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Background Households experiencing 'food insecurity' have limited access to food due to a lack of money or resources. Poor nutrition, from food insecurity, can impact physical and cognitive development of children. Study objectives were to document the prevalence of Tennessee child care programs screening for food insecurity, explore differences between programs receiving child and adult care food program (CACFP) funding and those screening for food insecurity, and understand possible burdens food insecurity places on child care families as perceived by child care program directors. Methods In this cross-sectional study of licensed Tennessee child care programs, a 10-question survey and four-question follow-up survey were electronically distributed. Analysis included descriptive statistics, a chi-square of programs receiving CACFP funds and screening for food insecurity, and themes analysis of open-ended responses. Results The average child care program enrollment (N = 272) was 80.16 with programs serving mostly preschoolers (98.53%) and toddlers (91.91%). Over half (56.99%) of programs reported they received CACFP funding, yet only 9.19% screen for food insecurity. Chi-square analysis found that programs receiving CACFP funds differ significantly on whether they screen households for food insecurity [Formula omitted].sup.2 (1, n = 237) = 16.93, p [less than or equal to] 0.001. Themes analysis (n = 41) revealed that many child care program directors do not view food insecurity as a burden for families. Conclusions Child care programs receiving CACFP funds are more likely to screen families for food insecurity than programs who do not. Programs indicate a willingness to include food insecurity screening questions on child care paperwork., Author(s): Tracy E. Noerper [sup.1] , Morgan R. Elmore [sup.1] , Rachel B. Hickman [sup.2] , Madison T. Shea [sup.3] Author Affiliations: (1) grid.440609.f, 0000 0001 0225 7385, Department of [...]