Objective: To assess and compare the nutrition environment and practices (as they relate to pre-schoolers) of centre-and home-based child-care facilities. Design: Using a cross-sectional study design, nineteen child-care facilities (ten centre-based, nine home-based) were assessed for one full day using the Environment and Policy Assessment and Observation (EPAO) tool (consisting of a day-long observation/review of the nutrition environment, practices and related documents). Specifically, eight nutrition-related subscales were considered. Setting: Child-care facilities in London, Ontario, Canada. Subjects: Child-care facilities were recruited through directors at centre-based programmes and the providers of home-based programmes. Results: The mean total nutrition environment EPAO scores for centre-and homebased facilities were 12·3 (SD 1·94) and 10·8 (SD 0·78) out of 20 (where a higher score indicates a more supportive environment with regard to nutrition), respectively. The difference between the total nutrition environment EPAO score for centre-and home-based facilities was approaching significance (P = 0·055). For both types of facilities, the highest nutrition subscale score (out of 20) was achieved in the staff behaviours domain (centre mean = 17·4; home mean = 17·0) and the lowest was in the nutrition training and education domain (centre mean = 3·6; home mean = 2·0). Conclusions: Additional research is needed to confirm these findings. In order to better support child-care staff and enhance the overall nutrition environment in child care, modifications to food practices could be adopted. Specifically, the nutritional quality of foods/beverages provided to pre-schoolers could be improved, nutrition-related training for child-care staff could be provided, and a nutrition curriculum could be created to educate pre-schoolers about healthy food choices.
KeywordsNutrition Child-care environment Pre-school children Child-care staff practices Nutritious diets are integral to children's healthy growth and development (1,2) . Specifically, researchers have demonstrated a clear connection between children's nutrition and both their physical and cognitive health and abilities, inclusive of higher academic performance (3)(4)(5) . It is important for children to develop healthy eating habits at an early age, as research indicates that food preferences and dietary habits established during childhood can impact their habits in later life (6)(7)(8) . During the early years, children's eating practices are highly influenced by others, such as family members, caregivers and/or child-care providers (9) . Given the increasing prevalence of childhood obesity, healthy nutrition practices are a key element to ensuring appropriate growth and wellness (9)(10)(11) .The child-care setting might serve as an ideal venue to initiate the development of pre-schoolers' healthy eating habits and facilitate a positive eating environment. With over half of Canadian pre-schoolers enrolled in child care (12) , coupled with the number o...