Obesity and nutritional deficiencies among young children are serious diet-related health issues. Since many young children consume large portions of their daily food and beverage intake at child care, it is especially important to examine dietary quality of meals and snacks served by in-home child care providers. This study investigated the dietary quality of foods and beverages served to children 2-5 years of age by in-home child care providers and qualitatively assessed the barriers and facilitators to serving foods and beverages that align with the Child and Adult Care Food Program (CACFP) nutrition standards. Dietary quality of the foods and beverages served for a lunch and one snack in 116 child care provider homes was assessed with direct diet observation, analyzed and compared to: a menu, Healthy U.S.-Style Eating Pattern food groups, Dietary Reference Intakes (DRI’s) and the American Heart Association recommendations. Results indicated that only 40% of menus matched the observations of foods and beverages served. Additionally, only 2% and 3% of in-home child care providers served foods and beverages that aligned with all of the food group recommendations for children 2-3 and 4-5 years-of-age respectively, whole grains and vegetables were the least met. Likewise, 47%, 35%, and 36% of child care providers did not serve the correct portions and types of CACFP-eligible fluid milk, vegetables and fruit. Only 40% of menus matched the observation of foods and beverages served. CACFP compliance was greater for those who also cared for children 4-5 years of age.A total of 67 of the 116 in-home child care homes were randomized into two groups to receive a 6-month nutrition education intervention or to receive a delayed intervention. There were no significant differences in lunch or snack CACFP scores or the total amount (cups, ounces, grams, milligrams, micrograms, percentage of calories) of food groups and nutrients served between the intervention and control child care providers after controlling for pre intervention CACFP scores, nutrient and food group amounts, location, age, and CACFP participation. Qualitative thematic analysis showed that in-home child care providers perceived food preferences of children and providers, higher cost and lower availability of CACFP-approved items, celebrations and food rewards, excessive time and effort needed to prepare foods and beverages and dietary restrictions to be barriers to them serving CACFP-eligible foods and beverages. Perceived facilitators included: using nutrition education, finding easy ways to prepare foods and beverages, using CACFP and WIC, increasing variety of foods and beverages served, child care provider modeling and encouragement, mixing preferred foods/beverages with less preferred, social media and peer support, providing children with food choices, serving the same food and beverages to all children regardless of age, and connecting eligible foods and beverages to children’s health and behavior.In conclusion, the foods and beverages served by in-home child care providers are not aligning with dietary recommendations for children 2-5 years-of-age. Efforts to enhance CACFP and nutrition guideline adherence should address provider needs and challenges in conjunction with tailored nutrition education that addresses shortcomings.
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