Diet Quality of Preschool Aged Children in Family Child Care Homes

Maggie You Ming Tsai, University of Rhode Island


Background: Although family child care homes (FCCH) are the second most utilized form of non-relative child care in the US, little is known about what children eat in this setting.

Objectives: The primary objective is to assess the quality of meals and snacks consumed by children aged 2-5 in FCCH compared to the 2015 Dietary Guidelines for Americans (DGA 2015). The secondary, exploratory objective is to explore the association between childcare provider acculturation and dietary consumption of children in FCCH.

Design: This cross-sectional study used baseline data from an ongoing cluster randomized controlled intervention trial in FCCH.

Participants/setting: Family childcare providers completed a demographic survey. Preschool-aged children (n = 124; 2-5 years old) enrolled in 43 FCCH, were observed during two meals and a snack each day for two days, following a standardized protocol.

Main outcome measures: Foods and beverages consumed were analyzed in the Nutrition Data System for Research 2015. Mean amounts consumed of each food group were compared to 2/3 of the daily intake recommendations established by the DGA 2015 for children 1-3 years old (1000 kcal) given that recommendations are not standard across age groups. For the exploratory analysis, acculturation was measured using a proxy measure of language spoken at home.

Statistical analyses: One-sample t-tests and one-sample sign tests tested for differences between mean food group amounts consumed compared to the national guidelines. Spearman’s correlations were run to examine the association between acculturation, income and education on food groups.

Results: Median and mean intakes of several foods groups did not meet recommendations. Children did not meet the recommended 0.67 cup of vegetables (Mdn = 0.20 cup, 42% of recommendation) (p<.001), 1.0 ounce of whole grains (Mdn = 0.25 ounce, 35% of recommendation) (p<.001), 9.34 grams of fiber (5.64±2.15 gram, 60% of recommendation) (p<.001) and exceeded the recommended 1.0 ounce of refined grains (1.69±0.77 cup, 169% of recommendation) (p<.001). Discretionary calories (17.14±7.02 % kcal), percent of calories from added sugars (Mdn = 6.28 % kcal) (p<.001), percent of calories from saturated fat (Mdn = 7.83 % kcal) (p<.001), and (834.86±317.33 mg) sodium (p<.001) did not exceed recommendations. There was a significant positive association with whole grain intake and acculturation, r =0.315, p <.05.

Conclusion: Dietary intake of children cared for in FCCH was not consistent with national recommendations for vegetables, whole grain, and refined grain intake. Future research should continue to develop and evaluate strategies to increase fruit, vegetable and whole grain intake in this setting.