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Background: Improving the nutritional quality of food, including beverages, served in early care and education settings should enhance children’s diet quality. However, few studies have explored the relationship between what is served and consumed in family child-care homes (FCCHs).

Objective: To describe the nutritional quality of food served to children in FCCHs and to assess the extent to which children eat what is served.

Design: This study was a cross-sectional analysis using baseline data (n=166) from a cluster-randomized controlled trial (2013-2016).

Participants/Setting: Eligible FCCHs in central North Carolina had to have at least two children between 18 months and 4 years, have been in business for at least 2 years, and serve at least one meal and one snack.

Main Outcome Measures: Food was captured using the Diet Observation at Child Care protocol.

Statistical Analyses: Frequencies, means, and multivariate analysis were used to examine the relationship between food served and consumed by food groups and by Healthy Eating Index (HEI-2010).

Results: Children consumed between 61% and 80% of what was served, with vegetables having the lowest percent consumed (61.0%). Total HEI-2010 score for food served was 63.6 (10.4) and for food consumed was 61.7 (11.5) out of a 100-point maximum. With regards to food served, FCCH providers came close to meeting HEI-2010 standards for dairy, whole fruit, total fruit, and empty calories. However, providers appeared to fall short when it came to greens and beans, seafood and plant proteins, total vegetables, whole grains, and fatty acids. They also exceeded recommended limits for sodium and refined grains.

Conclusions: Although FCCHs are serving some healthy food, mainly fruit, dairy, and few empty calories, there is room for improvement with regards to vegetables, grains, seafood and plant protein, fatty acids, and sodium. Future trainings should help providers find ways to increase the serving and consumption of these foods.