Fluid provision in the Irish full day care pre-school setting

Abstract

Background: Children of pre-school age should consume up to six cups of fluids daily. Milk, water and diluted juice (one part juice to 4–5 parts water) are advised with meals; milk and water are recommended between meals and with snacks; ‘no added sugar’ squash should not be offered to children under 5 years and the sodium content of bottled waters should be checked (Department of Health and Children (Ireland), 2004). The ‘Healthy Incentive for Pre-schools’ (HIP) project is an ongoing child care intervention in the Midlands of Ireland which aims to develop and evaluate an incentive scheme to improve pre-school nutrition practices. The aim of this study was to examine the baseline study data and characterise the fluids provided by pre-schools engaged in the project. Methods: Full day care pre-schools catering for children aged 3 months–5 years were invited to participate in the HIP project (n = 100). All meal and snack times were observed by a community dietitian during one full day spent in each pre-school. The eating environment, type, and timing of all fluids offered were recorded, using household measures, on an evaluation form developed for the HIP project. As drinks provided by parents could not be identified, they were classed as ‘parental drinks’. Ethical approval to carry out the study was obtained from the Irish Health Service Executive Dublin Mid-Leinster and the Dublin Institute of Technology Research Ethics Committees. Results: Seventy six pre-schools were included in the study. Eleven withdrew due to a change in the type of service offered. Two were deemed ineligible to participate by the local pre-school inspection team as major changes to overall pre-school care were required. Baseline data were collected in 63 pre-schools. The number of meals offered daily ranged from zero to two while the number of snacks provided ranged from one to five. The types of fluids provided with meals and snacks are outlined in Table 1. Only four of the 63 pre-schools provided recommended fluids outside meal and snack times. Table 1. Types and timing of fluids provided to children in full day care pre-schools Drinks with meals % (n) Drinks with snacks % (n) %, percentage; n, number. Milk and tap water 11 (7) 10 (6) Milk, tap water or diluted juice 33 (21) 11 (7) Bottled water 3 (2) 10 (6) Squash and juice drinks 38 (24) 59 (37) ‘No added sugar’ squash 21 (13) 25 (16) Undiluted juice 10 (6) 30 (19) Parental drinks 35 (22) 54 (34) Discussion: These data demonstrate that a variety of fluids are provided to children in full day care Irish pre-schools, many of which are not recommended in this age group. The consumption by children of drink types other than milk or water adversely affects dietary quality (Marshall et al., 2005). Although a limitation of the current study is that the actual volume of fluids consumed by children was not recorded, the gathering of data on the types and timing of fluid provision in this setting is important, when considering the possible detrimental effect of these on children's health. Conclusion: This study would suggest that best practice fluid guidelines are not being followed in the Irish pre-school setting; these data will inform the educational components of the HIP project.