Child Care Provider Adherence to Infant and Toddler Feeding Recommendations: Findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study

Abstract

Background: Identifying characteristics associated with the Institute of Medicine's (IOM) recommended feeding practices among infant and toddler care providers in child care centers could help in preventing childhood obesity.Methods: In 2009, at baseline in a pilot intervention study of 29 licensed Massachusetts child care centers with at least 50% of enrolled children identified as racial minorities, 57 infant and 109 toddler providers completed feeding questionnaires. To assess provider adherence to six IOM-recommended behaviors, we used cluster-adjusted multivariable logistic regression models including provider type (infant or toddler), race, education, and center Child and Adult Care Food Program (CACFP) participation.Results: In multivariable analysis, CACFP participation was associated with providers sitting with children at meals (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2-21.7), offering fruits and vegetables (OR, 3.3; 95% CI 1.7-6.2), and limiting fast food (OR, 3.5; 95% CI, 1.8-6.7). Providers at centers serving meals family style were less likely to allow children to leave food unfinished (OR, 0.27; 95% CI, 0.09-0.77). Infant providers were more likely than toddler providers to sit with children at meals (OR, 6.98; 95% CI, 1.51-32.09), allow children to eat when hungry (OR, 3.50; 95% CI, 1.34-9.16), and avoid serving sugary (OR, 8.74; 95% CI, or fast foods (OR, 11.56; 95% CI,.Conclusions: CACFP participation may encourage IOM-recommended feeding practices among infant and toddler providers. Child care providers may benefit from education about how to feed infants and toddlers responsively, especially when offering foods family style. Future research should explore ways to promote child-centered feeding practices, while addressing barriers to providing children with nutrient-rich foods.

Early Childhood Education Centers' Reported Readiness to Implement the Updated Child and Adult Care Food Program Meal Pattern Standards in the United States, 2017

“…Prior studies reported high rates of CACFP-participating center compliance with nutrition standards, 9,[11][12][13][14]16,17 which could be partly attributable to extensive training provided about the program from corporate headquarters, the Head Start program, and/or from Federal Food Program sponsors. Given that nearly 69% of our survey respondents fell into one of these categories, high levels of reported compliance are not surprising; however, even so, only 64% of these centers reported being ''very much'' familiar with the updated standards.…”

“…6 Before the updated standards, researchers found CACFP-participating centers in certain states to have stricter nutrition practices or to be more compliant with standards than non-CACFP-participating sites, to have more supportive nutrition practices, and to report better child health outcomes. [7][8][9][10][11][12][13][14][15][16][17] To date, only a few studies have assessed readiness for implementing and/or compliance with state and/or federal ECE nutrition standards. Research conducted in California found that 2 months after a new state-level beverage policy for child care centers was implemented, more than 60% of sampled sites (CACFP sites, 67.3% and non-CACFP sites, 42.2%) were aware of the policy.…”

Providers’ response to child eating behaviors: A direct observation study

“…The meals and snacks consumed at child-care contribute a significant portion of their dietary intake (Ball, Benjamin, & Ward, 2008; Fox M, 1997; Story et al, 2006). Additionally, providers’ feeding practices, like those of parents, can influence children’s dietary intake, eating behaviors, and food preferences (Benjamin Neelon, Briley, & American Dietetic, 2011; Blaine et al, 2015; Dev, McBride, & Team, 2013; Gubbels, Gerards, & Kremers, 2015; Hendy, 2002). This study has allowed a deeper exploration of these provider-child feeding interactions and demonstrated that the feeding practices providers use are at least partially a reaction to children’s behaviors.…”

Assessment of Nutrition Knowledge of Childcare Providers Regarding the Implementation of the 2017 CACFP Meal Pattern Update

“…Additionally, research shows that it is of utmost importance that healthy foods are served to children during mealtime in childcare in order to improve early childhood dietary quality and health outcomes. [17][18][19] Previous research has called for an update to CACFP recommendations in childcare settings; 10,20 specifically, the need for policies that comply with the Dietary Guidelines for Americans. 21 Head Start Performance Standards and the Academy of Nutrition and Dietetics have recommended that foods and beverages served to children in childcare should meet at least one half to one third of children's daily needs for energy and development.…”