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.
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, 3.05-25.06) or fast foods (OR, 11.56; 95% CI, 3.20-41.80).


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.
1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Rachel E
RE
Blaine
1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Kirsten K
KK
Davison
2University College London Institute of Child Health, London, United Kingdom.
Kathryn
K
Hesketh
3Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.
Elsie M
EM
Taveras
4Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
Matthew W
MW
Gillman
5Department of Community and Family Medicine, Duke University Medical Center and Duke Global Health Institute, Durham, NC.
Sara E
SE
Benjamin Neelon
D000328:Adult; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D018673:Nutrition Policy; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010865:Pilot Projects; D057566:Self Report; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology