title: Nutritional quality of meals compared to snacks in child care.
abstract: BACKGROUND
  Most young children are in child care. Previous studies suggest that children may receive insufficient vegetables, and foods and beverages with added sugars, fats, and sodium in these settings. None have compared the nutritional quality of meals to snacks.
  
  
  METHODS
  Directors from 258 full-day child-care centers in two urban counties of southwestern Ohio were surveyed via telephone in the fall of 2009 about their nutrition practices, and asked to provide a current menu. Lunch and afternoon snack menus were categorized according to average weekly frequency for fruits, vegetables, lean meats, juice (100%), and sweet or salty foods served. Frequencies were compared by meal occasion (lunch vs. snack) using the Fisher exact test.
  
  
  RESULTS
  Most (60%) directors reported serving 2% milk to children ≥3 years; 31% served whole milk. Menu analysis demonstrated the composition of lunches differed from snacks (p<0.0001) in all food categories. A total of 87% centers rarely (<1 time per week) listed nonstarchy vegetables for snacks, but 67% of centers included them at lunch ≥3 times per week. Juice (100%) was on snack menus >2 times per week in 37% centers, but in only 1 center as a regular component of lunch. Similarly, 87% centers listed sweet and salty foods at snack ≥3 times per week, but rarely at lunch.
  
  
  CONCLUSIONS
  Despite efforts to improve children's diets in child care, meals-and particularly snacks-still lack whole fruits and nonstarchy vegetables and contain added sugars and fats. Snacks represent a missed opportunity to improve the nutritional quality of foods served in childcare.
authors: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA. kristen.copeland@cchmc.org
authors: Kristen A
authors: KA
authors: Copeland
authors: Sara E
authors: SE
authors: Benjamin Neelon
authors: Angela E
authors: AE
authors: Howald
authors: Karen S
authors: KS
authors: Wosje
mesh_terms: D001628:Beverages; D002648:Child; D002656:Child Day Care Centers; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet / Q000592:standards* / Q000706:statistics & numerical data; D019422:Dietary Sucrose; D005247:Feeding Behavior; D005260:Female; D005522:Food Services / Q000592:standards / Q000706:statistics & numerical data; D005638:Fruit; D006293:Health Promotion; D006306:Health Surveys; D006801:Humans; D062409:Lunch; D008297:Male; D008612:Menu Planning; D018673:Nutrition Policy; D009753:Nutritive Value; D009820:Ohio / Q000453:epidemiology; D062410:Snacks; D012923:Social Class; D014505:Urban Population; D014675:Vegetables
chemical_list: D019422:Dietary Sucrose
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