Children In Childcare Centers Research Articles

Effect of a Fundamental Motor Skills Intervention on Fundamental Motor Skill and Physical Activity in a Preschool Setting: A Cluster Randomized Controlled Trial.

To determine the effect of a 12-week fundamental motor skill (FMS) program on FMS and physical activity (PA) on preschool-aged children. A cluster randomized controlled trial. The intervention (PhysicaL ActivitY and Fundamental Motor Skills in Pre-schoolers [PLAYFun] Program) was a 12-week games-based program, delivered directly to the children in childcare centers by exercise physiologists. Children in the control arm received the usual preschool curriculum. Outcomes included FMS competence (Test of Gross Motor Development-2) and PA (accelerometer) assessed at baseline, 12weeks, and 24weeks (12-wk postintervention). Fifty children (mean age = 4.0 [0.6]y; 54% male) were recruited from 4 childcare centers. Two centers were randomized to PLAYFun and 2 centers were randomized to the waitlist control group. Children attended on average 2.0 (1.0) 40-minute sessions per week. The PLAYFun participants demonstrated significant increases in object control (P < .001) and total FMS (P = .010) competence at week 12, compared with controls in a group × time interaction. Girls, but not boys, in PLAYFun significantly increased moderate to vigorous PA after the intervention (P = .004). These increases were not maintained 12-week postcompletion of PLAYFun. The PLAYFun Program is effective at improving FMS competence in boys and girls and increasing PA in girls. However, improvements are not maintained when opportunities to practice are not sustained.

A Nutrition Intervention to Promote the Consumption of Pulse-Based Foods in Childcare Centers: Protocol for a Multimethod Study.

BackgroundPlant-based foods, including pulses (dry beans, lentils, chickpeas, and peas), have gained worldwide attention owing to their health and environmental benefits. Despite high production, the consumption of pulses is low in Canada. Behavior change interventions systematically designed to promote the consumption of pulse-based foods are scarce.ObjectiveWe describe the utilization of intervention mapping (IM) in the development of a multicomponent nutrition intervention aimed at promoting consumption of pulse-based foods among preschool children in childcare centers in Saskatchewan, Canada.MethodsThe Pulse Discovery Toolkit intervention was developed following the six steps of the IM protocol. Decisions at each step were either based upon literature review, expert consultation, pretesting, or a combination of these. Following the initial phase of the study, which focused on intervention development, phases II and III of the study were concerned with pilot testing and roll-out of the intervention, respectively. In total, one, two, and four childcare centers participated in phases I, II, and III, respectively. A multimethod approach was designed to evaluate the intervention during pilot testing and roll-out.ResultsThe application of IM steps 1 to 3 in phase I resulted in the creation of performance objectives at different levels, including at the individual level (preschool children), and the social and environmental levels (parents, early childhood educators, and cooks). These objectives were then used to create a matrix of objectives matching the constructs of the social cognitive theory while taking Piaget cognitive development into consideration. This step was followed by defining program components, implementation, adoption, and evaluation strategies, which were utilized in phases II and III. Data have been collected from 2015 to 2018 and analyzed. The results will be reported elsewhere.ConclusionsThe IM protocol provided a rigorous framework for the development of a multicomponent evidence-based intervention to promote pulse-based foods in childcare centers.International Registered Report Identifier (IRRID)RR1-10.2196/22775

Implementing a School Readiness Intervention in Community-Based Childcare Centers: Director and Teacher Perceptions

ABSTRACT In the U.S., one-third of preschool children attend programs run by childcare centers. Childcare centers are generally isolated and under-resourced businesses, often challenged by high rates of teacher turnover and inconsistent financial support. Correspondingly, childcare centers often struggle to provide high-quality educational experiences for preschool children. This study introduced an evidence-based curriculum (REDI) to improve the educational experiences of preschool children in childcare centers and used a novel professional development (PD) model in which center directors were trained to serve as local coaches. Open-ended interviews with 45 teachers and 31 center directors evaluated the acceptability, feasibility, and effectiveness of the REDI intervention and coaching model. Participants also described their workplace and rated their intentions regarding future program use. Participants described multiple challenges in the workplace but generally positive perceptions of the REDI intervention. Perceptions regarding the feasibility of the coaching model were mixed. Workplace descriptions were associated with intervention experiences which, in turn, predicted intentions for future program use. Findings validate the importance of addressing the unique workplace challenges faced by childcare staff when designing classroom interventions and PD supports. Attending to program acceptability, feasibility, and perceived effectiveness in these settings may be critical to support sustained use.

The US Centers for Disease Control and Prevention Say that Young Children in Childcare Centers Can Spread COVID-19

The US Centers for Disease Control and Prevention Say that Young Children in Childcare Centers Can Spread COVID-19

Participation in the CACFP Ensures Availability but not Intake of Nutritious Foods at Lunch in Preschool Children in Child-Care Centers

BackgroundThe US Department of Agriculture Child and Adult Care Food program (CACFP) recently (October 2017) updated requirements for meal reimbursement and best practice recommendations for serving nutritious meals and beverages, and minimum age-specific serving sizes for five food groups. It is not known whether CACFP-funded child-care centers are meeting the updated meal pattern requirements and best practice recommendations, and whether children are meeting nutrition recommendations based on the current 2015-2020 Dietary Guidelines for Americans (DGA). ObjectiveThis study assessed whether the recruited CACFP-funded child-care centers in this study were meeting the updated (2017) CACFP requirements regarding foods served for lunch and whether children attending these child-care centers were meeting age- and sex-specific DGA recommendations regarding foods consumed. DesignThis was a cross-sectional study using the Dietary Observation for Child Care method. Participants and settingsChildren aged 3 to 5 years (n=108) from 10 classrooms in three CACFP-funded child-care centers in Lincoln, NE, were recruited by convenience sampling during spring 2018. Measurable outcomesFood served and consumed during observed lunches in comparison with updated CACFP requirements and DGA, respectively. Statistical analysisAdjusted mean amounts of foods served from each food group were compared with age specific minimum CACFP serving size requirements. Adjusted mean amounts of foods consumed from each food group were then compared with age- and sex-specific DGA recommendations. ResultsThe recruited child-care centers were meeting the updated CACFP requirements regarding foods served but showed limited adherence to the best practice recommendations during the observed lunches. However, the overall mean intake for grains, fruits, and vegetables was significantly lower (P<0.01) than DGA recommendations. In addition, approximately 25% of the children did not consume any vegetables during their meal. ConclusionsAlthough child-care centers were meeting the updated CACFP requirements by serving the recommended amounts of foods, children were not meeting DGA-recommended intakes. Future studies are needed to explore ways to improve adherence to best practice recommendations to improve children’s consumption of healthy foods in child-care centers.

Parental Feeding Behaviors Associated with Children’s Willingness to Try New Foods and Body Mass Index (BMI)

Abstract Objectives To examine associations between parental feeding behaviors and preschool children's willingness to try new foods (WTNF) and body mass index (BMI). Methods This study used baseline data collected from parents and children in childcare centers. Parents completed the Comprehensive Feeding Practices Questionnaire (CFPQ). We measured children's height and weight, calculated BMI z-scores (BMIz) and percentiles (%ile) using CDC criteria, and assessed WTNF by offering 6 novel and 3 familiar foods. Confirmatory factor analysis was conducted to examine the goodness of fit of the 8-subscales (child control, emotion regulation, involvement, modeling, monitoring, pressure to eat, restriction for health, and restriction for weight control) from the CFPQ. Logistic regressions was employed to examine the association between parents’ CFPQ scores and children's WTNF (dichotomized as high: tried ≥3 novel foods vs. low: tried &amp;lt;3 novel foods), and linear regressions to examine the association between parents’ CFPQ scores and child BMI, adjusting for child sex, age, race, full-time childcare center attendance [≥40 hours/week (hrs/wk)], and household income. Results The sample included 407 children (aged 48.2 ± 0.4 months) and their primary caregiver from 51 childcare centers. Majority of children were Caucasian (64%) and spent at least 40 hrs/wk at the childcare center (69%); 24% had BMI ≥85th %ile with mean BMIz of 0.36 (SD = 1.05). After dropping 3-items from the CFPQ due to low factor loadings (&amp;lt;0.4, n = 2) or theory (n = 1), the original 8-subscale structure demonstrated good model fit (RMSEA = 0.05, CFI = 0.97, TLI = 0.97, and SRMR = 0.07). Children of parents with elevated scores on the restriction for weight subscale had 1.53 (95% CI: 1.08–2.16) greater odds of high WTNF and 0.46 (95% CI: 0.30–0.63) increase in BMIz, compared to children of parents with low subscale scores. Conclusions Children of parents who restrict foods in an attempt to control their child's weight are more likely to try new foods in a childcare setting without parents present, and are likely to be heavier. Longitudinal research is needed to determine the direction of the associations and how they relate to maternal and child characteristics (e.g., perceived or real child weight and eating behaviors). Funding Sources National Institute of Diabetes and Digestive and Kidney Diseases.

Social Determinants of Health, Maternal Involvement, and Child Development: Direct and Mediated Pathways.

In the process of child development, a variety of factors are at play. In this regard, social determinants of health play a determining role in the development and growth of the child. This study aimed to design and test the model for social determinants of health for the development of 36-6o-month-old children in Tehran with the mediation of maternal involvement. This cross-sectional study was conducted among 1067 mothers and their 36-60-month-old children in childcare centers in Tehran, using multistage sampling. Data gathering tools consisted of a demographic questionnaire for mothers and children, a questionnaire on unhealthy behaviors, Ages and Stages Questionnaire, Economic and Social Status Questionnaire, Perceived Social Support Questionnaire, Perceived Stress Questionnaire, Spielberger Anxiety Inventory, Beck Depression Inventory, ENRICH: Marital Satisfaction Scale, and Participation Scale for Parents and Mothers. Model fit measures were suitable and goodness of fit (RMSEA = 0.031, GFI = 1) was satisfactory. In addition, the results of path analysis indicated that the participation of mothers in the development of children had a direct positive (ß = 0.089) and increasing effect. Findings indicated that depression, anxiety, stress, and marital satisfaction have both direct and indirect effects on the participation of mothers and child development. Moreover, the model fit measures indicated the utility and high proportionality of the model, as well as the logic of the adjusted relationships of variables based on the conceptual model.

Air Pollution as a Slow-Onset Disaster in Ulaanbaatar

Objectives: This research aimed to better understand how exposure to high levels of winter air pollution may be affecting the health of children living in areas where housing is predominantly ger type traditional homes and houses compared to those living in areas where housing is predominantly apartments in Ulaanbaatar. The objective of the research was to study the differences in health and missed school days in children from these areas. Methods: Data were gathered from 36 childcare centers (kindergartens), schools and primary centers and interviews conducted among 148 individuals in three districts of Ulaanbaatar namely Chingeltei, Songinokhairkhan and Khan-uul. The study was performed between October 1, 2015 and December 31, 2015. Results: This study revealed that at the beginning of the study, the rate of children reported to be sick was about the same for both ger and apartment district primary schools, however by the end of the study the number of children reported sick each day living in predominantly gers and cabins was more than reported in apartment districts, that is, about 4 per 10,000 in apartment districts vs about 7 per 10,000 in ger districts. At the end of the study, rates of sickness reported was 5 to 6 times higher in children in childcare centers compared to children attending in primary schools regardless of where they lived. Conclusion: This study suggests that air pollution is not only affecting children’s health, but also affecting their education in Ulaanbaatar.

Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial.

Early childhood education settings are critical for promoting physical activity (PA) but intervention effects are often small. The aim of this study was to develop, test, and compare two approaches to increasing physical activity among preschoolers at child care centers: one focused on a teacher-led PA curriculum (Active Play!) and the other on increasing outdoor child-initiated free play time (Outdoor Play!). We conducted a matched-pair cluster-randomized study in 10 centers in and around Seattle, WA, USA (n = 97 children, mean age 4.6). Pre- and post-intervention data were collected from observations and accelerometers. At pre-intervention, 19% of Active Play! and 25% of Outdoor Play! children achieved >120 min/day of PA during child care. The total opportunity for PA increased in both interventions (Active Play! = 11 min/day; Outdoor Play! = 14 min/day), with the largest increase in outdoor child-initiated free playtime (Active Play! = 19 min/day; Outdoor Play! = 24 min/day). No changes in sedentary time, light or moderate- to vigorous-intensity PA (MVPA) were observed in either intervention and there was no difference between interventions in the percentage of children attaining more than 120 min/day of PA. A small (<3 min/day) relative increase in teacher-led outdoor activity was observed in the Active Play! intervention. Both intervention strategies led to an increase in active play opportunities, predominantly outdoors, but neither was able to substantially increase the intensity and/or duration of children’s PA. Future studies are needed to better understand and inform sustainable approaches to increase PA in early learning settings.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Environmental Cleaning Strategies Used by Child Care Centers During Illness Outbreaks

Purpose: Over 75% of children use non-parental child care nationally. Children attending child care centers (CCC) have more upper respiratory infections and diarrheal illness than children who stay at home exclusively. Children in CCC are also substantial contributors to the spread of illness into the community. The American Academy of Pediatrics (AAP) provides guidelines for the routine cleaning, sanitizing, and disinfecting of CCC facilities, but studies on cleaning practices are lacking. We partnered with our local county’s consortium of CCC directors to examine current centers’ practices and …

Screening for mental health problems in a Norwegian preschool population. A validation of the ages and stages questionnaire: Social-emotional (ASQ:SE).

Early detection of mental health problems in childhood is important. However, studies on screening instruments for preschool children are rare. The aim of this study was to validate the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) with teacher reports and examine its screening accuracy in a preschool population. A total of 1428 children, aged 18months - 5years, attending child-care centers were recruited in Norway. Their teachers completed a survey including the ASQ:SE and the Caregiver-Teacher Report Form (C-TRF). The Spearman's correlation was calculated for the convergence between the ASQ:SE and the C-TRF and the screening accuracy of the ASQ:SE was assessed using receiver operating characteristic (ROC) analysis with the criterion of a score at or above the 90th percentile for the C-TRF total problem score. The Spearman's correlation between the total scores for the ASQ:SE and the C-TRF were from .49 to .72. The ROC analyses demonstrated that the ASQ:SE had a promising ability to classify children at risk based on the C-TRF criterion with AUC ranging from .87 to .96 for the different forms. The ASQ:SE generally demonstrated high specificity across all forms and some forms (from age 30months upwards) produced both high sensitivity and high specificity using the selected cutoff values. The ASQ:SE could serve as a good starting point for screening for social-emotional problems among children in child-care centers. The 30- to 60-month ASQ:SE forms exhibit promising psychometric properties and may prove useful for early detection. The 18- to 24-month ASQ:SE forms demonstrate more limited efficacy in detecting children at risk.

Pandemic Influenza Preparedness Among Child Care Center Directors in 2008 and 2016.

Children in child care centers represent an important population to consider in attempts to mitigate the spread of an influenza pandemic. This national survey, conducted in 2008 and 2016, assessed directors' reports of their child care centers' pandemic influenza preparation before and after the 2009 H1N1 novel influenza pandemic. This was a telephone-based survey of child care center directors randomly selected from a national database of licensed US child care centers who were queried about their preparedness for pandemic influenza. We grouped conceptually related items in 6 domains into indexes: general infection control, communication, seasonal influenza control, use of health consultants, quality of child care, and perceived barriers. These indexes, along with other center and director characteristics, were used to predict pandemic influenza preparedness. Among 1500 and 518 child care center directors surveyed in 2008 and 2016, respectively, preparation for pandemic influenza was low and did not improve. Only 7% of directors had taken concrete actions to prepare their centers. Having served as a center director during the 2009 influenza pandemic did not influence preparedness. After adjusting for covariates, child care health consultation and years of director's experience were positively associated with pandemic influenza preparation, whereas experiencing perceived barriers such as lack of knowing what to do in the event of pandemic influenza, was negatively associated with pandemic influenza preparedness. Pandemic influenza preparedness of child care center's directors needs to improve. Child care health consultants are likely to be important collaborators in addressing this problem.

Viral excretion and antibody titers in children infected with hepatitis A virus from an orphanage in western India

BackgroundHepatitis A is endemic in India and mainly causes sporadic infections. However, children in childcare centers, schools and orphanages are vulnerable to common-source outbreaks as they have naive hosts. ObjectivesTo investigate hepatitis A outbreak in an orphanage from Pune, India. Study DesignMonitoring of virus excretion and anti-HAV antibody levels in hepatitis A virus (HAV) infected children. ResultsThe orphanage housed 93 children of the age 1 month-6.5 years. Analysis of the collected serum (n=78) and stool samples (n=63) revealed 20 children to be either positive for anti-HAV IgM antibodies or excreting HAV, 14 being symptomatic and 6 asymptomatic, while 32 were already anti-HAV IgG positive either due to past HAV exposure (n=7, mean log antibody titers: 2.96) or maternal antibodies (n=25, mean log antibody titers: 1.13). Serum samples, taken 4 weeks apart, did not show any significant difference in the IgM and IgG antibody levels either. However, virus excretion decreased significantly after 15 days in symptomatic children (mean log HAV RNA copies/ml 1.03+0.30), while asymptomatic children continued to excrete higher viral loads, at constant levels (mean log HAV RNA copies/ml 2.33+0.33), for up to 90 days. ConclusionsThough virus excretion continued up to 90 days in all HAV infected children, asymptomatic children excreted higher viral loads for longer period and hence can contribute significantly in person-to-person virus transmission. All children should be vaccinated in such set ups.

Development of a Tool to Evaluate Asthma Preparedness and Management in Child-Care Centers.

Introduction: Asthma is a common condition affecting many children in child-care centers. The National Asthma Education and Prevention Program offers recommendations about creating an asthma-friendly child-care setting. However, no studies have investigated the extent to which child-care centers adhere to these recommendations. This study describes the development of a novel instrument to determine the ability of child-care centers to meet national recommendations for asthma. Methods: The Preparing for Asthma in Child Care (PACC) Instrument was developed using information from existing recommendations and standards, the peer-reviewed literature, site visits, and expert interviews. The survey questions were pilot-tested at 36 child-care centers throughout San Francisco. Results: The instrument is composed of 43 items across seven domains: smoking exposure, presence of a medical consultant and policies, management of ventilation and triggers, access to medication, presence of asthma action plans, staff training, and encouragement of physical activity. Discussion: The PACC Instrument is an evidence-based and comprehensive tool designed to identify areas to target to improve asthma care for children in child-care centers.

Children in Child Care Centers that Participated in the Healthy Apple Award (HAA) Program in San Francisco had Greater Decreases in BMI Percentile than Children in Other Local Child Care Centers

First Lady Michelle Obama's Let's Move! Child Care initiative aims to improve nutrition and physical activity (PA) practices in child care sites to promote healthy childhood weight, nationwide. This analysis tested if a new program in San Francisco, the HAA program, designed to support implementation of Let's Move!, impacts childhood weight, locally. Child care centers served by the Child Care Health Program (CCHP) were randomly selected for early (2013) or lagged (2014) invitation to the HAA. Child care centers that enrolled in 2013 (CCHP+HAA) were offered a self‐assessment modeled on Let's Move! and the University of North Carolina's Nutrition and Physical Activity Self Assessment in Child Care (NAP SACC) in Spring, technical assistance for goal setting and staff trainings about drinking water and PA in Summer, and re‐assessment and award recognition in the Fall. All CCHP+HAA (n=18) and CCHP‐only (n=20) centers were offered child‐sized water pitchers in Fall 2013, health worker assessment of drinking water and PA resources and BMI screening for all enrolled children in Fall 2013 and Spring 2014 (n=871, 3‐4y). In CCHP+HAA centers, the proportion of children with access to visible and self‐serve drinking water (61% to 83%) and a PA curriculum (36% to 50%) increased. Corresponding changes in CCHP‐only centers were 63% to 73% and 45% to 34%. Mean BMI percentile decreased by 2.4 (1.2) more percentage points in CCHP+HAA vs. CCHP‐only centers (p&lt;0.05). The results suggest that the HAA program supports local implementation of Let's Move!.

Profit in the Food Desert: Walmart Stakes its Claim

By opening stores where customers need them most, will help build families and stronger communities. We believe every single person, in both rural and urban areas, should have access to an abundant selection of fresh fruits and vegetables at an affordable price. We are proud to say we are well on the path toward meeting our goal of opening 275-300 stores serving food deserts by 2016.- Statement, Partnership for a Healthier America 2013It seems there is good news in the movement for food justice: a highprofile non-profit organization has been created to tackle the urgent national health crisis of childhood obesity, in part by to eradicate food deserts (Partnership for a Healthier America 2013). The organization, called the Partnership for a Healthier is an outgrowth of First Lady Michelle Obama's Let's Move campaign, and it negotiates agreements directly with companies to improve the way they manufacture, distribute, and sell food products to families and institutions. The organization was originally designed to harness the strongest available empirical findings to inform public health strategies to combat childhood obesity.Millions of Americans-myself included-are thrilled about the attention Ms. Obama's campaign has directed on healthy eating and active lives. I would also like to support the Partnership for a Healthier America. However, despite the ambitions of some of the organization's originators and the well-intentioned efforts of the nutritionists and advocates on its staff, the Partnership's position as a state-sanctioned corporate clearinghouse requires further scrutiny. The the Partnership secures from companies encompass a range of activities, many of which are laudable. Some pledge funding to create more opportunities for students to do exercise at school. Some are designed to increase the availability of water for children in childcare centers, and the coverage of obesity-prevention measures in healthcare plans. But in the meaningful commitments these company representatives have signed, most are working together with us to simply make their products more available for us to buy.In this paper I focus on company's to the Partnership for a Healthier America: Walmart's. I examine whether this company's commitment is designed to contribute to a healthier America, as advertised, or whether the terms of its commitment belie other motives that conflict with its stated goal. It is important to focus on in the consideration of food justice and sustainability because the company-the largest US private-sector employer and world's largest company by revenue (Fortune 2014)-has also become the largest food retailer in the US. Food & Water Watch reports that one out of every three dollars spent on groceries in this country goes to Walmart (Hauter 2014). This kind of dominance does not sprout up organically. Rather, it requires a great deal of ongoing, coordinated support from the state, along with clear, consistent messaging that gamers positive public opinion and distracts from any need for regulation. I argue here that an organization like the Partnership for a Healthier with its ostensible focus on remedies for obesity and food deserts, serves as a conduit through which a dominant private sector actor like can appear to cooperate with the state and the public, avoid regulatory scmtiny, and gain legitimacy by crafting a message that turns its profit-maximizing activities into the solution to public health and food access problems. By questioning this corporation's relationship with the state and the specific terms of its much-touted public commitment to open stores in food deserts, we can better assess whether its activities foster or impair the movement for food justice.WALMART: ALWAYS HIGH GROWTHWalmart has come under intense scmtiny from activists, journalists, and scholars for its gender wage disparities (Featherstone 2004), unsustainable practices (Mitchell 2011), reliance on the Supplemental Nutrition Assistance Program and Medicaid to counter low wages (Simon 2012), harmful domination of product supply chains (Food & Water Watch 2012), and anti-union retaliation (Logan 2013), among other issues. …

Development of an Ecological Model to Improve Health Care Management for Children in Child Care Centers.

PURPOSE: This study was conducted to identify current health care management and barriers in health care management according to ecological systems, and to develop an ecological model for enhancing health care in child care centers.METHODS: Focus group interviews were conducted with directors and teachers of child care centers, and with parents of children enrolled in child care. Data were analyzed by the latent content analysis method.RESULTS: Twelve categories of health care management were identified. Barriers to child health care included knowledge deficit and lack of competence in health care by teachers, lack of useful health care manuals, non-existence of professional child health care personnel in child care centers, lack of mutual information sharing and disagreement on child health conditions between child care personnel and parents, lack of specific health related child care inspection criteria and time flexible child care centers with a lack of policy on collaboration with health care facilities. The ecological model developed included specific strategies to improve health care management in child care.CONCLUSION: The proposed ecological model to improve child health care management should be useful to plan future health care program considering both the immediate and indirect social environment surrounding children in child care.

Child Care Food Subsidies

In 2008, nearly 15 percent of U.S. households were food insecure, meaning the household members lacked consistent access to enough food for healthy lives. Half of low-income, female-headed households with children were food insecure in 2008. To address food insecurity and inadequate child nutrition, more than a dozen federal programs provide food and nutrition support to children and families. Each of these programs has been widely studied, except for the Child and Adult Care Food Program (CACFP). CACFP reimburses caregivers for meals and snacks provided to children in child-care centers, family day care homes, after-school programs, and homeless shelters, as well as to adults in adult day care centers—although children account for 96.3 percent of CACFP expenditures. Here, we summarize our recent research that highlights the effectiveness of CACFP in reaching needy children. Considering CACFP rules, and those of other child-care and food subsides, we use our results to offer suggestions to improve the targeting of nutritional assistance and child-care subsidies. Policymakers or advocates who see CACFP primarily to support employment of low-income mothers by subsidizing their caregivers may not be concerned about the low rates of participation among low-income children, especially among those in exclusive parental care. However, because many poor women use unlicensed care and such care is eligible for general childcare subsidies, making unlicensed providers eligible for CACFP should also promote employment among low-income women. The exclusion of unlicensed providers is even more problematic for those who emphasize CACFP’s nutritional goals because children in unlicensed homes and exclusive parental care miss out on a nutritional benefit provided to equally needy children in licensed care. Finally, CACFP may be seen primarily to supplement other childcare subsidy programs or other food assistance programs. In this case, it might be more efficient to increase assistance in these other programs directly (if they are inadequate), rather than through the CACFP program that fails to reach many low-income children.

Comparison of Menus to Actual Foods and Beverages Served in North Carolina Child-Care Centers

Menus from child-care centers are an important source of information for parents, researchers, and child-care regulators, but previous research suggests that menus do not accurately represent foods served. The purpose of this study was to compare menus with actual foods and beverages served to children in child-care centers. Menus were collected and a dietary observation was conducted to document all foods and beverages served to children during the course of 1 day in 84 child-care centers in North Carolina in the fall of 2005. Frequencies of foods and beverages on the menus vs those served were computed by eating occasion, food category, and individual foods and beverages. Of the 254 meals and snacks served, 131 (52%) meals and snacks matched entirely what was stated on the menu. Of the 820 individual foods and beverages served, 710 (86.6%) matched those listed on the menus. An additional 110 foods and beverages were served but not listed on the menus. Grains, juice, and vegetables were served less often than indicated on the menus, and milk, protein-rich foods, fruits, mixed dishes, and foods of low nutritional value were served more often than listed on the menus. Overall, just over half of all meals and snacks matched menus, and nearly 90% of individual foods and beverages served matched those stated on menus. Parents of children in child care and dietetics practitioners providing consultation to child-care centers can encourage not only provision of healthy foods and beverages, but also accurate menus in child care.