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ABSTRACT

DIETARY INTAKE AND NUTRITIONAL STATUS OF PRESCHOOL
CHILDREN IN WESTERN MICHIGAN DAY CARE CENTERS

BY

Donna Kimberley Brooks

This study involved a two-day investigation of
nutrient intake of 275 preschool children attending nine
Western Michigan day care centers as well as a comparison
of nutrient intake with height and weight increments of
the children over a three—month interval.

All food served to the children for meals and
snacks for one day was weighed prior to serving and the
remaining food, uneaten and spilled food was subtracted
to determine total daily intake for each nutrient. The
total calories and ten nutrients contributed by these
foods were calculated from food composition tables and
compared with the 1968 Recommended Dietary Allowances
taking into account the proposed recommendations by the
Michigan Department of Public Health for day care provision
for the child's nutrient needs. The nutrient supplied most
often in lowest amounts was iron followed by calories and

thiamin. Protein and riboflavin were supplied in the

Donna Kimberley Brooks

greatest amounts. Overall average intake for all nutrients
except iron for all nine day care centers met the recom—
mended range. The per cent contribution of meals and snacks
to calorie, protein and total nutrient intake was dependent
on the number of meals served with snacks contributing
almost 50 per cent of the total caloric and nutrient intake
in centers serving only one meal.

Heights and weights of 140 preschool children,
average age 4 years, at six of the day care centers were
taken twice over a three-month period and compared with
an average of increments suggested by various authors for
this age group. Height increment averages for both girls
and boys were in good agreement with the standard increments
whereas weight increments for both girls and boys were above
the standards. These data indicated that the average of
seven hours spent per day at the center at least did not
have a negative impact on growth and may have played a
large part in contributing to this growth.

Menus were obtained ahead of time to observe how
closely they were followed by the cooks. Modifications
were found to a considerable degree at some centers but,
in general, the changes were only slight.

Hemoglobin data were obtained for children at two
day care centers. Average values for each center fell

within the acceptable range as set by the ICNND.

Donna Kimberley Brooks

During the two—day period of study at each day care
center, descriptive information concerning general opera-
tions and menu planning and food service practices was also
obtained through personal observation and informal inter-

views with the cooks and/or directors.

DIETARY INTAKE AND NUTRITIONAL STATUS OF PRESCHOOL

CHILDREN IN WESTERN MICHIGAN DAY CARE CENTERS

BY

Donna Kimberley Brooks

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE

Department of Food Science and Human Nutrition

1971

...-
; I /
f

' 3 , ’

ACKNOWLEDGMENTS

The author wishes to express sincere gratitude to
Dr. Rachel Schemmel for her guidance and advice throughout
the graduate study. Special thanks also go to Miss Katherine
Hart for her understanding and encouragement and to Drs. Olaf
Mickelsen and Dorice Narins for their helpful suggestions and
assistance.

Appreciation is extended to Mrs. Linnea Werner,
Miss Frances Heymans and Miss Gladys Duppstadt for their
guidance in the initiation of this study and their concern
and interest throughout.

Special gratitude is extended to the staff and
children of the nine participating day care centers for
their c00peration in making this study possible.

Deepest thanks go to my husband, Jim, for his
invaluable assistance and continued patience and reas—

surance 0

ii

TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS . . . . . . . . . . . . . ,ii

LIST OF TABLES . . . . . . . . . . . . . . V

LIST OF FIGURES . . . . . . . . . . . . . Vi
Chapter

I. REVIEW OF LITERATURE . . . . . . . . . 1

Day Care . . . . . . . l

Nutritional Patterns of Preschool Children . 7

Nutritional Status of Preschool Children . . 19

II. INTRODUCTION . . . . . . . . . . . . 25

III. METHODS O O O O O O O O O O O O O O 27

Selection and Description of Sample . . . . 27
Food Intakes . . . . . . . . . . . 28
Heights and Weights . . . . . . . . . 3l
Hemoglobin Data . . . . . . . . . . 32
IV. RESULTS AND DISCUSSION . . . . . . . . . 36
Nutrient Intake . . . . . . . . . 36
Menu Modification and Typical Representation . 40
Height and Weight Increment . . . . . . 42
Hemoglobin . . . . . . . . . . . . 45

V. DESCRIPTIVE FACTORS CONCERNING NINE WESTERN
MICHIGAN DAY CARE CENTERS . . . . . . . . 64

General Operational Information . . . . . 64
Menu Planning and Food Service Practices . . 67
VI. CONCLUSIONS AND SUGGESTIONS FOR FURTHER STUDY . 76
Conclusions . . . . . . . . . . . . 76

iii

Page
BIBLIOGRAPHY. . . . . . . . . . . . . . . 81

APPENDIX 0 O C O O O O O O O O O I O I O 8 8

iv

LI ST OF TABLE S

Table Page

1. Description of Nine Western Michigan Day Care
Centers and the Participating Children . . . 33

2. Total Number of Preschool Children Eating Meals
and Snacks During a Two-day Study at each of
Nine Western Michigan Day Care Centers . . . 34

3. Outline of Procedures Used in Collecting Height
and Weight Data for Preschool Children in
Nine Western Michigan Day Care Centers . . . 35

4. Nutrient Content of Selected Foods on a 100 gram
Basis with Per Cent Agreement Between Two
Food Composition Tables . . . . . . . . 46

5. Nutrient Content of Selected Mixed Dishes on a
100 gram Basis with Per Cent Agreement Between
Calculated Recipes and Two Food Composition
Tables . . . . . . . . . . . . . . 47

6. Average Daily Calorie and Nutrient Intake of
Preschool Children Ages 2%-6 in Nine
Western Michigan Day Care Centers . . . . . 48

7. Per Cent Calories, Protein and Overall Nutrient
Intake Average of Preschool Children Contri-
buted by Meals and Snacks at Nine Western
Michigan Day Care Centers. Bottom Part Shows
Comparison of this Between Centers Serving
Two Meals and Those Serving One . . . . . 49

8. Food Group Composition of Lunch Menus for Five
Days at Eight Western Michigan Day Care
centers 0 O O O O O O O O O O O O 50

9. Total Number, Average Age, 3-month Height
Increments, and 3-month Weight Increments of
Preschool Girls and Boys Attending Six
Western Michigan Day Care Centers . . . . . 53

10. Day Care Center Sample Menus . . . . . . . 89

LIST OF FIGURES

Figure Page

1. Comparison of average daily caloric intake of
preschool children in nine Western Michigan
day care centers with the Recommended
Dietary Allowances (RDA) . . . . . . . 54

2. Comparison of average daily protein intake of
preschool children in nine Western Michigan
day care centers with the Recommended
Dietary Allowances (RDA) . . . . . . . 55

3. Comparison of average daily calcium intake of
preschool children in nine Western Michigan
day care centers with the Recommended
Dietary Allowances (RDA) . . . . . . . 56

4. Comparison of average daily iron intake of
preschool children in nine Western Michigan
day care centers with the Recommended
Dietary Allowances (RDA) . . . . . . . 57

5. Comparison of average daily vitamin A intake of
preschool children in nine Western Michigan
day care centers with the Recommended
Dietary Allowances (RDA) . . . . . . . 58

6. Comparison of average daily thiamin intake of
preschool children in nine Western Michigan
day care centers with the Recommended
Dietary Allowances (RDA) . . . . . . . 59

7. Comparison of average daily riboflavin intake
of preschool children in nine Western
Michigan day care centers with the Recom-
mended Dietary Allowances (RDA). . . . . 60

8. Comparison of average daily niacin intake of
preschool children in nine Western Michigan
day care centers with the Recommended
Dietary Allowances (RDA) . . . . . . . 61

vi

Figure

Page
9. Comparison of average daily ascorbic acid
intake of preschool children in nine
Western Michigan day care centers with
the Recommended Dietary Allowances (RDA). . 62

10. Comparison of 3-month height and weight incre-
ments of preschool children, average age
4 years, in 6 Western Michigan day care
centers with an average of increments
recommended by Simmons (1944), Simmons &
Todd (1938), Watson & Lowrey (1967) &

Jackson & Kelly (1945) for children of
the sanle age 0 O O O O O O O O O O 63

vii

CHAPTER I

REVIEW OF LITERATURE

Day Care

History

Although there has been a sharp increase in day
care facilities for children in the last five or six years,
they have existed in this country for more than one
hundred years (Juhas, 1970). It was the state of Massa-
chusetts that first showed concern for the care and
protection of low-income children and, subsequently, the
first child develOpment nursery schools in college and
university settings were established. Since the early
decades of this century, these experimental nursery
schools have been used for research in child and human
development (HEW, 1968a).

The Work Projects Administration (WPA) in the
1930's and the Lanham program of World War II were two
national programs which involved group day care of large
numbers of children (HEW, 1968a). Both programs placed
major emphasis on providing child care for employed

women in contrast to Project Head Start, initiated in

the sixties, which concentrated on the developmental
aspects of the children.

The proliferation of day care centers was a

natural outgrowth of Head Start. Prior to this time,
day care centers were stereotyped for the poor while
nursery schools were for the well-to-do (HEW, 1968a).
Ruderman (1968) explained that day care centers were
viewed as a service to the deprived where special
emphasis had to be placed on the child's adjustment
and emotional development as well as the family's social
and emotional problems. She contrasted these with the
nursery schools which provided social and educational
experiences and were a potential benefit to the more
advantaged children from middle class homes rather than
a reflection of the inadequacy on the part of the family.
This differentiation from nursery schools was
also spelled out in the 1960 edition of the Child Welfare
League of America's Standards for Day Care Service (CWLA,
1960):

Day care service has to be differentiated from
the nursery school or kindergarten, and from extended
school services and other programs for school-age
children offered as part of elementary school systems.
These have education of young children as their main
purpose. The primary purpose of a day care service
is the care and protection of children. This pur-
pose, the reasons for which a child and family may
need it, and the responsibility shared with parents
distinguish a day care service from education programs.

These 1960 standards state the primary purpose of

day care as follows:

The primary purpose of a day care service dis-
tinguishing it from other resources for family and
children, is to care for and protect children.

In contrast to this set of standards are the revised

standards of 1969 (CWLA, 1969) which state:

The primary purpose of a day care service is to
supplement the care and protection that the child
receives from his parents.

In addition, the revised version specifies that

day care programs include the essential components of
care, protection, education, health supervision, social
work, parent participation, and planning and coordination.
Consequently, it is apparent that day care is now
recognized as a supplementary service for the parents
which should be developed and carried out in such a way
as to maintain a stable family environment for the
children. It should stress not only care and protection,
but also deve10pment and education.
Present Differences Between Danyare
Centers and Nursery Schools

With the latter point in mind, one can see that the
once distinct dividing line between nursery schools and
day care centers is rapidly diminishing to the point that
there are probably two basic differences today.

The first difference concerns their goals. Although

both nursery schools and day care centers now stress

develOpment and education, this is still the major goal

of nursery schools whereas day care centers are equally
concerned with the supplementary care and protection of
the child.

A second more specific difference lies in the
educational qualifications of the staff. In Michigan
the head teacher of a nursery school must meet the
educational qualifications as established by the Michi-
gan Department of Education (State of Mich., 1968) and
all assistant teachers should have a minimum of two years
of study at the college level. The director of a day
care center, on the other hand, shall have a minimum of
two years of study at the college level, and all other
staff members should have some experience in working

with children.

Factors Influencing Danyare Develgpment

One might ask what has promoted this shift in
outlook during the sixties from scarce recognition of
day care to the creation of a prosperous movement in
which demand greatly exceeds the capacity to serve. The
factors responsible for this change can be divided into
four major categories. Probably the greatest impact has
come from the first of these, namely, the tremendous
increase in the number of working mothers.

Working Mothers.--It is felt that one of the
primary reasons day care centers did not develOp more

rapidly in earlier years is the fear that more women

would be tempted to seek work outside of the home if
these centers were available to care for their children
(Caldwell, 1971). But statistics reveal that more
mothers have started working despite the lack of day
care centers. Since 1940 the number of working mothers
has increased more than sixfold and has more than doubled
since 1950 (U.S. Dept. of Labor, 1967). There are more
than five million children in this country under six
years of age with working mothers (HEW, 1970), yet
according to 1968 statistics, there are licensed day
care facilities for only 637,000 of these children

(U.S. Dept. of Labor, 1969). It is estimated that there
will be a 43 per cent increase between 1970 and 1980 in
the number of working mothers, ages 20-44, with children
under the age of five (U.S. Dept. of Labor, 1969).

In 1965 the U.S. Department of Labor investigated
how children of working mothers were cared for during the
day (Low, et al., 1968). This study involved 6.3 million
mothers who had worked 27 weeks or more in 1964 and their
12.3 million children under the age of 14. The results
of the survey indicated that:

a. 46% of the children were cared for in their own
homes usually by another relative.

b. 16% were cared for away from home.
c. 13% were watched by their own mothers during work.

d. 15% had mothers who worked only during their
school hours.

e. 8% cared for themselves and were, thus, called
latch-key children; of those children, less
than 4% were under the age of six.

f. 2% attended group care centers.
Factors affecting the increase in working_mothers.--
Three main reasons for the increase in working mothers in.
contemporary times include:

1. recent acceptance of the fact that a woman will
not be abandoning her parental responsibilities
or showing a lack of concern for her children if
she chooses to work outside her home (Emerson,
1969),

2. the rising cost of living plus higher economic
aspirations both of which demand a higher income
need and thus are reSponsible for a greater
number of women in the labor force (Linden,
1970) and

3. the idea that a middle class, well-educated mother
who feels she must stay home may be depriving the
community of the benefit of her skills as well as
depriving her child of the stimulation offered by
other children and professional educators (Stern,
1969).

.Work Incentive Program.--A second major factor

 

which is responsible for the recent day care movement is
the Work Incentive Program (WIN) authorized under the 1967
amendments to the Social Security Act and operative since
1968 (U.S. Dept. of Labor, 1969). This is a manpower
develOpment program to train persons on welfare for perma-
nent jobs at decent pay. The law specifies that day care
services must be provided for children whose mothers are
participating in these training programs.

Socio-economicL cultural, and health factors.—-A

third reason day care has shown such expanded develOpment

is due to increased awareness of the existence of such
conditions as physical or mental handicaps of the children
or parents, illness or death of the mother, economical and
cultural deprivation, poor family relationships, slum
living conditions with no place to play, and socially

and intellectually impoverished environments at home

(U.S. Dept. of Labor, 1967, 1969; HEW, 1968b).

Importance of child develgpment.--Finally, there

 

is recognition of the fact that the first few years of a
child's life are the critically formative ones and, there-
fore, provision should be made for optimum deveIOpment of
all who might otherwise be deprived (HEW, 1968a).
Nutritional Patterns of Preschool Children
Effects of Poor Nutrition on Growth
and Development
Poor nutrition can be in the form of either under-
nutrition or malnutrition or both. According to Lowenberg,
et al. (1968), undernutrition is getting too few calories
to maintain normal body weight and normal activity, whereas
malnutrition may involve adequate calories but insufficient,
or in some cases, excess amounts of certain needed nutrients.
Since adequate nutrition is a prerequisite for prOper growth
and develOpment in the child, these states of poor nutrition
may have profound effects on the child's physical and mental

develOpment.

8

Physical growth and development.--Almost any kind
of nutritional deficiency including calories, protein,
vitamins and minerals can result in growth retardation
(Pearson, 1968). A sensitive indicator of undernutrition
in the young child is the failure to thrive and the children
who do grow in spite of this undernutrition are smaller than
well-nourished children of the same age (Lowenberg, et al.,
1968).

In a study on nutrition and growth, McCance and
Widdowson (1960) found that rats undernourished during
suckling continued, upon subsequent unlimited feeding,
to gain weight less rapidly than their controls and they
remained smaller and lighter throughout life.

Winick and Noble (1966) also found that caloric
restriction of rats from birth to weaning resulted in
decreased growth due to curtailment of cell division.
Subsequent recovery did not occur with refeeding. Rats
restricted between 21 and 42 days of age showed decreased
growth with recovery upon refeeding occurring only in the
brain and lung, the two organs growing by cell enlarge-
ment at this time rather than cell division. A restric-
tion between 65 and 86 days of age, when growth is primarily
characterized by cell enlargement, caused reduced cell size
but subsequent recovery did result upon refeeding. It was

concluded that permanent stunting results from reduction

in cell number but growth recovery will occur after a
reduction in cell size.

A later study by these same researchers (Winick
& Noble, 1967) demonstrated the reverse response with
increased feeding in neonatal rats. Increasing the
number of calories accelerated growth by increasing the
rate of cell division. At weaning these rats were sig-
nificantly heavier than their controls, their organs
were composed of a larger number of cells, and their
increased weight was maintained in adulthood.

Schemmel, et a1. (1969), however, found that
overfeeding of rats by using a high fat diet from 21 days
of age resulted in increased weight due to an increase in
fat only. There was no increase in lean body mass in
rats fed the high fat diet as compared to their controls
fed a grain ration.

The work done by Berg, et a1. (1960) raises some
questions as to the desirability of increased growth.with
increased nutrition. They found that rats given restricted
amounts of food from 28 days of age showed increased lon-
gevity and delayed onset of disease as compared to the
controls fed ad libitum.

Two malnutrition syndromes prevalent in many
children throughout the world are marasmus and kwashiorkor.
Marasmus is partial starvation or a chronic calorie defi-

ciency whereas kwashiorkor is a form of protein-calorie

10

malnutrition (Lowenberg, et al., 1968). Marasmus, which
is more common in children below one year of age, is
primarily characterized by retardation in growth and
development, muscular wasting, and lack of subcutaneous
fat. Kwashiorkor is more prevalent during the second
and third years and is characterized by edema, growth
retardation, variable degree of dermatosis and muscular
wasting (Scrimshaw, et al., 1961).

Mental development.--Coursin (1965) indicates that
it is often difficult to obtain meaningful data in evalu-
ating mental ability because of such factors as genetic
background; family, environmental, and cultural circum-
stances; time of onset of undernutrition; degree of its
severity and duration; adequacy of treatment; subsequent
environment, etc.

To study the effects of early malnutrition on
mental function, Champakam, et a1. (1968) compared the
intelligence and sensory development test performance
of 19 children who had previously been successfully
treated for kwashiorkor with that of a properly matched
control group. Performance was poorer in the experimental
group with a significant difference in intelligence test
performance. For both tests differences tended to dimin-
ish with age.

Cabak and Najdanvic (1965) also showed lower

intelligence scores for children who had had marasmus

l

11

in childhood. Fifty per cent of these children were
below the normal intelligence limit as compared to 21
per cent of the control children.

Kugelmass, et a1. (1944) administered two intelli-
gence tests to two groups of children, each group consisting
of both mentally retarded and normal children but those in
group 1 had been malnourished at the time of the first
test and well-nourished at the second, whereas the
children in group 2 were well-nourished throughout. In
group 1 there was a 10 point rise on the second test for
the retarded children and an 18 point rise for the normal
children compared to an average zero change for group 2
retarded children and -.09 change for the normal children.

Using height-for-age as the basis for defining
malnutrition and a group of children from a rural village
where diet was poor, Cravioto, et a1. (1966) compared the
shortest-for-age and tallest-for-age children with respect
to ability to integrate visual, haptic, and kinesthetic
information. The children retarded in height-for-age
performed significantly poorer than the taller children.
No differences were reflected in a group of upper class
children of the same age range which was selected as the
control. Of the various background variables investigated
in relation to the child's height, only mother's educa-
tional level showed a positive relationship. Therefore,

the authors suggested that interference with the child's

12

physical growth and intersensory development was not from
a difference in social background but rather from malnutri-
tion itself.

In a later study Cravioto, et al. (1967) investigated
the ability of children to integrate auditory and visual
stimuli, again using height—for—age as an indicator of
malnutrition. Mean performance of the taller group was
higher than that of the shorter, but integration improved

with age for all the children.

Nutrient Intake of Preschool Children

 

During the preschool years growth proceeds at a
slower rate than during the first two years of life, but
increasing emphasis is placed on maturation and develop-
ment (Beal, 1954). This change may be reflected in emotional
behavior as well as variation in eating patterns (Beal, 1955).
Beal (1953, 1954, 1955, 1956) found that both appetite and
nutrient intake varied in healthy children from upper middle
class families between birth and the age of five. The
median daily intakes of all nutrients increased during the
first year to year and a half of life. Between the ages of
one and three, the median intakes varied: calorie, fat,
carbohydrate and niacin intakes continued to increase
slightly; protein, thiamin and ascorbic acid intakes
leveled off to a plateau; and calcium, phosphorus, iron,

riboflavin, vitamin A, and vitamin D intakes decreased.

13

From ages three to five the median intakes for all nutri-
ents again increased with the exception of vitamin D which
continued to decrease.

These intake patterns reflected to a great extent
the change in eating patterns of these children during
their preschool years. It was found that there was a marked
decrease between the ages of one and three in the consump-.
tion of milk and vegetables, which was reflected in the
decreased intakes of calcium, phosphorus, riboflavin,
vitamin D and vitamin A. Iron intakes were largely a
reflection of the iron added to specially prepared baby
foods which accounted for the increase during the first
year of life and subsequent decrease when family foods
were introduced.

Median daily intakes of all nutrients except iron
and niacin either met or exceeded the Recommended Dietary
Allowances (RDA) for children of this age. Although
niacin and iron intakes were low relative to the RDA,
there were no deficiency symptoms apparent in the children
in either case.

Diercks, et al. (1965) found the mean total intake
for calories, protein, iron, vitamin A, thiamin, riboflavin,
calcium, and ascorbic acid for 115 preschool children
studied were close to the RDA except for niacin. A sub-
stantial number of individual intakes were low in iron

and ascorbic acid. Kerrey, et al. (1968) also found that

14

mean daily intakes of 40 preschool children from two dif-
ferent socio-economic groups either met or exceeded the
RDA for all nutrients except iron and calories. Many
individual children, however, were low in iron, calcium,
calories, and ascorbic acid consumption. Similarly,
Metheny, et a1. (1962) found that the least supplied
nutrients in diets of 104 preschool children were, in
decreasing order, calcium, calories, thiamin, and iron.
Ascorbic acid was often low in individual intakes. In
agreement with this latter study were the findings of
Crumrine and Fryer (1970) which showed that iron intakes
of 40 preschool children were the lowest followed by
calories, calcium, and thiamin yet all nutrients were
close to the RDA except iron.

In these studies there appeared to be universal
agreement that iron was the nutrient most often low in
the diets of preschool children. Other nutrients often
supplied in the least amounts were calcium, thiamin,

niacin, ascorbic acid, and calories.

Importance of Snacks

 

Because children frequently cannot eat a great
deal of food at one time, it has been found beneficial to
serve snacks to preschool children in addition to their
regular meals. These prevent the children from becoming

overly hungry between meals and provide extra energy. In

15

studying the effect of midmorning snacks on lunch appetites,
Munro (1957) found that the average caloric intake at lunch
decreased but total caloric intake for both snack and lunch
increased for the majority of the children. Eppright,

et al. (1970) noted in their North Central Regional Study
that snacks were just as frequent as meals in the diets of
preschool children and they deserved as much emphasis as
meals in nutrition education. They also found that eating
less than four times a day negatively affected caloric
intake, whereas it was positively affected by eating six

or more times a day.

Recommendations for Nutrition in
Dainare Centers

 

 

Although studies have not been conducted on the
role of nutrition in day care centers, various recommenda-
tions have been put forth as a guide for nutrition in
group care of children, particularly day care centers.
The Michigan Department of Public Health (1970) recom-
mended that children in group care from five to eight
hours a day should have one-third to one—half of their
daily nutrient needs met at the center. Therefore, this
must be provided through one regular meal and one or two
snacks. Children in group care longer than eight hours
a day should receive two-thirds of their daily nutrient
needs at the center. This can be provided by two regular

meals and one or two snacks. Hille (1969) has set forth

16

similar recommendations for feeding groups of young children
cared for during the day.

Similar meal patterns for feeding young children
have been devised by various groups (MDPH, 1970; Hille,
1969; USDA, 1970). These suggest foods to be included
in each meal and snack and differ only in slight respects.
The U. S. Department of Agriculture (1970) specifies
inclusion of milk and an enriched bread component in
every meal and snack served at the center, whereas the
patterns by Hille (1969) and the Michigan Department of
Public Health (1970) do not make this specification.

They do, however, recommend that a good Vitamin C source
be served daily and a good vitamin A source be served at
least twice a week.

Considerations in Preschool Group
Feeding Situations

 

 

Food preferences.-—Food preferences become very

 

apparent in children during their preschool years, and
there appears to be wide agreement that vegetables are

the least liked foods. Beal (1953) found a marked decrease
in the consumption of vegetables and milk between the ages
of one and three. In studying food intake of nursery
school children for the noon meal, Merone, et al. (1965)
found that vegetables, excluding potatoes were consumed

in the smallest amounts and desserts were consumed in

largest amounts. In a questionnaire in which mothers

17

indicated the child's food preferences, Diercks, et al.
(1965) found that vegetables were the most disliked or

not eaten at all, whereas meats were most liked as were
fruits, sweets, cereals, and cereal products. Similarly,
Eppright, et a1. (1969) found from an interview with
mothers of preschool children that by the age of three
many children had developed a dislike for certain foods,
most notably vegetables. They also noted a sharp decrease
in milk consumption after the age of six months which also
corresponds with Beal's (1953) findings.

Introduction of new foods.--The eating situation

 

is a learning experience for the child and at the same

time carries along with it an emotional impact (HEW, 1968a).
Foods which are familiar to a child will be much more
acceptable to him than new foods. Therefore, Wagner

(1954) has suggested acquainting the child with the new

food before it is prepared and then introducing it with
familiar and well-liked foods at the mealtime. Breckenridge
and Murphy (1969) feel the introduction of a new food is a
learning experience. Through repeated experimentation they
feel children will learn to accept new foods.

Foods as rewards or punishments.--Hille (1969)

 

stresses that withholding desserts as punishment or giving
desserts as rewards only serves to place exaggerated
importance on these foods. In order to avoid this problem,

Wagner (1954) has noted that desserts in her nursery school

18

have been planned as a nutritional part of the meal and
have thus been served with the meal and second servings
have been permitted.

Self—selection of diet.--Eppright, et al. (1969)

 

have concluded from their study that about half the
children who enter school have had little experience

in making decisions about food selection. Therefore,

it appears that during the preschool years a child should
be given the freedom of some choice in the amounts and
types of foods he eats. Because of the variation in a
child's appetite from day to day, Wagner (1954) feels
that a process of modified self-selection for preschool
children would be most advantageous. In this manner a
child may select the types and amounts of foods he desires
but the adult controls the variety of foods which are
presented.

Attitudes.--Finally, a very important factor in

 

the feeding of young children is the attitudes of these
children and the influence of the environment on their
formation. It is generally felt that a relaxed nonpressured
atmosphere is important in helping a child develop healthy
attitudes about food and mealtimes (Wagner, 1954). Metheny,
et al. (1962) have stated that a child's attitude toward
food at home may differ from his attitude toward food in a
group-eating situation. This could possibly be explained

by a relaxed atmosphere in the group which may not be as

19

apparent in the home, or vice versa. Likewise, it has been
noted that "problem eaters" often disappear in the relaxed

atmosphere where everybody eats (HEW, 1969).

Nutritional Status of Preschool Children

Height and Weight as Indicators

 

In assessing the nutritional status of children,
appraisal of growth and development in relation to age
and sex is of great importance. Height and weight, in
addition to skinfold thickness, are the most commonly
used anthropometric measurements in children to determine
growth and development (Pearson, 1968).

Krogman (1948) notes that there is considerable
variation in "normal" human growth in general but with
the exception of a few cases, this variation follows an
orderly progress within an expected range. The few excep-
tions may be partially explained by such factors as heredity,
food and health habits and health vicissitudes.

Bayer and Bayley (1959) relate growth in height to
the rate of physical maturing. They indicate that most
children mature and grow in a similar pattern but their
rates of maturing may vary greatly. Simmons and Todd
(1938) further indicate that increments of stature (height)
register true body growth whereas weight changes are more

nearly an indication of health.

20

In considering weight as an indicator of nutri-
tional status, there are conflicting ideas. Watson and
Lowrey (1967) feel that body weight is probably the best
index of nutrition and growth because it sums up all the
increments in size. They do, however, recognize the
extraneous factors which enter into its determination.
These factors have been listed by Krogman (1948) as.

(a) time of day, (b) before or after meals, exercise or
elimination, (c) season of year, (d) socioeconomic status,
and (e) health, nutrition, body build, ethnic stock and
family line. It is because of factors such as these that
Simmons and Todd (1938) emphasize that weight cannot be

as reliable or as valid an indicator of growth as stature
until it becomes possible to distinguish weight as a true
reflection of growth from weight as a reflection of other
factors.

Hundley, et a1. (1955) studied.'Ume reliability
of height and weight measurements as a continuing index
of the nutritional status of school children. Data were
obtained for first—grade children from both favorable
and underprivileged areas during the depression era and
pre- and post-control periods of economic prosperity.
Children from economically favored areas were taller and
heavier than the children from underprivileged areas,
but the latter group showed no change in its secular

growth trend during the depression era whereas the former

21

group did show significant deviation. Due to other inde—
pendent variables which may have influenced the results,
it was concluded that further study should be done to

test the reliability of these measurements.

Methods of Expressing Height and Weight

Heights and weights in determining the nutritional
status of children can be used in a number of ways. Among
these ways are the use of tables, curves, or grids; deter-
mination of growth increment; and determination of develop-
mental age.

Height-weight tables.--Various tables (Watson &

 

Lowrey, 1967) have been developed to present sex-age-height
data and sex-age-weight data. These tables are usually
based on means or percentiles of a large number of children
and are used to compare a child's own height and weight
with the norm at his particular age. Watson and Lowrey
(1967) enumerate several objections to the use of these
tables: (1) there is a question as to what extent devia-
tions from mean figures must occur to be considered
abnormal; (2) deviations are apt to be overlooked unless
there are excessive deviations from the usual physique;

(3) with these tables it is more difficult to compare a
child's progress than it is with graphic representations.
Nevertheless, because these tables are a convenient

standard, they are widely used.

22

'Height-weight curves.--Curves for height and weight,
like tables, are usually derived from averages of large
numbers of children at each age. These curves (Bayer &
Bayley, 1959; Jackson & Kelly, 1945) have an advantage
over tables in that they allow comparison of an individual's
pattern of growth with that of a large group of his own age.
Children with accelerated development will show curves
higher than the average and likewise, children showing
retarded development will fall below the average curve
(Bayer & Bayley, 1959).

Height-weight grids.--The third method of appraisal

 

is by the Wetzel Grid (Wetzel, 1943) which Krogman (1948)
feels is the best present device available. By simply
plotting heights and weights on the grid, one is able to
estimate the physical condition of children. Two major
steps are involved in this technique of appraisal. The
first is the evaluation of physical status which includes
physique, developmental level and nutritional grade; this
evaluation applies to each individual point plotted from
the height and weight data. The second step is evaluation
of physiCal progress as defined by channel course, which
indicates if changes in physique are accompanying develop-
ment, and auxodrome progress which shows whether a child's
development is progressing on schedule. This step applies

to the curves which are drawn through the plotted points.

pl

:1

23

The greatest advantage of this Grid method is the
ability to detect a developmental lag characterized in
Wetzel's terms by "drifting off" in the channel course
and "behind schedule" in auxodrome progress (Wetzel,
1943). In this way one is forewarned of oncoming malnu—
trition which cannot be detected by height and weight
tables or clinical means.

Height-weight increment.--Increments in height

 

and weight are another way to measure a child's progress
in growth and development. These increments can be deter-
mined by taking the difference between heights and weights
at successive age levels. Robinow (1942) feels these are
particularly beneficial for following the progress of
children over shorter periods of time so he undertook a
study to establish norms for weight and length increments
during successive intervals from birth to six years of age.
It was found that the rate of growth in both height and
weight decelerates rapidly throughout the first year,
slowly decreases from one to two years of age, and from
two to six years of age weight increments remain practi-
cally constant while length increments continue to decrease.
Bayer and Bayley (1959) note the importance of
increment curves in determining whether a child's slow
and fast growth periods are occurring at the expected

times.

24

Developmental age and index.--Developmental age
(Drash, et al., 1968) expresses in terms of age an indi—
vidual's state of development as he relates to a standard
population and can be used for any anthropometric charac-
teristic which varies predictably with age and for which
certain standards have been set for children at various
ages. Specifically in reference to height and weight,
the develOpmental age is the height age and weight age,
respectively. Height age expresses an individual's height
as the age at which his height is equivalent to the mean
of a standard pOpulation. Weight age is expressed in a
similar fashion. As a further step, developmental index
can be obtained by dividing developmental age by chro-
nological age. Therefore, a value of one would indicate
normal develOpment, less than one retarded development,

and greater than one accelerated development.

CHAPTER II

INTRODUCTION

Because day care is still in relatively early
stages of development, studies on preschool nutrition
have not yet been conducted in this specific area. On
the basis that there is an increasing need for day care
for preschool children (U.S. Dept. of Labor, 1967; 1969;
HEW, 1970; Low, et al., 1968), that nutrition plays a
crucial role in the development of children during this
period of life (Winick & Noble, 1966; 1967; McCance &
Widdowson, 1960; Champakam, et al., 1968; Cabak &
Najdanvic, 1967; Kugelmass, et al., 1944; Cravioto, et al.,
1967), and that preschool children exhibit many changes
in eating patterns and attitudes (Beal, 1953; 1954; 1955;
1956) which-can be influenced by their environment (Wagner,
1954; Metheny, et al., 1962; HEW, 1969), a study on the
nutritional adequacy of the food served at day care centers
is justified. Therefore, this study was conducted to
investigate nutrient intake of preschool children at nine
day care centers. Nutrient intake was compared with
height and weight increments of the children over a
three-month period. In addition, for each participating

day care center, descriptive factors concerning general

25

26

operations, menu planning and food service practices were

noted.

CHAPTER III

METHODS

Selection and Description of Sample

Through the cooperation of the day care consultant
for Western Michigan day care centers, ten day care centers
in Western Michigan were selected for the study on the
basis of location, expected cooperation, full-day program
availability, and participant or non-participant in the
USDA Special Food Service Program for Children (USDA, 1970).
Midway in the study one day care center was informed it
would be closing permanently due to lack of funding and
attendance was drOpping rapidly as a result. This center
was, therefore, eliminated from the study as it would not
have been representative of the on-going day care centers
and the number of children would have been very small.

Table 1 summarizes descriptive information about
each of the nine day care centers. Of these, one each
was located in Newaygo, Muskegon, Grand Haven, Holland,
and Portage and four in Kalamazoo. All centers provided
full-day programs, although some of the children attended
on a part-time basis at six of the day care centers. Six
of the nine centers were participants in the USDA Special

Food Service Program for Children.

27

28

Food Intakes

 

Preliminary Study

A preliminary study on individual food intakes was
conducted prior to this study at one day care center for
five consecutive days. Due to the limited capability of
observing many individual children at one time as well
as the risk of absences from day to day, it was decided
that determination of average intake from several centers
for a two-day period would be more beneficial than deter-
mination of a few individual intakes at fewer centers for

longer periods of time.

Initial Planning

 

Two observation dates for each day care center
were set for the six-week period between the middle of
March and end of April. These dates involved two con-
secutive days at three centers, one day in-between at
three centers, a weekend in-between at two centers, and

two days plus a weekend in-between at one center.

Collection of Menus

 

Menus for the two observation dates at each day
care center were obtained ahead of time for seventeen of
the eighteen days for the purpose of observing how closely
the menus were followed. In addition, extra menus were
requested to determine whether the meals served during

the study were typical for each day care center.

29

Weighing of Food

 

The total quantity of each food prepared for a snack
or a meal was weighed with its container to i 0.5 ounces on
a Hanson household scale. This weight was corrected for the
weight of the container and any food remaining in the serving
dish. When the plates were scraped, the individual foods
that were uneated were put onto separate plates to determine
the weight of wastage for each. Spilled foods were also
collected and weighed. The total weight of food served was
corrected for these wastes; the resulting values represented
the total'weight of food eaten by all the children. The
average weight of food eaten by each individual child was
then determined by dividing the weight of the total food
consumed by the number of children eating the meal or snack
(see Table 2). No food eaten by the staff was included

in these weights.

Analysis of Data

 

Average daily intakes for calories, protein, fat,
carbohydrate, calcium, vitamin A, iron, thiamin, riboflavin,
niacin and ascorbic acid for all meals and snacks served
at each day care center were calculated using the food
composition tables. Watt & Merrill (1963) was used for
those foods appearing therein; otherwise Church & Church
(1969) was used. For food items not listed in the tables,
recipes were either obtained from the cooks or cookbooks

(Rombauer, et al., 1967; Better Homes and Gardens New

 

Cookbook, 1968; Junior Welfare League, 1964), and

30

nutritive composition of individual ingredients was calcu-
lated using the food tables by Watt & Merrill (1963).

Niacin equivalents were calculated using the
tryptophan values for each food given by Church and Church
(1969) and for those foods not listed, 1.4 per cent tryptophan
was figured for proteins of animal origin and 1.0 per cent
for proteins of vegetable origin (Food and Nutr. Bd., 1968).
For each day an allowance of 135 mg. tryptophan was sub—
tracted for its requirement1 and for the remaining amount
60 mg. of tryptophan were converted to one mg. of niacin.

Average daily intakes for calories and the nutrients
listed were compared to the 1968 Recommended Dietary Allow-
ances (RDA) and the portion of these allowances which day
care centers were recommended to provide. The Michigan
Department of Public Health (1970) recommended that day
care centers provide l/3-l/2 of the child's RDA if he
attended 5 to 8 hours daily (one regular meal and one or
two snacks) and 2/3 of his daily RDA if he attended more
than 8 hours a day (two regular meals and one or two
snacks). The RDA for children ages 3-4 and 4-6 were
averaged to obtain the most representative standard for

this group of children. Percentage of total intake

 

1Reynolds (1957) has suggested 500mg. of tryptophan
as a safe allowance to meet the daily needs of tryptophan
in young men. Therefore, using the RDA for protein as a
basis for conversion, the allowance was calculated for
preschool children and 1/2-2/3 of this value was used in
the calculations for day care centers.

31

contributed by snacks and meals was calculated for each
day care center and compared between centers serving two
meals and those serving one.

Any vitamin supplements given to the children at
the day care centers were not included in the dietary

intakes.

Heights and Weights

 

Procedure

 

A total of 159 children in seven day care centers
were measured and weighed (see Table 3) twice during the
duration of this study--once in February or early March
and again in May. Data were not collected for both of
these times at two centers so they were eliminated from
this aspect of the study. Weights were recorded to the
nearest half pound when possible and heights to the nearest
eighth inch. The first set of data was collected by a
staff member of each day care center while the second
set was collected by the researcher at six of the centers

and by a staff member at the remaining center.

Analysis of Data

 

Three-month height and weight increments were
determined for each child by subtracting the first set
of data from the second set. Average age and average

height and weight increment were determined for both

32

boys and girls at each day care center. An average was
taken of increments suggested by Simmons (1944), Simmons
& Todd (1938), Watson & Lowrey (1967), and Jackson &
Kelly (1945) for the average age of the children and

compared to actual data obtained.

Hemoglobin Data

 

Hemoglobin data were available from records at the
two day care centers for children of low income families.
These were obtained for 62 children at the one center and
12 children at the other and were compared with levels
suggested by the Interdepartmental Committee on Nutrition

for National Defense (1963).

33

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34

TABLE 2.--Total number of preschool children eating meals and
snacks during a two-day study at each of nine Western
Michigan day care centers.

 

Center Day Breakfast A.M. Snack Lunch P.M. Snack

 

 

A 1 51 51 51 51
2 53 53 53 53
B 1 23 -- 28 21
2 24 -- 29 26
c1 1 18 18 18 --
2 20 21 21 5
D 1 —- 25 21 19
2 -- 25 25 14
E 1 -- 8 14 11
2 —- 11 13 9
F 1 -- 33 36 32
2 -- 32 34 33
G 1 -- 55 55 55
2 -- 47 50 53
H2 1 -- 23 22 23
2 -- 20 19 20
1 1 10 -- 16 17
2 17 -- 20 18
1

The low and zero number for P.M. snack is due to the
fact that children were allowed to go home early on Mondays
and Fridays only, the two days the study was conducted, and
very few, if any, were present for snack.

2A.M. snacks were not served but figures indicate
total number of children receiving reinforcement foods periodi—
cally, at regular intervals, throughout the day.

35

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CHAPTER IV

RESULTS AND DISCUSSION

Nutrient Intake

 

Agreement Between Food Tables
and Recipes

 

 

Since both Watt & Merrill (1963) and Church & Church
(1969) were used for calculation of the nutrient content of
the foods ingested by the children, a comparison of the
nutrient content of 100 gram portions of representative
foods from various food groups as given in the two food
composition books was done (Table 4). For single food
items, there was 100 per cent agreement whereas for mixed
food items such as fruit cocktail, agreement between the
two books ranged from 20 per cent to 100 per cent for the
individual nutrients. However, the low value of 20 per
cent agreement for ascorbic acid in fruit cocktail may be
misleading since the content of this vitamin was so low
in one and not very high in the other. Therefore, for
this study using the two books in order to locate the
published nutrient value of most food items was justi-
fiable. Similarly, data in Table 5 for mixed dishes,
although not in as good agreement as for single food

items, would justify the use of the food composition

36

37

table either for the recipe as such, if given, or the
nutrient content of the single food items contained in

the recipe.

Calculated Data

 

Calculated values for average caloric and nutrient
intake of the children ranging in age from 2 1/2 to 6 years
for both days in all nine day care centers as well as the
Recommended Dietary Allowance (RDA) for that age group for
calories and each nutrient are given in Table 6. The table
also includes a breakdown into percentages of each nutrient
which, according to the Michigan Department of Public
Health (1970), should be served each day to each child
dependent upon the total hours in daily attendance for
that child. Graphic presentation of these data is shown
in Figures 1-9. Average intakes either met or exceeded
2/3 of the RDA for riboflavin (Figure 7) and protein
(Figure 2) for half or more of the 18 days; 1/2 the RDA
for calcium (Figure 3), vitamin A (Figure 5), niacin
equivalent (Figure 8) and ascorbic acid (Figure 9); 1/3
the RDA for calories (Figure l) and thiamin (Figure 6)
and fell below 1/3 the RDA for iron (Figure 4).

The relatively low intakes of iron, thiamin and
calories have also been found by other researchers
(Crumrine & Fryer, 1970; Metheny, et al., 1962) for

this age group. Crumrine & Fryer (1970) found that

38

less than half the 40 preschool children studied met the Recom-
mended Dietary Allowances for thiamin, calcium, calories and
iron while all intakes for protein were above the allowance.
Metheny, et al., (1962) found calcium, calories, thiamin and
iron were low in the diets of 104 preschool children while
riboflavin and protein were high.

In her study on Denver preschool children, Beal
(1953, 1954, 1955, 1956) found that mean daily intakes of all
nutrients except iron and niacin met the Recommended Dietary
Allowances. Studies conducted since that time such as the
ones listed above have confirmed the low iron intakes but,
in general, low niacin intakes have not been as frequent.
This may be due to the recent recognition of niacin equiva-
lents from tryptophan (Food & Nutr. Bd., 1968) which are now
calculated in addition to the regular niacin intake.

Suggested Explanations for Intake
Variations

 

The relatively low intakes by Center D for most
nutrients in relation to other centers could be attributed
to the fact that many of the children attended on a part-
time basis, were from higher socio-economic level families
and may, therefore, have had more food at home and smaller

1

appetites at the center. The high intakes of calcium

(Figure 3) and riboflavin (Figure 7) by Center I reflected

 

1As a specific example, one boy commented one morning
that he did not want any snack because he had had four pan-
cakes for breakfast.

39

their milk consumption three times daily and their very

low ascorbic acid (Figure 9) levels reflected the fact that
no juice or fruit was served during the two—day period of
study. Spaghetti with meat and iron-fortified dry cereal
contributed to the relatively high iron intake by Center

F. The very low intakes of vitamin A (Figure 5) for
Centers G and H occurred because no good vitamin A source
was served either day at either center whereas the extremely
high intake for Center E reflected the use of carrots, a
good source of vitamin A, in some form both days. The
extremely high intake of ascorbic acid (Figure 9) by

Center C reflected the large consumption of orange juice

by the children.

Contribution byAMeals and.Snacks

 

Table 7 shows the per cent contribution meals and
snacks made toward the daily caloric, protein and total
nutrient intake. In general, snacks contributed a greater
percentage of calories than of protein. In the centers
serving two meals plus snacks a much greater percentage
of calories, protein, and overall nutrient intake was
contributed by the meals as was eXpected. In centers
serving only lunch plus snacks, the snacks came close
to providing almost 50 per cent of the daily caloric

and overall nutrient intakes.

40

Menu Modification and Typical
Representation

 

 

Modifications

' Of the seventeen menus which were obtained ahead
of time, two were received verbally, i.e. the cooks had
not made out the menus but specified what they would
serve that next day of observation. In both of these
cases the cook did follow what she said.

Of the remaining fifteen menus, six, which were
from three centers only, were followed with no modifica-
tions. In the other nine, the modifications which occurred
were slight with the exception of one where the cook had
forgotten which menu she had sent and began following a
different one. She switched, howeVer, to the original
menu and followed it as soon as she became aware of the
mistake.

Some examples and reasons for the slight modifica-
tions were: substituted birthday cake for regular planned
snack or dessert (child's birthday); changed salmon loaf
to salmon patties (easier for children to handle); omitted
cheese sauce (children didn't care for it); added whipped
cream topping to gelatin (children liked it); added
sausage to a breakfast menu (to give children more protein
since they were just having salmon patties at noon); sub-
stituted apple crisp for cherry cobbler (children didn't

like thick dough and wouldn't eat cherry crisp); added

41

relishes such as green pepper, lettuce and tomato (left-
overs to be used up); substituted milk for cider or apple
juice (didn't have any cider or apple juice); substituted
bread for bran muffins (children wouldn't eat bran muffins).
Generally speaking, the modifications which o¢curred
were slight enough to have little effect on the nutrient
intake of the children. Many of the reasons the cooks
gave for the modifications concerned the likes and dislikes
of the children which brings to question why certain foods
as these were even planned on the menu. There were a
considerable number of small modifications at one center
in which a retired dietitian planned the menus but there
were no modifications at another center where menus were
planned by a retired dietitian. Also, some of the modi-
fications which occurred were made by cooks who either
planned the menu or were consulted in the planning.
Therefore, no conclusions can be drawn as to the
effects of menu planner on the extent of menu modifica-
tion, but from this study at least it can be concluded
that menu modification did occur to some extent but the
types of modifications made were minor for the most part
and many of the reasons for which they occurred, at least
according to the cooks, were for the benefit of the

children's likes and dislikes.

42

Typical Representation of Menus

 

Table 8 indicates a breakdown of five-day lunch
menus into food groups for the two days of study at each
day care center (days 1 and 2) plus three different days
either from the same week or a different week. One center
did not provide an extra set of menus so no comparison
could be made and it was, therefore, eliminated.

All menus from days 1 and 2 appeared to be quite
typical as compared to those from days 3, 4, and 5 for
all centers with the exception of Center H which served
no fruits or juices for lunch during the days of study
but these were listed for the other three days of com-
parison. Ascorbic acid intake for this center was still
above average, however, since fruits and juices were
served at times other than lunch time throughout the

day.

Height and Weight Increment

 

Height increment averages (Table 9, Figure 10a)
for girls and boys at six centers for three spring months
were 0.72 and 0.64, respectively. These were in good
agreement with standard increments of 0.74 and 0.66,
respectively, obtained by averaging four suggested
increments for a 4-4 1/2 year old obtained from Simmons
(1944), Simmons & Todd (1938), Watson & Lowrey (1967—-

modified Stuart Meredith tables) and Jackson & Kelly

43

(1945). This age range was selected since the average
age of all girls and boys at the time of the first measure-
ments ranged from 3.8 to 4.2 years with the exception of
one group of six boys from Center E who averaged 4.9
years of age. With these boys a slightly lower increment
in height and weight would be eXpected. Actual results
showed that these boys were, in fact, the closest group
to the standards in both height and weight.

Weight increment averages (Table 9, Figure 10b)
for the girls and boys were 2.03 and 1.29, respectively
as compared to the respective standards of 1.28 and 1.13.

In general, the girls grew in height and gained
in weight slightly more than the boys as was expected
from the standard increments given. One finding contrary
to expectations was the greater growth found in weight
rather than height which should have been the reverse
for the period during the spring months. Possibly part
of the difference could be attributed to types of shoes
which were worn at both times. In February boots may
have been worn in some cases which would have increased
the height slightly for the February data thereby making
the increment smaller. However, in the two centers
where measurements were taken without shoes (C and F)
increments were still below the standard for height in
both cases and above the standard in weight for both.

In reference to weight, winter clothing may have had a

43

(1945). This age range was selected since the average
age of all girls and boys at the time of the first measure-
ments ranged from 3.8 to 4.2 years with the exception of
one group of six boys from Center E who averaged 4.9
years of age. With these boys a slightly lower increment
in height and weight would be eXpected. Actual results
showed that these boys were, in fact, the closest group
to the standards in both height and weight.

Weight increment averages (Table 9, Figure 10b)
for the girls and boys were 2.03 and 1.29, respectively
as compared to the respective standards of 1.28 and 1.13.

In general, the girls grew in height and gained
in weight slightly more than the boys as was eXpected
from the standard increments given. One finding contrary
to expectations was the greater growth found in weight
rather than height which should have been the reverse
for the period during the spring months. Possibly part
of the difference could be attributed to types of shoes
which were worn at both times. In February boots may
have been worn in some cases which would have increased
the height slightly for the February data thereby making
the increment smaller. However, in the two centers
where measurements were taken without shoes (C and F)
increments were still below the standard for height in
both cases and above the standard in weight for both.

In reference to weight, winter clothing may have had a

45

for Center C boys and girls. Children from Center D had
below average nutrient intakes but height increments
were average for both boys and girls while weight incre-
ments were above standard for girls and below standard

for boys.

Hemoglobin

 

Calculation of the average hemoglobin values for
the children from each of the two day care centers from
which data were available resulted in an average of 11.3
gm. for the 12 children at Center C and 11.8 gm. for the
62 children at Center A. Both of these values fell in
the "acceptable" range as set by the Interdepartmental
Committee on Nutrition for National Defense (ICCND, 1963).
For individual values at Center C, 17 per cent fell in
the "low" range (lo-10.9 gm.) and 83 per cent in the
"acceptable" range (ll-12.4 gm.). At Center A 2 per
cent (1 child) were "deficient" (<10.0 gm.), 19 per cent
were "low" (lo-10.9 gm.), 48 per cent were "acceptable"
(ll-12.4 gm.), and 31 per cent were "high" (>12.5 gm.).

The children from Center A had a higher hemoglobin
level than those from Center C but the reverse was true

for the iron intake for the children of these two centers.

446

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E9

CHAPTER V

DESCRIPTIVE FACTORS CONCERNING NINE WESTERN

MICHIGAN DAY CARE CENTERS

During the two-day period of study at each day care
center an attempt was made to gather information concerning:

(1) general operations and (2) menu planning and food service 3

 

practices. This was done by personal observation and infor-

mal interviews with the cooks and/or directors.

General Operational Information

 

Qperational Age of Center

 

The nine centers investigated have been Operating
for a range of one to 37 years. Of these, one has been
in operation for five years, seven for three years or less
and one for 37 years. The latter was originally estab-
lished under a different name and did not become known

by its present name until three years ago.

Location of Centers

 

Five of the centers are located in presently
operating churches, one in an old church no longer in

Operation, one in a presently operating elementary school,

64

65

one in an old school building no longer in operation,

and one is located in its own private building.

Funding of Center

 

Two centers are strictly for children of low
income families so no fees are charged and all funding
comes from federal, state and local levels. In one
center all families pay a fee, and in the remaining
centers some families pay fees while others are on ADC
and the fees are paid by the state. On a weekly basis
the fees are $21.00 at one center, $22.50 at two centers,
$27.50 at one, $30.50 at one and $15-$20 per week at one
according to income level of the family. Fees for half-
day attendance range from $2.25 (plus $.25 for lunch) to

$3.00 per half day.

Months, Days, and Hours of Operation

 

Seven centers are in operation year-round while
two centers are open from the first of September to the
middle of June. All operate on a five-day week, Monday
through Friday. Daily opening time ranges from 6:30 to
8:00 a.m. and closing time from 4:00 to 6:00 p.m. The
centers are open an average of 10 hours per day with a

range of 8 to 11 1/2 hours.

Number and Ages of Children

 

The total enrollment at the time of this study'

for all nine centers was 434 children and average daily

 

66

attendance for all centers totaled approximately 305

children. This attendance fluctuates daily. Enrollment
at individual centers ranged from 27 to 100 children and
average daily attendance ranged from 19 to 70. The

children range in ages from 2 l/2—5 years at five centers
and 2 l/2-6 years at three centers. Most of the six year -filfli
olds, which were few in number, attended kindergarten for ‘ A

half days and, therefore, attended the day care center

 

for half days only. :'}

Full- or Part-time Attendance

 

In three centers all children attended on a daily
full-time basis. In the remaining six centers, children
attended on both full- and part-time bases. Most of the
children were full-time in four of these six centers while
most attended on a part-time basis in the other two.
Part-time refers to either attending half days or attend-

ing only certain days of the week.

Ethnic Groups Represented

 

At the time of the study Whites, Negroes, and
Mexican-Americans were represented in four of the centers,
Whites and Negroes in two centers, Whites only in two

centers and Negroes only in one center.

Description of Staff

 

Some or all of the following staff members are

found in each day care center: director, assistant

67

director, cook, nurse, teachers, teacher aides, co-op
students, community aide, bus drivers, and volunteers.
The number of staff at each center ranges from 4 to 20

with an average of 10 per center.

Menu Planning and Food Service Practices

 

Although not a Head Start center, one center
receives all its meals from a central kitchen which dis-
tributes meals to all Head Start centers in the area and
thus has no on-premise food service operation. Therefore,
some of the following questions will not be applicable to
this center and will refer to the remaining eight day care

centers only.

Who plans the menu?

 

The cook plans the menu at four centers, the
director at two centers with the cook consulted at one
of these, a retired consultant dietitian at two centers

and a dietitian at one (the Head Start central kitchen).

When is the menu‘planned?

 

One center uses a pre—planned cycle menu planned
well in advance of serving; another plans the menu one
month ahead of time, another two to four weeks ahead of
serving, four centers the week before, one center on
Monday of the same week, and at the remaining center an

attempt is made to plan it the weekend before.

68

Is a cycle menu used?

 

Only one center uses a written cycle menu which was
planned by a retired consulting dietitian. Two six-week
cycle menus have been planned, one each for winter and
summer. Another center uses a cycle menu more or less

from memory about every three weeks.

Is the menu posted at the center?

 

This question was not asked at any one center but
from observation and recall, there were four centers in
which the weekly menu was posted in a fairly conspicuous
place so parents could see it.

Are snacks planned as a part of the
written weekly menu?

 

 

Snacks are planned as a part of the written menu

at four of the nine centers.

Who purchases the food and how often?

 

The cook purchases the food at six centers and the
director at two. Frequency of purchasing varies with the
types of food but most is done on a weekly basis. Three
centers order some foods from a wholesaler and most centers
purchase the majority of their food from one grocery store
in town. All food is delivered to four centers. At the
other centers most or all of the food is picked up by the

director or cook.

 

69

Who prepares the meals and snacks?

Two cooks prepare the meals at one center and one
cook at the remaining seven. Morning snacks are prepared
by the cook at two centers, cook and teacher at one center,
and the teachers at three centers. Three centers do not
serve morning snacks. Afternoon snacks are prepared by
the cook at five centers and the teachers at four. Gen-
erally speaking, the snacks prepared by the teachers are
also planned by the teachers but this is not true in every

case .

 

What are the cook's hours each day?

 

Arrival time for each cook ranges from 6:30 to
10:00 a.m. and departure time from 12:30 or 1:00 to 3:30
p.m. Total number of working hours ranges from four to
eight per day with an average of six. -

What types of meals and snacks are served
and at what times of the day?

 

 

One center serves breakfast, lunch, and morning
and afternoon snacks; three centers serve breakfast, lunch
and an afternoon snack; four centers serve lunch and
morning and afternoon snacks; and one center serves lunch,
an afternoon snack, and reinforcement foods periodically
throughout the day depending on the child's performance
in various activities. Breakfast is usually served between

8:30 and 9:00 a.m., morning snack between 9:30 and 10:30

70

a.m., lunch between 11:30 a.m. and 12:30 p.m., and after—

noon snack between 2:30 and 3:30 p.m.

What is the style of service?

 

Four centers serve family style in which separate
serving dishes for all foods are placed on each table. At
two centers the cook prepares the individual plates in the
kitchen and the teachers carry them to the tables. At one
center the cook and teachers walk around to each table and
serve the children from serving dishes or pans. There is
a modified family style service at one center in which
separate serving dishes are prepared for each table but
the teachers usually walk around the table and serve the
children rather than sitting at the table with them. At
the center where food is transported in, the teachers

prepare the individual plates of food for the children.

How is milk served?

 

Milk is poured from 8—ounce cartons into small
cups at the table in four of the centers. At two centers
milk is poured from pitchers at the table and at one of
these centers, the pitchers are small enough that the
children often pour it themselves. Milk is poured from
half gallon cartons at the table at two centers and at
the remaining center the children, usually using a straw,

drink directly from the 8-ounce carton.

 

71

What type of milk is used and is it
vitamin D-fortified?

 

 

Five centers use whole milk, one uses 2% fat
milk, one uses skimmed milk, one uses whole white and
chocolate milk, and one uses chocolate milk only. The
milk is not vitamin D—fortified at the latter two centers
or at one of the five centers using whole milk.

Do the children eat at the same table and with
the same children each day?

 

 

The children eat at the same table and with the
same children at three centers but at the other center
children do not eat at the same table or with the same
children each day.

Do the teachers sit at the tables
with the children?

 

 

The teachers sit at the tables with the children
at five centers--the four centers serving family style
and the one center in which both the teachers and cook
walk around to each table to serve the children and then
sit down with them. At one center the teachers do not
sit with the children but stand in the middle of a circle
which the tables form and help the children as needed.
At three centers teachers sometimes sit with the children.
At two of these centers they do so to help the children
while at the third the primary purpose is to have the chil-
dren experience eating with an adult as well as with

children only.

72

Does the cook eat with the children?

 

The cook eats with the children at three centers,

sometimes at one center and not at all at four centers.

How many children sit at each table?

 

The usual number of children per table is six to

eight. This was true for eight centers. At the remaining F
3

center the number of children sitting at each table varied ;

from six to 22 dependent on table size.

 

Are children required to finish their meal before L
having dessert or leaving the table?

 

Personnel at all centers agree that no children
are forced to finish their meals but, in general, most
feel they should taste everything. At one center they
are not given dessert if they haven't eaten anything.
One center does insist the children drink their milk
but average milk consumption for this center did not
differ markedly from that for any other center.

Are children required to remain at the table
until everyone is finished eating?

 

At three centers the children must remain seated
until everyone is finished eating and at three other
centers they should, generally speaking, but some may
be excused and some slower children may stay longer if
the teachers think they'll eat more. At one center the
children are supposed to remain seated but the teachers

have found this difficult to achieve. At two centers

73

the children may leave the table as soon as they are
finished and at one of these centers the children also

may start eating before everyone is seated which is contrary
to the procedure followed at the other eight centers.

What types of dishes, glasses and
flatware are used?

 

 

Three of the four centers serving breakfast use
paper plates while the other one uses china. For lunch,
three centers use china dishes, two use paper plates,
three use plastic dishes, and one uses styrofoam divided
plates with snap-shut attached covers. Paper plates or
napkins are used by all centers for snacks. For both
snacks and meals small paper cups are used by six centers,
small plastic glasses by one center, and 8-ounce plastic
mugs by one center. At the remaining center small paper
or plastic cups are used for snacks and no cups are used
for lunch since the children drink out of the milk carton.
The type of flatware used is plastic in three centers
and metal in six centers. Of the latter group, only one
center uses child-sized flatware. Flatware consists of

spoons only at two of the centers.

Is children's furniture used at mealtime?

 

Children's furniture is used by all centers for

meals and snacks.

74

Do the children help with meal service?

 

At eight centers children help in one or more of
the following ways: make birthday cakes, bake cookies,
prepare tossed salad, make applesauce, set the tables,
carry serving dishes to the tables, take serving dishes
to the kitchen for refills, scrape plates, throw away their
disposables and sweep the floor after meals. At the
remaining center such help was discontinued due to problems
it presented primarily for the cook.

Do the children eat together for
afternoon snack?

 

 

At five centers the children eat together at one
time for the afternoon snack whereas at three centers the
children eat as they awaken. This means that snack time
can last as long as 1 1/2 hours. At one center the children
awaken from naptime at approximately the same time and
consume their snack shortly thereafter, but remain standing
while doing so which is in contrast to the other eight
centers where all children are seated for snack time.

Does the center conduct any type of nutrition
education program for the children or staff?

 

 

The only type of nutrition education program con-
ducted for the staff has been a nutrition workshop at one
day care center. Two centers indicated no type of nutri-
tion education program for the children and the remaining

centers indicated only an informal educational experience

75

of learning about foods through snacks, special food prepa-
ration, pictures of foods, eXperimentation with different
fruits and vegetables, health and safety practices or
discussion of dental caries.

Do the children receive nutrient
supplements?

 

 

The children receive fluoride tablets at one center

and multiple vitamin tablets at two centers.

Does the center receive government
supplus foods?

 

 

Four centers receive government surplus foods and
two centers do not. Two centers which are eligible to
receive them do not, feeling they are more trouble to
obtain than they are worth to them.

Does the center participate in the USDA Special
Food Service Program for Children?
Six centers do participate in this program and

three centers do not.

* ‘1‘.

 

a

CHAPTER VI

CONCLUSIONS AND SUGGESTIONS

FOR FURTHER STUDY

Conclusions

 

On the basis of the findings from an investigation
of nutrient intake of preschool children from meals and
snacks provided by nine Western Michigan day care centers,
it can be concluded that these meals and snacks as well
as the food intake of the children provided adequate
nutrients when compared with the recommendations as set
up by the Michigan Department of Public Health and The
Food and Nutrition Board (Recommended Dietary Allowances).
The low iron intakes relative to the Recommended Dietary
Allowances should not be of great concern since this has
been a common finding among most of the studies concerning
nutrient intake of preschool children and leads one to
believe that perhaps the Recommended Dietary Allowances
for this nutrient have been set at levels higher than
necessary.

Generally speaking, average caloric intakes from
centers serving more than one meal in addition to snacks
were higher than those from centers serving only one meal

plus snacks. The difference was so slight, however, that

76

77

it is safe to conclude that it was the quality of each meal
and snack rather than the quantity which was a deciding
factor in the nutrient intakes of the children. Therefore,
menu planning which includes consideration of both meals
and snacks becomes important for feeding children in day
care centers.

The fact that the average gain in height and weight
from February to May for six centers was in agreement with
published values for 3-month height and weight increments
further supported the fact that children were receiving
sufficient nutrients. These increments implied that the
center did not negatively affect growth and may have,
indeed, played a large role in positively affecting the

growth which occurred.

Suggestions for Further Study

 

Since this study on nutrition provided by day care
centers was one of the first of its kind, there are ample
opportunities for further research in this area. Some
suggestions for further research are the following: (1) a
study in Detroit similar to this one to observe the effect
of locale on nutrition provided by day care centers; (2) a
study on individual intakes at day care centers in relation
to number of hours of attendance and to heights and weights;
and (3) a study on individual intakes of children at the
day care center as well as at home for the same day to

determine if, between the day care center and home, the

 

78

child is receiving adequate daily nutrition and what per-
centage is provided by the home and center.

From the preceding suggested studies plus many more
which could be conducted, one will be able to more conclu-
sively assess the nutritional adequacy of day care centers

and determine wherein the need for nutrition education lies. 3

Programs could then be devised in such a way as to most

effectively teach the day care center staff, children and

 

—1..1ur..-_' ‘0 - 1 .I.

parents the principles, importance and goals of nutrition

for preschool children. J

Helpful Hints

 

For anyone interested in conducting a study on
nutrition in day care centers, the following suggestions
may be of some benefit.

1. Remember that development of day care is still
recent enough that major efforts are concentrated on the
fundamentals and nutrition is scarcely recognized as an
entity in itself at the present time. Therefore, the pur-
pose and importance of the study should be made very clear
to the persons involved.

2. A preliminary study at any day care center is
advised to detect any obvious procedural problems which
might be encountered.

3. If possible, a preliminary visit should be made
to each participating center to acquaint the director SEQ

remaining staff with the study ahead of time. Especially

79

make sure the teachers are informed because they are the ones
in direct contact with the children during meals and snacks.

4. Make definite plans well in advance and send
reminders to each center shortly before the actual visit
to the center.

5. Have all forms and data sheets prepared ahead
of time. Good ideas for the types and format of data sheets
needed can be obtained through the preliminary study.

6. Be familiar ahead of time with the center's
daily activities and especially the style of service at
mealtime to determine the most effective method of procedure
with as little disruption of the normal daily routine as
possible.

7. Try to eat with the children as often as possible
to observe eating habits.

8. Have food composition tables on hand at all times
to identify all foods served. For food items not listed in
the tables, obtain recipes from the cook and for commercial
foods, write to the food companies for information on nutrient
composition of the foods.

9. If heights and weights are to be studied in
conjunction with intake data, try to obtain these person-
ally using standardized procedures rather than relying on
each center to do it.

10. Show appreciation and gratefulness to the staff

throughout the study for making it possible and provide

80

each center with the results upon completion of the study.
This could be the first step in nutrition education of

the staff.

 

BIBLIOGRAPHY

81

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Bayer, L. M., and Bayley, N. Growth Diagnosis. Selected
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Beal, V. A. "Nutritional Intake of Children, I. Calories,
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.‘g, . .

 

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83

 

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Child Welfare League of America, Inc. Standards for Day
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Child Welfare League of America, Inc. Standards for Day
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Church, D. F., and Church, H. N. Food Values of Portions
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Coursin, D. B. "Undernutrition and Brain Function."
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Crumrine, J. L., and Fryer, B. A. "Protein Components of
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Food and Nutr. Bd. Recommended Dietary Allowances. National
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85

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K“ ..‘E' ."
Fl

APPENDIX

88

 

89

xHHE

 

 

 

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Emmuu moH monowmm oHHwn kuusm w pmmum 005mmedm¢
Houusm a pmmum Houuom w pmmum nouuom w pmwum mcmom cwmuo umpuom a pmwum M
pmHmm powwoe muonnmu poxooo mmmm mmoumuom pmoHo mmanHmm w
oHouowmmu mooawpom pwnmmz mon coomm a mosmm ummz q
prooz mass wmoq pom: coonLU powum cm>o mmmm panEmuom LHHB Hupwnmmmm
N .02 ago:
xHHZ mg ”a
Law: xfiflz mcflmmoe commflrz xaflz xflflz p_w
mchcsm mumHooono pumpmsu oon moHuuwQBMHum cmuoum OHHwo “Houm mchosm mHchm> m2
xHHz xHHz xHHz xHHx
mmHde mexOOU xHHz mCHmHmm nuHB #Hsum cmwum
uwuusm a pmwum Hmuuom a pmwum mmmcmuo mchpom pmmum prwsm a woman M
monum wouumu monuw wanwO Hmausm a pmonm monum pmHmm pwmmoa u
HHooooum pmumuuom mwoumfioe pmSwum mammumdmfi xHonU a pouumv mooumvom pwnmmz MW
mooumuom Conmmz omwwcu a Hcoumomz pmHmm camped LUHBCQmm poo: mmmm a :UMCHQm
monum :mHh wcoHco a H0>Hq cwquLU poHHm cm>o doom oHnmuomo> mMOH Em:
xi: xi: w. .v.
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meHuwmcmB pmmum pmuoupom mpwxomuo memuo mmmpmz demm Howuzm a woman m2
xHHz xHHz xHHz xflflz xaflz m
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mmqm kuusm uocmmm mmmm pwHQEmuom mchHmm mwxmocmm H
meuumm xuom mwmem cuou coomm :uHB Hmeumo wmmmsmm e
onon omcmuo HHouxoou uHsum monomwm pooHHm mxcscu demmwch mummm w
xmpmusze xmpmmccmz mmpmwse hmpcoz H .02 9:02

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v .02 5:02

 

90

 

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a mmHHHwQBmuum mmmm pmHH>mo EHHS oHHwh mEHH wauwu hum mmHCBOHm x.
xHHz xHHz xHaz
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xHH: oxmouuocm monommm pooHHm :HDMHmu xunmncmuu LuHB momma hwumzu 1
mvooHudm pmHHHco ommunnmmcHo Hmmm Hmuusm a HHom mouusm a woman . com mom #0: m
uwuusm w pmmum kuuom w pmoum mcmwm cwwuo mchmwno oume :mHHmm m
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1
mamHooonO Dom xHHz a
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mcoHuomm uHsuwmmmuw umuomz HooHnmd moHsn mmcmuo mwOHHm mmcmuo monHm wmcmuo 3
mopHum mmpmnoce xmomocpmz xmowosa ampcoz m .oz and:

 

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v .02 ocmZ
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xHHz xHHz HHH:
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kuuom a pmmum Hmuusm w pmmum mcmwm :mwuw mcmemHo m mm we on o
pmHmm pounce mmCHm Hmmmmm cwmuw uoxomw CH mmoumuom HHooooum mwawm nomwnm q
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mumHooozu pom xHHz a
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v .02 5cm:
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a mmHHHwQ3muum mmmm pmHH>mQ cwHS oHHwh mEHH wanwu who meconm x.
xHHz xHHz xHaz
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mmeon mHHom chcHQ Hop3om mcmem meHum mmom a muouumu o
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com co wavmnumm mmoonu w Hcoumoo: HHom xwxusa £HH3 OUHm ancmmm mmOH wow: ,1
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ummOB Umwmuusm QSHMm ummOH pmumuusm moflm mo Emwuu monsu owomcu W
mom pmxoou whom umMOB nocmum mmom pwzomom no ummnz mo Emmuu mxcHA mmxoam s
wUHDh uHsumwmmno moHSh mmcmuo mwmpmz mmcmno mmcmcmm pmoHHm moHsn wmcmuo 4
mprum mmpmuscfi mmvmocpmz hmpwmse mmpcoz m .02 scmz

 

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xHHz
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mmmm pmHnEmuom a uwuusm uCmem a ummoe COCOCE mOOuMHOC proHHmom COH3©Cmm J
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xHHz xHHZ xHHz xHHE xHHz 3
xmpHum hmpmusce ampmepmz xmpmmsh hmpCoz h .02 DCOZ

 

.UODCHHCOUII.OH mqmdfi

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