Nutritional practices in full-day-care pre-schools

Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review

BACKGROUND

Children aged 2-11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children's food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools.

METHODS

The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003-2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study.

RESULTS

Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool.

CONCLUSIONS

The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.

Gaps in Nutrition Policy Implementation in Childcare Centres in The Edmonton Metropolitan Region: A Cross-Sectional Survey

Purpose: To describe (i) nutrition policies in childcare centres, (ii) the resources and processes used to enable policy implementation, and (iii) the association between policy implementation and childcare centres' or administrators' characteristics.Methods: Between October 2018 and June 2019 a web-based survey that addressed nutrition policy, policy implementation, and sociodemographic characteristics was sent to eligible childcare programs (centre-based and provided meals) in the Edmonton (Alberta) metropolitan region. The survey was pretested and pilot tested. Statistical tests examined the relationship between policy implementation with centres' and administrators' characteristics.Results: Of 312 childcare centres that received the survey invitation, 43 completed it. The majority of centres had a nutrition policy in place (94%). On average, centres had about 9 of the 17 implementation resources and processes assessed. Most often administrators reported actively encouraging the implementation of the nutrition policy (n = 35; 87%) and least often writing evaluation reports of the implementation of the nutrition policy (n = 9; 22%). Administrator's education level was associated with implementation total score (p = 0.009; Kruskal-Wallis).Conclusion: Most childcare centres had a nutrition policy in place, but many lacked resources and processes to enable policy implementation. Additional support is required to improve nutrition policy development and implementation.

Childcare Food Provision Recommendations Vary across Australia: Jurisdictional Comparison and Nutrition Expert Perspectives

Early childhood is a critical stage for nutrition promotion, and childcare settings have the potential for wide-reaching impact on food intake. There are currently no Australian national guidelines for childcare food provision, and the comparability of existing guidelines across jurisdictions is unknown. This project aimed to map and compare childcare food provision guidelines and to explore perspectives amongst early childhood nutrition experts for alignment of jurisdictional childcare food provision guidelines with the Australian Dietary Guidelines (ADG). A desktop review was conducted and formed the basis of an online survey. A national convenience sample of childhood nutrition experts was surveyed. Existing guideline recommendations for food group serving quantities were similar across jurisdictions but contained many minor differences. Of the 49 survey respondents, most (84-100%) agreed with aligning food group provision recommendations to provide at least 50% of the recommended ADG serves for children. Most (94%) agreed that discretionary foods should be offered less than once per month or never. Jurisdictional childcare food provision guidelines do not currently align, raising challenges for national accreditation and the provision of support and resources for services across jurisdictions. Childhood nutrition experts support national alignment of food provision guidelines with the ADG.

A Three-Arm Randomised Controlled Trial of High- and Low-Intensity Implementation Strategies to Support Centre-Based Childcare Service Implementation of Nutrition Guidelines: 12-Month Follow-Up

The study aimed to compare the effectiveness of a suite of implementation strategies of varying intensities on centre-based childcare service implementation of nutrition guideline recommendations at 12-month follow-up. A six-month three-arm parallel group randomised controlled trial was undertaken with 69 services, randomised to one of three arms: high-intensity strategies (executive support; group face-to-face training; provision of resources; multiple rounds of audit and feedback; ongoing face-to-face and phone support); low-intensity strategies (group face-to-face training; provision of resources; single round of audit and feedback); or usual care control. Across all study arms, only three high-intensity services were compliant with overall nutrition guidelines. A significant group interaction was found between the three arms for compliance with individual food groups. Relative to control, a significantly greater proportion of low-intensity services were compliant with dairy, and a significantly greater proportion of high-intensity services were compliant with fruit, vegetables, dairy, breads and cereals, and discretionary foods. No significant differences between the high- and low-intensity for individual food group compliance were found. High-intensity implementation strategies may be effective in supporting childcare service implementation of individual food group recommendations. Further research is warranted to identify strategies effective in increasing overall nutrition compliance.

Effectiveness of a Web-Based Menu-Planning Intervention to Improve Childcare Service Compliance With Dietary Guidelines: Randomized Controlled Trial

BACKGROUND

Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines.

OBJECTIVE

This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed.

METHODS

A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up.

RESULTS

No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable.

CONCLUSIONS

Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx.

Randomised study demonstrates sustained benefits of a pre-school intervention designed to improve nutrition and physical activity practices

BACKGROUND

Health-promoting programmes must demonstrate sustained efficacy in order to make a true impact on public health. This study aimed to determine the effect of the Healthy Incentive for Pre-schools project on health-promoting practices in full-day-care pre-schools 18 months after a training intervention.

METHODS

Thirty-seven pre-schools completed the initial study and were included in this follow-up study. The intervention consisted of one training session with either the pre-school 'manager-only' or 'manager and staff' using a specifically developed needs-based training resource pack comprised of written educational material and a validated health-promoting practice evaluation tool. Direct observation data of health-promoting practices were collected and allocated a score using the evaluation tool by a research dietitian at three time points; pre-intervention, between 6 and 9 months post-intervention and at 18-month follow-up. An award system was used to incentivise pre-schools to improve their scores.

RESULTS

Health-promoting practice scores improved significantly (P < 0.001) from the 6-9 month post-intervention to the 18-month follow-up evaluation. No significant differences were observed between 'manager-only' and 'manager and staff' trained pre-schools.

CONCLUSIONS

The introduction of a pre-school evaluation tool supported by a training resource was successfully used to incentivise pre-schools to sustain and improve health-promoting practices 18 months after intervention training.

Menu planning practices in early childhood education and care - factors associated with menu compliance with sector dietary guidelines

ISSUE ADDRESSED

Despite recommendations, early childhood education and care services do not plan menus in accordance with sector dietary guidelines. This study aimed to examine the following among Australian long day care services: (a) menu planning practices; (b) prevalence of menu compliance with sector dietary guidelines; and (c) menu planning practices associated with higher menu compliance with sector dietary guidelines.

METHODS

Long day care services within Hunter New England, NSW participated in a pen and paper survey assessing menu planning practices and socio-demographic and service characteristics. Two-week menus were assessed for compliance with sector dietary guidelines, based on the number of servings of food groups and discretionary foods provided per child, per day.

RESULTS

Staff from 72 services completed the survey and 69 provided their menu. Results indicated the service cook was fully responsible for planning the menu in 43% of services, and 57% had received written support to assist with menu planning. Service menus were compliant with an average of 0.68 out of six food groups and discretionary foods. In poisson regression models, a shorter menu cycle length (P = .04) and the receipt of training opportunities to support menu planning (P < .01) were significantly associated with higher menu compliance.

CONCLUSIONS

Menu compliance with sector dietary guidelines is low among participating long day care services. SO WHAT?: The implementation of practices such as shortening of the menu cycle and the provision of training opportunities may assist in the planning of menus that are more compliant with dietary guidelines in this setting.

Challenges of Increasing Childcare Center Compliance With Nutrition Guidelines: A Randomized Controlled Trial of an Intervention Providing Training, Written Menu Feedback, and Printed Resources

PURPOSE

To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines.

DESIGN

Parallel group randomized controlled trial.

SETTING

Hunter New England region, New South Wales, Australia.

PARTICIPANTS

Forty-four childcare centers that prepare and provide food on-site to children while in care.

INTERVENTION

The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers.

MEASURES

Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each individual food group assessed via menu assessments. Cook knowledge of recommendations, intervention acceptability, adverse events, and barriers were also assessed via questionnaires with cooks and managers.

ANALYSIS

Logistic regression models, adjusted for baseline values of the outcome.

RESULTS

At baseline and follow-up, zero centers in the intervention and control groups were compliant with the overall menu guidelines or for the vegetable and meat food groups. Follow-up between-group differences in compliance for discretionary (33.3 vs 5, P = .18), dairy (41.7 vs 15, P = .16), breads and cereals (8.3 vs 10 P = 1.00), and fruit (16.7 vs 10, P = .48) were all nonsignificant. Relative to the control group, intervention centers showed a significantly greater increase in percentage of cooks with correct knowledge for vegetable servings (93.3 vs 36.4, P = .008).

CONCLUSION

Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required.

Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare services: A systematic review

Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to provide foods that are consistent with guideline recommendations. Developing strategies to improve childcare service adherence to menu dietary guidelines requires a comprehensive understanding of factors that may impede or promote implementation. The primary aim of this systematic review is to describe factors (barriers and facilitators) that may influence the implementation of menu dietary guidelines regarding food provision in centre-based childcare services and to map these factors to a theoretical framework. Over 7000 citations were identified from all sources. Duplicate abstracts were removed and selection criteria applied. Twelve studies (1994-2015) were included in the review. Dual data extraction was conducted and the reported factors were synthesised using the theoretical domains framework (TDF). Barriers and facilitators identified in qualitative studies were classified into 8 and 10 of the 14 TDF domains. Barriers and facilitators reported in quantitative studies covered 6 and 3 TDF domains respectively. The most common domain of which both barriers and facilitators to the implementation of menu dietary guidelines were identified was 'environmental context and resources'. This is the first study that comprehensively assesses literature to identify factors that influence the implementation of menu dietary guidelines in childcare services utilising a theoretical framework. Findings provide guidance to support researchers and policy makers design strategies to improve menu dietary guideline implementation and, as such have the potential to improve food provision in care.

A randomised controlled trial of an online menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol

INTRODUCTION

The implementation of dietary guidelines in childcare settings is recommended to improve child public health nutrition. However, foods provided in childcare services are not consistent with guidelines. The primary aim of the trial is to assess the effectiveness of a web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines regarding food provision to children in care.

METHODS AND ANALYSIS

A parallel group randomised controlled trial will be undertaken with 54 childcare services that provide food to children within New South Wales, Australia. Services will be randomised to a 12-month intervention or usual care. The experimental group will receive access to a web-based menu planning and decision support tool and online resources. To support uptake of the web program, services will be provided with training and follow-up support. The primary outcome will be the number of food groups, out of 6 (vegetables, fruit, breads and cereals, meat, dairy and 'discretionary'), on the menu that meet dietary guidelines (Caring for Children) across a 1-week menu at 12-month follow-up, assessed via menu review by dietitians or nutritionists blinded to group allocation. A nested evaluation of child dietary intake in care and child body mass index will be undertaken in up to 35 randomly selected childcare services and up to 420 children aged approximately 3-6 years.

ETHICS AND DISSEMINATION

Ethical approval has been provided by Hunter New England and University of Newcastle Human Research Ethics Committees. This research will provide high-quality evidence regarding the impact of a web-based menu planning intervention in facilitating the translation of dietary guidelines into childcare services. Trial findings will be disseminated widely through national and international peer-reviewed publications and conference presentations.

TRIAL REGISTRATION

Prospectively registered with Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12616000974404.

Consumo alimentar de crianças de 12 a 30 meses que frequentam Centros Municipais de Educação Infantil no município de Colombo, Sul do Brasil

Objetivo:Analisar o consumo alimentar de crianças de 12 a 30 meses que frequentam Centros Municipais de Educação Infantil.Métodos:Estudo transversal realizado com 86 crianças dos Centros Municipais de Educação Infantil do município de Colombo, Paraná. O consumo alimentar nas creches foi avaliado pelo método da pesagem direta individual dos alimentos em dois dias não consecutivos e, no domicílio, utilizando-se o recordatório alimentar de 24 horas. Foram analisadas as medianas e o risco de inadequação de energia e de nutrientes de acordo com as Ingestões Dietéticas de Referência e as recomendações do Programa Nacional de Alimentação Escolar.Resultados:A maioria dos nutrientes apresentou ingestão mediana diária acima dos valores recomendados pelas Ingestões Dietéticas de Referência; o cálcio apresentou o maior risco de inadequação entre os nutrientes; 43% das crianças mostraram elevada ingestão energética e o lipídeo apresentou valor abaixo do aceitável. O consumo nas creches foi inferior às recomendações do Programa Nacional de Alimentação Escolar para energia, carboidrato, lipídeo, cálcio, ferro e fibras. A contribuição da ingestão de energia e lipídeo no domicílio foi superior a 50% em relação à ingestão diária.Conclusão:Os valores medianos dos nutrientes, geralmente acima das recomendações, associados aos riscos de inadequação de alguns micronutrientes e ao elevado consumo energético, evidenciam a importância de adequar o consumo alimentar e promover hábitos alimentares saudáveis nas crianças.

A randomised controlled trial of an active telephone-based recruitment strategy to increase childcare-service staff attendance at a physical activity and nutrition training workshop

ISSUE ADDRESSED

Centre-based childcare services represent a promising setting to target the prevention of excessive weight gain in preschool-aged children. Staff training is a key component of multi-strategy interventions to improve implementation of effective physical activity and nutrition promoting practices for obesity prevention in childcare services. This randomised controlled trial aimed to examine whether an active telephone-based strategy to invite childcare-service staff to attend a training workshop was effective in increasing the proportion of services with staff attending training, compared with a passive strategy.

METHODS

Services were randomised to an active telephone-based or a passive-recruitment strategy. Those in the active arm received an email invitation and one to three follow-up phone calls, whereas services in the passive arm were informed of the availability of training only via newsletters. The proportion of services with staff attending the training workshop was compared between the two arms.

RESULTS

One hundred and twenty-eight services were included in this study. A significantly larger proportion (52%) of services in the active arm compared with those in the passive-strategy arm (3.1%) attended training (d.f.=1, χ2=34.3; P<0.001).

CONCLUSIONS

An active, telephone-based recruitment strategy significantly increased the proportion of childcare services with staff attending training. Further strategies to improve staff attendance at training need to be identified and implemented. SO WHAT?: Active-recruitment strategies including follow-up telephone calls should be utilised to invite staff to participate in training, in order to maximise the use of training as an implementation strategy for obesity prevention in childcare services.

An implementation intervention to encourage healthy eating in centre-based child-care services: impact of the Good for Kids Good for Life programme

OBJECTIVE

To determine the impact of an implementation intervention designed to introduce policies and practices supportive of healthy eating in centre-based child-care services. Intervention strategies included staff training, resources, incentives, follow-up support, and performance monitoring and feedback.

DESIGN

A quasi-experimental design was used to assess change over 20 months in healthy eating policy and practice in intervention and comparison child-care services.

SETTING

The Hunter New England (HNE) region of New South Wales (NSW), Australia.

SUBJECTS

All centre-based child-care services (n 287) in the intervention region (HNE) were invited and 240 (91% response rate) participated. Two hundred and ninety-six services in the rest of NSW were randomly selected as a comparison region and 191 participated (76% response rate). A sub-analysis was conducted on those services that provided children food (n 196 at baseline and n 190 at follow-up). Ninety-six provided menus for analysis at baseline (HNE, n 36; NSW, n 50) and 102 provided menus at follow-up (HNE, n 50; NSW, n 52).

RESULTS

Services in the intervention region were significantly more likely to provide only plain milk and water for children (P = 0.018) and to engage parents in nutrition policy or programmes (P = 0.002). They were also more likely (P = 0.056) to have nutrition policy on home packed food. In addition, menus of services that provided lunch were significantly more likely to comply with healthy eating guidelines for sweetened drinks (P < 0.001), fruit (P < 0.001) and vegetables (P = 0.01).

CONCLUSIONS

An implementation intervention was able to modify policy and practice in a large number of child-care services so that they were more supportive of healthy eating.

Healthy incentive scheme in the Irish full-day-care pre-school setting

A pre-school offering a full-day-care service provides for children aged 0-5 years for more than 4 h/d. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years' setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guidelines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day-care pre-school setting.

Pre-school manager training: a cost-effective tool to promote nutrition- and health-related practice improvements in the Irish full-day-care pre-school setting

OBJECTIVE

To evaluate the impact on nutrition- and health-related practice of two methods of delivery of a nutrition and health intervention in Irish full-day-care pre-schools: training of pre-school managers only or training of managers and their staff.

DESIGN

A simple randomised study with pre-schools divided into two training groups: 'manager trained' and 'manager and staff trained'. Direct observational data--food and fluid provision, physical activity, outdoor time, staff practices and availability of nutrition and health resources--were recorded during one full day spent in each pre-school both pre- and post-intervention, using a specifically developed and validated Pre-school Health Promotion Activity Scored Evaluation Form. Post-intervention, self-assessment data were also collected using the same evaluation tool.

SETTING

Pre-schools, Midlands of Ireland.

SUBJECTS

A convenience sample of forty-two pre-schools registered with the Irish Health Service Executive.

RESULTS

From pre- to post-intervention, significant improvement (P < 0.05) in nutrition- and health-related practice was observed within both intervention delivery groups in all areas evaluated: environment, food service, meals and snacks. No additional effect attributable to staff training was observed. Scores assigned by direct independent observation were lower than pre-school self-assessment scores.

CONCLUSIONS

The implementation of a training intervention in pre-schools significantly improved practice with no significant benefit of additional staff training. Direct independent observation is required to quantify practice accurately.