Nutrition practices and mealtime environments of North Carolina child care centers.
BACKGROUND
The majority of children in the United States attend out-of-home child care. However, little is known about the nutritional quality of foods served and the mealtime environments.


METHODS
We assessed 96 child care centers over one full day using a researcher-administered structured observation and document review. We focused on eight nutrition domains: (1) fruits and vegetables, (2) whole grains, (3) high-sugar, high-salt, and high-fat foods, (4) beverages, (5) food availability and service, (6) staff behaviors, (7) training and education, and (8) policies. We computed daily means and frequencies for each domain.


RESULTS
Seventy-five percent of centers participated in the Child and Adult Care Food Program, indicating they served low-income children. Centers enrolled 66 children on average; 60% were white, 28% were black, 4% were Native American, and 8% identified as mixed race. On the day of observation, seven centers did not serve a fruit and 15 did not serve a vegetable. Eighty centers served a high-sugar or high-salt food and 84 did not serve any whole grains. Five centers did not provide water indoors to children, 22 served juice twice, and 50 served whole milk. Seventeen centers had a vending machine on site visible to parents and children. Overall, children were served excessive juice, high-sugar and high-salt snack foods, and too much whole milk.


CONCLUSIONS
Centers had room for improvement and could strive to serve more nutritious foods and create healthier mealtime environments for children.
Department of Community and Family Medicine, Duke University Medical Center and Duke Global Health Institute, Durham, NC 27705, USA. sara.neelon@duke.edu
Sara E
SE
Benjamin Neelon
Amber
A
Vaughn
Sarah C
SC
Ball
Christina
C
McWilliams
Dianne S
DS
Ward
D001628:Beverages / Q000706:statistics & numerical data; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004034:Diet Surveys / Q000592:standards / Q000706:statistics & numerical data*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D002523:Edible Grain; D005638:Fruit; D006801:Humans; D007223:Infant; D009657:North Carolina / Q000208:ethnology; D012959:Socioeconomic Factors; D014675:Vegetables
D004040:Dietary Carbohydrates; D004041:Dietary Fats