An Assessment of Nutrition Policies and Practices in Licensed Child Care Agencies in Tennessee

Objective Research was conducted to determine the extent to which a sample of licensed child care agencies in Tennessee met 31 nutrition and food service standards as contained in the National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs and to identify any significant differences by type of agency, USDA Child and Adult Care Food Program (CACFP) participation, and profit status.

Design A random sample of 300 licensed child care agencies stratified by type was surveyed by mailed questionnaire composed of 59 open and closed-ended items and five-point Likert-like scaled items. Three primary scores were calculated to describe Performance (with four sub-scores: Snack Time Performance; Infant Feeding Performance; Toddler/Preschooler Feeding Performance; and Mealtime Performance), Written Policies, and Staff and Environment.

Statistical Analysis Analyses included frequencies, means, and standard deviations for descriptive data. Significant differences were identified by the Wilcoxon rank sum and Kruskal-Wallis tests.

Results A total of 53.6% (n=158) respondents returned surveys, of these 93.7% (n=148) were useable. The Performance, Written Policies, and Staff and Environment scores were 86.9, 6.5, and 3.5 (maximum possible points = 100.0, 12.0, and 5.0, respectively). Significant differences were found for type of agency where both family day care homes and group day care homes met the standards included in the Staff and Environment Score better than child day care centers. Participants in CACFP had significantly higher score than nonparticipants for Written Policies and Staff and Environment Scores. Nonparticipants in CACFP had significantly higher scores than participants for the Snack Time sub-score. For profit agencies had significantly higher scores than nonprofit agencies for Staff and Environment. Results indicate that agencies do not always have written polices covering: staffing; food procurement, preparation and service; nutrition education; and menus as recommended in the Guidelines. Nutritionists or Dietitians are consulted infrequently.

Applications/Conclusions Results suggest that involvement of Nutritionists or Dietitians, having written nutrition plans and maintaining low child to staff ratios at mealtime are areas that would require some effort to meet the standards. The State Department of Human Services was identified as the primary source of nutrition information therefore, Registered Dietitians at the community level can build partnerships with child care agencies through the Department of Human Services.