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Objective This study assessed the dietary quality of lunches and feeding practices (family-style service, teacher role modeling) in Connecticut child care centers and made comparisons by center participation in the federal Child and Adult Care Food Program (CACFP). Design Plate waste methods and visual observation of lunches served and consumed. Setting A total of 97 randomly selected licensed Connecticut child care centers (53 CACFP and 44 non-CACFP). Participants A total of 838 preschool-aged children. Main Outcome Measures Total energy intake, macronutrient intake, and intake by CACFP meal component as well as use of family-style dining, management of additional helpings, and whether and what teachers consumed in view of children. Analysis Child dietary intake at lunch was compared with dietary and CACFP recommendations using a mixed linear regression model. Results The CACFP centers were more likely to offer family-style service and have staff eat the same foods as the children. Children in non-CACFP centers consumed more saturated fat (4.1 vs 2.7 g; P  < .001) and trans fats (0.1 vs 0.1 g; P  = .02) and less milk (3.5 vs 2.7 oz; P  < .001) than did children in CACFP centers. Caloric intake and dietary fiber were below recommendations in both groups. Participation in CACFP was a significant predictor of low-fat milk consumption. Conclusions and Implications The CACFP-participating centers confer some nutritional advantages in terms of provider behavior during meals, characteristics of food offerings, and child intake. Current feeding practices in child care settings require further exploration in the context of serving children at risk for food insecurity and in light of recent work on responsive feeding. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is a growing interest in studying the influence of child-care center policies on the health of preschool-aged children. Objective: To develop a reliable and valid instrument to quantitatively evaluate the quality of written nutrition and physical activity policies at child-care centers. Design: Reliability and validation study. A 65-item measure was created to evaluate five areas of child-care center policies: nutrition education, nutrition standards for foods and beverages, promoting healthy eating in the child-care setting, physical activity, and communication and evaluation. The total scale and each subscale were scored on comprehensiveness and strength. Setting: Analyses were conducted on 94 independent policies from Connecticut child-care centers participating in the Child and Adult Care Food Program. Statistical analyses performed: Intraclass correlation coefficient was calculated to measure inter-rater reliability, and Cronbach''s α was used to estimate internal consistency. To test construct validity, t tests were used to assess differences in scores between Head Start and non–Head Start centers and between National Association for the Education of Young Children–accredited and nonaccredited centers. Results: Inter-rater reliability was high for total comprehensiveness and strength scores (intraclass correlation coefficient=0.98 and 0.94, respectively) and subscale scores (intraclass correlation coefficient=0.84 to 0.99). Subscales were adequately internally reliable (Cronbach''s α=.53 to .83). Comprehensiveness and strength scores were higher for Head Start centers than non–Head Start centers across most domains and higher for National Association for the Education of Young Children–accredited centers than nonaccredited centers across some but not all domains, providing evidence of construct validity. Conclusions: This instrument provides a standardized method to analyze and compare the comprehensiveness and strength of written nutrition and physical activity policies in child-care centers. [Copyright &y& Elsevier]

Background: The federal Child and Adult Care Food Program (CACFP) provides reimbursable meals to 4.6 million children annually and sets nutrition standards for foods served. Licensing regulations in many states extend these rules to nonparticipating programs., Objective: To evaluate the quality of meals and snacks served in Connecticut licensed childcare centers in 2019 and assess implementation of a state licensing requirement to adhere to CACFP minimum nutrition standards in all centers., Design: Cross-sectional survey., Participants/setting: Two hundred licensed childcare centers in Connecticut in 2019., Main Outcome Measures: Meal/snack quality was assessed based on menus. Foods/beverages listed were compared to the minimum CACFP nutrition standards and optional best practices. Surveys completed by center directors measured center characteristics., Statistical Analysis: Logistic and linear multivariable regression models tested differences in centers' adherence to nutrition standards and best practices by CACFP participation status., Results: CACFP centers complied with more required nutrition standards than non-CACFP centers (an adjusted mean of 4.7 vs 3.4 standards among programs serving meals, P < 0.001), with particularly large mean differences for whole grains and low-fat milk. Implementation of optional best practices, except for beverages, was relatively low among all centers, especially for snacks. Compliance (adjusted mean number of minimum nutrition standards met) was greater among centers accredited by the National Association for the Education of Young Children and those using a registered dietitian or a sponsoring agency to prepare menus and receiving food from a vendor. Recent completion of nutrition training was associated with greater mean implementation of best practices., Conclusions and Implications: Better adherence to minimum nutrition standards and best practices among CACFP-participating childcare centers contributed to higher nutritional quality of meals and snacks offered. Snack quality would benefit most from greater compliance with nutrition standards. Providers outside of CACFP need additional supports in the implementation of licensing regulations to improve the food environment for young children., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)