CCC's stage of readiness to change was associated with CCC nutrition and physical activity environment, measured via the Environment and Policy Assessment and Observation (EPAO) tool. DESIGN: Mixed-models analysis with the CCC as the random effect assessed the impact of readiness to change over time on EPAO outcomes. PARTICIPANTS: Eighty-eight CCC teachers and support staff completed the HC2 readiness to change survey in August 2015 and 68 in August 2016. Only teachers and staff randomized to the treatment arm of the trial were included. MAIN OUTCOME: Readiness to change and the EPAO. RESULTS: Results showed the majority of CCC staff in advanced stages of readiness to change at both time points. For every increase in readiness to change stage over 1 year (eg, precontemplation to contemplation), there was a 0.28 increase in EPAO nutrition scores (95% confidence interval [CI], 0.04-0.53; P = .02) and a 0.52 increase in PA score (95% CI, 0.09-0.95; P = .02). CONCLUSIONS: This analysis highlights the importance between CCC staff readiness to change and the CCC environment to support healthy weight development. Future similar efforts can include consistent support for CCC staff who may not be ready for change to support successful outcomes.

Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C): development and psychometric evaluation of a measure of sustainability determinants in the early childhood education and care setting.

BACKGROUND: There is a need for valid and reliable measures of determinants of sustainability of public health interventions in early childhood education and care (ECEC) settings. This study aimed to develop and evaluate the psychometric and pragmatic properties of such a measure - the Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C). METHODS: We undertook a two-phase process guided by the COnsensus-based Standards for the selection of health status Measurement INstruments checklist (COSMIN) and Psychometric and Pragmatic Evidence Rating Scale (PAPERS). Phase 1 involved measure development; i.e., determining items and scales through an iterative process and assessment of face and content validity. Phase 2 involved the evaluation of psychometric and pragmatic properties. The 29-item measure completed by service executives (directors and nominated supervisors) was embedded in a larger survey from a national sample of Australian ECEC services assessing their implementation of nutrition and physical activity programs. Structural validity, concurrent validity, known groups validity, internal consistency, floor and ceiling effects, norms, and pragmatic qualities of the measure were assessed according to the PAPERS criteria. RESULTS: The final measure contained 26 items, with respondents reporting how strongly they agreed or disagreed on a five-point Likert scale. Phase 1 assessments confirmed the relevance, and face and content validity of the scale. In Phase 2, we obtained 482 completed surveys, of which 84% (n = 405) completed the entire measure across 405 ECEC settings (one executive per service). Three of the four fit indices for the confirmatory factor analysis met the pre-specified criteria (SRMR = 0.056, CFI = 0.993, RMSEA = 0.067) indicating 'good' structural validity. The IMPRESS-C illustrated: 'good' internal consistency, with Cronbach's alpha values from 0.53 to 0.92; 'emerging' concurrent validity; 'poor' known groups validity; 'good' norms; and 'good' overall pragmatic qualities (cost, readability, length, and assessor burden). CONCLUSIONS: The IMPRESS-C possesses strong psychometric and pragmatic qualities for assessing service executive-level perceptions of determinants influencing sustainment of public health interventions within ECEC settings. To achieve a full range of perspectives in this setting, future work should be directed to also develop and test measures of sustainability determinants at the implementer level (e.g., among individual educators and staff).

Change in Nutrition and Physical Activity Practices in Early Childcare and Education Settings in Illinois During the COVID-19 Pandemic.

CONTEXT: For many young children, early childcare and education (ECE) programs are the only source of nutritious meals and physical activity (PA); however, the COVID-19 pandemic led to program closures, restrictions, and changed practices. OBJECTIVE: To examine changes in nutrition and PA-related best practices in ECE settings in Illinois from 2019, just prior to the pandemic, as compared to 2022. We also examined how changes over time varied by program type (ie, centers vs homes), Child and Adult Care Food Program (CACFP) status, and/or Head Start/Early Head Start status. DESIGN: The study design is a repeated cross-sectional survey administered in December 2019 and October 2022. SETTING: State of Illinois. PARTICIPANTS: A total of 888 and 1162 ECE providers completed initial and follow-up surveys, respectively. INTERVENTION: NA. MAIN OUTCOME MEASURE: Provider report of meeting 14 nutrition and 9 PA-related best practices. RESULTS: Overall, 9 nutrition-related best practices were maintained and 5 declined over time. Centers, CACFP, and Head Start providers reported significant declines in meeting nutrition-related practices over time. A total of 8 PA-related best practices were maintained and 1 declined over time. Centers reported a significant decline in 5 of the PA-related best practices over time, and these declines were significantly different than in homes over time. Similarly, Head Start programs reported a decline in 4 PA-related best practices over time, and the change was significantly different from non-Head Start programs in 3 of the 4 practices. CONCLUSION: The findings of this study should be considered a new baseline for ECE nutrition and PA-related best practices in Illinois and should serve as a wake-up call for advocates nationwide with regard to the provision of nutrition and PA-related best practices in centers and by CACFP and Head Start providers postpandemic.

Children's physical activity in family child care homes: Influence of quality status, environment and policy features, and child characteristics.

BACKGROUND: About half of preschool-age children are not meeting recommendations of 15 min/h of physical activity (PA), and nearly one out of seven children between the ages of 2-5 years are living with obesity. Furthermore, children attending family child care homes (FCCHs), compared with larger child care centers, engage in lower levels of PA and appear to be at a higher risk of obesity. Therefore, examining PA and multi-level factors that influence PA in children who attend FCCHs is essential. METHODS: The Childcare Home Eating and Exercise Study (CHEER) examined PA behaviors of 184 children enrolled in 56 FCCHs and FCCH quality status, environment and policy features, and child characteristics. PA was assessed by accelerometer, and FCCH environment and policy was assessed via structured observation. Multiple linear regression was used to model associations between school day total PA and FCCH quality status, environment and policy features, and child characteristics. RESULTS: Child participants were on average 3.1 years old; participants were non-Hispanic Black (47.3%), Non-Hispanic White (42.9%), other race/ethnicity (7.1%), and Hispanic/Latin (2.7%). Children in FCCH settings participated in 11.2 min/h of total PA, which is below the recommended 15 min per hour. The PA environment and policy observation yielded a score of 11.8 out of a possible 30, which is not supportive of child PA. There were no associations between total child PA and FCCH quality status, environment and policy features, and child characteristics in these FCCH settings. CONCLUSIONS: This study was unique in its examination of PA and a comprehensive set of factors that may influence PA at the individual, organizational, environmental, and policy levels in a diverse sample of children attending FCCHs in South Carolina. Additional research is needed to better understand how to increase children's physical activity while they are in the FCCH setting. This research should use multi-level frameworks and apply longitudinal study designs.

Nutrition environments in early childhood education: do they align with best practice?

OBJECTIVE: To assess the comprehensiveness (scope of nutrition guidance) and strength (clarity of written language) of centre-based nutrition policies (CBNP) within early childhood education (ECE) centres. To also consider the applicability of an existing CBNP assessment tool and policy alignment with best practice food provision and feeding practices. DESIGN: Cross-sectional online study to assess written ECE CNBP using the Wellness Child Care Assessment Tool. SETTING: Licenced ECE centres in the state of Victoria, Australia. PARTICIPANTS: ECE centres (operating at least 8 h per d, 48 weeks per annum), stratified by location (rural and metropolitan), centre management type (profit and not-for-profit) and socio-economic area (low, middle, high). RESULTS: Included individual CBNP (n 118), predominantly from metropolitan centres (56 %) and low-medium socio-economic areas (78 %). Policies had low overall Wellness Child Care Assessment Tool scores, particularly strength scores which were low across all four domains (i.e. nutrition education, nutrition standards, health promotion and communication/evaluation). The nutrition standards domain had the lowest strength score. The communication/evaluation domain had the lowest comprehensiveness score. Content analysis indicated low scores may relate to the Wellness Child Care Assessment Tool applicability for the Australian context due to differences in best practice guidance. CONCLUSION: Despite the presence of written nutrition policies in ECE centres, many showed weak language and lacked comprehensiveness and strength. This may relate to poor implementation of best practice food provision or feeding practices. Low scores, however, may partly stem from using an assessment tool that is not country-specific. The redevelopment of country-specific tools to assess ECE CNBP may be warranted.

[Heat and heavy rain prevention measures in daycare centres and care facilities: an evaluation of risk perception, communication and information materials]. / Maßnahmen zur Hitze- und Starkregenvorsorge in Kitas und Pflegeeinrichtungen: Eine Evaluation von Risikowahrnehmung, Kommunikation und Informationsmaterialien.

BACKGROUND AND AIM: Heat and heavy rain can have negative health impacts for people in Germany. Vulnerable groups in particular, such as children and the elderly, are at increased risk and require special precautions. This paper examines how employers of the municipal administration and facilitating organisations perceive the risk of heat and heavy rain for daycare centres and care facilities, and to what extent an exchange takes place between the municipal level and the facilities. In addition, specially developed information materials with recommendations for action for adapting to heat and heavy rain that are aimed at such facilities were evaluated. METHODS: In the summer of 2021, we conducted a quantitative survey. A total of 333 respondents from municipal administrations, facilitating organisations and institutions participated. Descriptive analyses and ANOVAs were conducted. RESULTS: Risk perception and adaptation knowledge concerning heat was perceived higher than concerning heavy rain. The intention to support institutions in finding measures for adaptation was also higher with regard to heat. The majority of interviewees from municipal administrations and institutions communicated with institutions through various channels on different topics including the natural hazards mentioned. The information material was evaluated positively. DISCUSSION: This article shows that facilities are seen as very affected by heat waves. Awareness towards heavy rainfall needs to be raised. The feedback on the information material clearly shows a high need in this area.

Macro-structural predictors of Australian family day care quality.

Introduction: This study explores the predictive power of macro-structural characteristics on quality rating and improvement system (QRIS) outcomes of Family Day Care (FDC) services in Australia. Methods: The dataset consisted of 441 FDC National Quality Standard (NQS) ratings from all Australian states and territories, with overall ratings of Exceeding NQS, Meeting NQS, Working Towards NQS, or Significant Improvement Required. Results: Multinomial logistic regressions confirmed that management type, community socioeconomic status (SES), level of urbanization, and government jurisdiction explained 6.9 to 19.3% of the variation in QRIS outcomes. Results indicated that lower FDC NQS ratings were more likely for (1) private for-profit vs. not-for-profit; (2) low-SES vs. high-SES area; and (3) regional or remote area vs. metropolitan. State/territory jurisdiction also influenced NQS ratings. Discussion: These findings imply the need for policy attention to inequalities in FDC quality associated with systemic and organizational differences. Greater effort is needed to promote equality and equity in FDC services.

Association of Child Masking With COVID-19-Related Closures in US Childcare Programs.

Importance: It is not known how effective child masking is in childcare settings in preventing the transmission of SARS-CoV-2. This question is critical to inform health policy and safe childcare practices. Objective: To assess the association between masking children 2 years and older and subsequent childcare closure because of COVID-19. Design, Setting, and Participants: A prospective, 1-year, longitudinal electronic survey study of 6654 childcare professionals at home- and center-based childcare programs in all 50 states was conducted at baseline (May 22 to June 8, 2020) and follow-up (May 26 to June 23, 2021). Using a generalized linear model (log-binomial model) with robust SEs, this study evaluated the association between childcare program closure because of a confirmed or suspected COVID-19 case in either children or staff during the study period and child masking in both early adoption (endorsed at baseline) and continued masking (endorsed at baseline and follow-up), while controlling for physical distancing, other risk mitigation strategies, and program and community characteristics. Exposures: Child masking in childcare programs as reported by childcare professionals at baseline and both baseline and follow-up. Main Outcomes and Measures: Childcare program closure because of a suspected or confirmed COVID-19 case in either children or staff as reported in the May 26 to June 23, 2021, end survey. Results: This survey study of 6654 childcare professionals (mean [SD] age, 46.9 [11.3] years; 750 [11.3%] were African American, 57 [0.9%] American Indian/Alaska Native, 158 [2.4%] Asian, 860 [12.9%] Hispanic, 135 [2.0%] multiracial [anyone who selected >1 race on the survey], 18 [0.3%] Native Hawaiian/Pacific Islander, and 5020 [75.4%] White) found that early adoption (baseline) of child masking was associated with a 13% lower risk of childcare program closure because of a COVID-19 case (adjusted relative risk, 0.87; 95% CI, 0.77-0.99), and continued masking for 1 year was associated with a 14% lower risk (adjusted relative risk, 0.86; 95% CI, 0.74-1.00). Conclusions and Relevance: This survey study of childcare professionals suggests that masking young children is associated with fewer childcare program closures, enabling in-person education. This finding has important public health policy implications for families that rely on childcare to sustain employment.

Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes.

Child care environments foster children's healthy eating habits by providing exposure to healthy foods and feeding practices. We assessed the healthfulness of nutrition environments, menu/meal quality, and the achievement of Child and Adult Care Food Program (CACFP) guidelines and best practices in Oklahoma CACFP-enrolled family child care homes (FCCHs) (n = 51). Two-day classroom observations were conducted. Healthfulness of classroom nutrition environments was assessed using the Environment and Policy Assessment and Observation (EPAO). Foods served to and consumed by children were quantified using the Dietary Observations in Child Care (DOCC) tool. Nutrient analysis was performed to determine total energy for foods listed on menus, served to, and consumed by children. Menu and meal food variety and CACFP Guideline Achievement Scores were determined. Average nutrition environment score was 11.7 ± 1.2 (61.5% of maximum possible score). Energy (kcals) from menus and consumed by children was insufficient to meet two-thirds of their daily reference intake. Children were exposed to 1.7 vegetables and 1.3 fruits per meal. CACFP Guideline Achievement Scores were 66.3% ± 7.8 for menus and 59.3% ± 7.6 for mealtimes. Similar to previous research, our findings indicate a need for improved FCCH nutrition practices. Tailored interventions for FCCHs are needed.

Implementation of Minimum Nutrition Standards and Best Practices in Childcare Centers.

BACKGROUND: The federal Child and Adult Care Food Program (CACFP) provides reimbursable meals to 4.6 million children annually and sets nutrition standards for foods served. Licensing regulations in many states extend these rules to nonparticipating programs. OBJECTIVE: To evaluate the quality of meals and snacks served in Connecticut licensed childcare centers in 2019 and assess implementation of a state licensing requirement to adhere to CACFP minimum nutrition standards in all centers. DESIGN: Cross-sectional survey. PARTICIPANTS/SETTING: Two hundred licensed childcare centers in Connecticut in 2019. MAIN OUTCOME MEASURES: Meal/snack quality was assessed based on menus. Foods/beverages listed were compared to the minimum CACFP nutrition standards and optional best practices. Surveys completed by center directors measured center characteristics. STATISTICAL ANALYSIS: Logistic and linear multivariable regression models tested differences in centers' adherence to nutrition standards and best practices by CACFP participation status. RESULTS: CACFP centers complied with more required nutrition standards than non-CACFP centers (an adjusted mean of 4.7 vs 3.4 standards among programs serving meals, P < 0.001), with particularly large mean differences for whole grains and low-fat milk. Implementation of optional best practices, except for beverages, was relatively low among all centers, especially for snacks. Compliance (adjusted mean number of minimum nutrition standards met) was greater among centers accredited by the National Association for the Education of Young Children and those using a registered dietitian or a sponsoring agency to prepare menus and receiving food from a vendor. Recent completion of nutrition training was associated with greater mean implementation of best practices. CONCLUSIONS AND IMPLICATIONS: Better adherence to minimum nutrition standards and best practices among CACFP-participating childcare centers contributed to higher nutritional quality of meals and snacks offered. Snack quality would benefit most from greater compliance with nutrition standards. Providers outside of CACFP need additional supports in the implementation of licensing regulations to improve the food environment for young children.

Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines.

Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools; we compiled data about the costs, feasibility, acceptability, and effects on health equity of the selected interventions; and we developed the following conditional recommendations: we suggest that child care centers and schools implement allergy training and action plans; we suggest that they use epinephrine (adrenaline) to treat suspected anaphylaxis; we suggest that they stock unassigned epinephrine autoinjectors, instead of requiring students to supply their own personal autoinjectors to be stored on site for designated at-school use; and we suggest that they do not implement site-wide food prohibitions (eg, "nut-free" schools) or allergen-restricted zones (eg, "milk-free" tables), except in the special circumstances identified in this document. The recommendations are labeled "conditional" due to the low quality of available evidence. More research is needed to determine with greater certainty which interventions are likely to be the most beneficial. Policymakers might need to adapt the recommendations to fit local circumstances.

The Association between Australian Childcare Centre Healthy Eating Practices and Children's Healthy Eating Behaviours: A Cross-Sectional Study within Lunchbox Centres.

The association between healthy eating practices and child dietary intake in childcare centres where parents pack foods from home has received little attention. This study aimed to: (1) Describe the nutritional content of foods and beverages consumed by children in care; and (2) Assess the association between centre healthy eating practices and child intake of fruit and vegetable servings, added sugar(grams), saturated fat(grams) and sodium(milligrams) in care. A cross-sectional study amongst 448 children attending 22 childcare centres in New South Wales, Australia, was conducted. Child dietary intake was measured via weighed lunchbox measurements, photographs and researcher observation, and centre healthy eating practices were assessed via researcher observation of centre nutrition environments. Children attending lunchbox centres consumed, on average 0.80 servings (standard deviation 0.69) of fruit and 0.27 servings (standard deviation 0.51) of vegetables in care. The availability of foods within children's lunchboxes was associated with intake of such foods (p < 0.01). Centre provision of intentional healthy eating learning experiences (estimate -0.56; p = 0.01) and the use of feeding practices that support children's healthy eating (estimate -2.02; p = 0.04) were significantly associated with reduced child intake of saturated fat. Interventions to improve child nutrition in centres should focus on a range of healthy eating practices, including the availability of foods packed within lunchboxes.

Risk for Fomite-Mediated Transmission of SARS-CoV-2 in Child Daycares, Schools, Nursing Homes, and Offices.

Severe acute respiratory syndrome coronavirus 2 can persist on surfaces, suggesting possible surface-mediated transmission of this pathogen. We found that fomites might be a substantial source of transmission risk, particularly in schools and child daycares. Combining surface cleaning and decontamination with mask wearing can help mitigate this risk.

WHO Guideline on the prevention of drowning through provision of day-care and basic swimming and water safety skills

This guideline addresses: provision of day-care for children under the age of 6 years and provision of basic swimming skills and water safety training to children aged 6 years and older. Developed following GRADE methodology, approved by the WHO Guideline Review Committee and intended for use by policy-makers and practitioners, the guideline issues strong recommendations in favour of both interventions for drowning prevention.

Preschool Healthy Food Policy Did Not Increase Percent of Food Wasted: Evidence from the Carolinas.

This research evaluates the effects of a South Carolina (SC) policy, which changed the nutrition standards for foods served in early care and education (ECE) settings, on wasted food. A two-group pre-test/post-test evaluation was performed in ECE centers serving children age 3-5 from households with lower incomes in SC (n = 102 children from 34 centers, intervention) and North Carolina (NC; n = 99 children from 30 centers, comparison). Direct observation was performed to assess the quantity and kcal of food served and quantity and percent of food discarded, by food group and nutrient, enabling assessment of waste in the absence of intervention. Mixed-effects linear models were fit to estimate, by state, differences in change from baseline to post-implementation at the center level. Covariates were selected a priori, including center enrollment, racial composition, director educational attainment, years in operation, for-profit status, and Child and Adult Care Food Program (CACFP) participation. Waste of food was high across states and time points. The policy was not associated with a change in percent of food discarded in SC compared to NC in adjusted analyses.

Preschool environment and preschool teacher's physical activity and their association with children's activity levels at preschool.

OBJECTIVE: The aim of this study was to investigate the association between preschool playground size, formalized physical activity (PA) policies, time spent outdoors and preschool teacher's levels of PA and children's objectively assessed levels of PA and sedentary time (ST) during preschool hours. METHODS: In total, 369 children and 84 preschool teachers from 27 preschools in Södermalm municipally, Stockholm Sweden wore an Actigraph GT3X+ accelerometer during 7 consecutive days. Preschool environmental and structural characteristics were measured via the Environment and Policy Evaluation Self-Report (EPAO-SR) instrument and time in- and outdoors was recorded by preschool teachers during the PA measurements. Weight and height of children were measured via validated scales and parents filled out a questionnaire on demographical and descriptive variables. Linear mixed models, nested on preschool level, were used to assess the association between predictors and outcomes. RESULTS: The mean child age was 4.7 years (SD 0.8) and 45% were girls. We found that children were more active in preschools with a formalized PA policy, compared to preschools without such a policy, but not less sedentary. The association between policy and activity seemed to be more pronounced when accounting for other environmental factors. Similar associations were found in children spent most time outdoors (uppermost quartile) compared with children spent least time outdoors (Lowermost quartile). Preschool teachers' light PA (LPA) (ß = 0.25, P = 0.004) and steps (ß = 0.52, P<0.001) were associated with children's LPA and steps while the preschool playground size showed no association with PA in children, when accounting for other environmental factors. CONCLUSION: The current study showed that preschool structural characteristics such as formalized PA policies and more time spent outdoors were positively associated with children's PA. These findings suggest that formalized PA policies and time outdoors may be of importance for promoting children's PA during preschool hours.

Comparison of Urban and Rural Physical Activity and Outdoor Play Environments of Childcare Centers and Family Childcare Homes.

The purpose of this study was to examine the physical activity environment in childcare programs across type (childcare centers [CCCs] and family childcare homes [FCCHs]) and geographic location (urban and rural) as assessed by physical activity best practices according to the Go Nutrition and Physical Activity Self-assessment in Child Care. Results showed CCCs compared with FCCHs reported higher achievement of best practices. Further, urban childcare programs (CCCs and FCCHs) reported higher achievement of best practices in comparison to rural childcare programs. There is a need to deliver targeted interventions that promote children's physical activity in FCCHs and CCCs in rural areas.

Participation in the CACFP Ensures Availability but not Intake of Nutritious Foods at Lunch in Preschool Children in Child-Care Centers.

BACKGROUND: The US Department of Agriculture Child and Adult Care Food program (CACFP) recently (October 2017) updated requirements for meal reimbursement and best practice recommendations for serving nutritious meals and beverages, and minimum age-specific serving sizes for five food groups. It is not known whether CACFP-funded child-care centers are meeting the updated meal pattern requirements and best practice recommendations, and whether children are meeting nutrition recommendations based on the current 2015-2020 Dietary Guidelines for Americans (DGA). OBJECTIVE: This study assessed whether the recruited CACFP-funded child-care centers in this study were meeting the updated (2017) CACFP requirements regarding foods served for lunch and whether children attending these child-care centers were meeting age- and sex-specific DGA recommendations regarding foods consumed. DESIGN: This was a cross-sectional study using the Dietary Observation for Child Care method.  PARTICIPANTS AND SETTINGS: Children aged 3 to 5 years (n=108) from 10 classrooms in three CACFP-funded child-care centers in Lincoln, NE, were recruited by convenience sampling during spring 2018. MEASURABLE OUTCOMES: Food served and consumed during observed lunches in comparison with updated CACFP requirements and DGA, respectively. STATISTICAL ANALYSIS: Adjusted mean amounts of foods served from each food group were compared with age specific minimum CACFP serving size requirements. Adjusted mean amounts of foods consumed from each food group were then compared with age- and sex-specific DGA recommendations. RESULTS: The recruited child-care centers were meeting the updated CACFP requirements regarding foods served but showed limited adherence to the best practice recommendations during the observed lunches. However, the overall mean intake for grains, fruits, and vegetables was significantly lower (P<0.01) than DGA recommendations. In addition, approximately 25% of the children did not consume any vegetables during their meal.      CONCLUSIONS: Although child-care centers were meeting the updated CACFP requirements by serving the recommended amounts of foods, children were not meeting DGA-recommended intakes. Future studies are needed to explore ways to improve adherence to best practice recommendations to improve children's consumption of healthy foods in child-care centers.

Nutrition Provided to Infants in Licensed Childcare Centers and Homes: A Descriptive Study.

BACKGROUND: Infant nutrition can influence development, eating behaviors and obesity risk. Nearly half of infants in the U.S. are in non-parental care where they consume much of their daily nutrition. Because little is known about the quality of infant nutrition in childcare, the study objective was to characterize the foods and beverages provided to infants in childcare in California. METHODS: From a randomly selected sample of 2,400 licensed childcare in California, 736 responded to a 2016 survey; a subset of 297 cared for infants. Differences in 26 foods and 7 beverages provided between centers and homes, and by CACFP participation, were assessed using logistic regression models adjusted for CACFP participation and whether the site was a center or home, respectively. RESULTS: Several differences between centers and homes were identified. One the day prior to the survey, more centers than homes ever provided cow's milk (25.1% vs 13.0%, p = 0.02) and whole grains (76.7% vs 62.9%, p = 0.03), and fewer centers than homes provided frozen treats (1.4% vs 10.3%, p = 0.003). When comparing difference by CACFP participation, fewer CACFP than non-CACFP sites usually provided breastmilk (32.6% vs 54.2%, p = 0.0004) and ever provided cow's milk (14.2% vs 37.1%, p < 0.0001). On the day prior to the survey, more CACFP than non-CACFP provided vegetables (91.0% vs 80.8%, p = 0.02), fruit (centers only) (97.2% vs 80.8%, p = 0.0003), and infant cereals (86.0% vs 61.2%, p < 0.0001). Fewer CACFP than non-CACFP provided sweetened yogurt (14.8% vs 36.7%, p < 0.0001). CONCLUSIONS FOR PRACTICE: Childcare centers and CACFP participants tended to serve nutritious foods more than childcare homes and non-CACFP participants, respectively. Additional education and policies for childcare providers on appropriate foods and beverages for infants is recommended.