Implementation of Minimum Nutrition Standards and Best Practices in Childcare Centers



      The federal Child and Adult Care Food Program (CACFP) provides reimbursable meals to 4.6 million children annually and sets nutrition standards for foods served. Licensing regulations in many states extend these rules to nonparticipating programs.


      To evaluate the quality of meals and snacks served in Connecticut licensed childcare centers in 2019 and assess implementation of a state licensing requirement to adhere to CACFP minimum nutrition standards in all centers.


      Cross-sectional survey.


      Two hundred licensed childcare centers in Connecticut in 2019.

      Main outcome measures

      Meal/snack quality was assessed based on menus. Foods/beverages listed were compared to the minimum CACFP nutrition standards and optional best practices. Surveys completed by center directors measured center characteristics.

      Statistical analysis

      Logistic and linear multivariable regression models tested differences in centers’ adherence to nutrition standards and best practices by CACFP participation status.


      CACFP centers complied with more required nutrition standards than non-CACFP centers (an adjusted mean of 4.7 vs 3.4 standards among programs serving meals, P < 0.001), with particularly large mean differences for whole grains and low-fat milk. Implementation of optional best practices, except for beverages, was relatively low among all centers, especially for snacks. Compliance (adjusted mean number of minimum nutrition standards met) was greater among centers accredited by the National Association for the Education of Young Children and those using a registered dietitian or a sponsoring agency to prepare menus and receiving food from a vendor. Recent completion of nutrition training was associated with greater mean implementation of best practices.

      Conclusions and implications

      Better adherence to minimum nutrition standards and best practices among CACFP-participating childcare centers contributed to higher nutritional quality of meals and snacks offered. Snack quality would benefit most from greater compliance with nutrition standards. Providers outside of CACFP need additional supports in the implementation of licensing regulations to improve the food environment for young children.


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        • Pan L.
        • Freedman D.S.
        • Park S.
        • Galuska D.A.
        • Potter A.
        • Blanck H.M.
        Changes in obesity among US children ages 2 through 4 enrolled in WIC during 2010-2016.
        JAMA. 2019; 321: 2364-2366
        • Skinner A.C.
        • Ravanbakht S.N.
        • Skelton J.A.
        • Perrin E.M.
        • Armstrong S.C.
        Prevalence of obesity and severe obesity in US children, 1999-2016.
        Pediatrics. 2018; 141e20173459
      1. US Department of Health and Human Services and US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. Published December 2015. Accessed December 16, 2020.

        • Fox M.K.
        • Condon E.
        • Briefel R.R.
        • Reidy K.C.
        • et al.
        Food consumption patterns of young preschoolers: Are they starting off on the right path?.
        J Am Diet Assoc. 2010; 110: S52-S59
        • Slining M.M.
        • Mathias K.C.
        • Popkin B.M.
        Trends in food and beverage sources among US children and adolescents: 1989-2010.
        J Acad Nutr Diet. 2013; 113: 1683-1694
        • Reidy K.C.
        • Deming D.M.
        • Briefel R.R.
        • Fox M.K.
        • et al.
        Early development of dietary patterns: Transitions in the contribution of food groups to total energy—Feeding Infants and Toddlers Study, 2008.
        BMC Nutr. 2017; 3: 5
        • Benjamin Neelon S.E.
        • Briley M.E.
        Position of the American Dietetic Association: Benchmarks for nutrition in child care.
        J Am Diet Assoc. 2011; 111: 607-615
        • Kaphingst K.M.
        • Story M.
        Child care as an untapped setting for obesity prevention: State child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States.
        Prev Chronic Dis. 2009; 6: 1-13
        • US Department of Agriculture
        Food and Nutrition Service. Child and Adult Care Food Program.
        (Accessed December 16, 2020)
        • Ritchie L.D.
        • Boyle M.
        • Chandran K.
        • Spector P.
        • et al.
        Participation in the Child and Adult Care Food Program is associated with more nutritious foods and beverages in child care.
        Child Obes. 2012; 8: 224-229
        • Korenman S.
        • Abner K.S.
        • Kaestner R.
        • Gordon R.A.
        The Child and Adult Care Food Program and the nutrition of preschoolers.
        Early Child Res Q. 2013; 28: 325-336
        • Andreyeva T.
        • Kenney E.L.
        • O’Connell M.
        • Sun X.
        • et al.
        Predictors of nutrition quality in early child education settings in Connecticut.
        J Nutr Educ Behav. 2018 May; 50: 458-467
        • Andreyeva T.
        • Henderson K.E.
        Center-reported adherence to nutrition standards of the Child and Adult Care Food Program.
        Child Obes. 2018; 14: 421-428
        • Erinosho T.
        • Vaughn A.
        • Hales D.
        • Mazzucca S.
        • et al.
        Participation in the Child and Adult Care Food Program is associated with healthier nutrition environments at family child care homes in Mississippi.
        J Nutr Educ Behav. 2018; 50: 441-450
        • Sigman-Grant M.
        • Christiansen E.
        • Fernandez G.
        • Fletcher J.
        • et al.
        Child care provider training and a supportive feeding environment in child care settings in 4 states, 2003.
        Prev Chronic Dis. 2011; 8: A113
        • Liu S.
        • Graffagino C.L.
        • Leser K.A.
        • Trombetta A.L.
        • et al.
        Obesity prevention practices and policies in child care settings enrolled and not enrolled in the Child and Adult Care Food Program.
        Matern Child Health J. 2016; 20: 1933-1939
      2. Department of Agriculture, Food and Nutrition Service. Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act of 2010; Final Rule 7 CFR Parts 210, 215, 220.

        • Institute of Medicine
        Child and Adult Care Food Program: Aligning Dietary Guidance for All.
        The National Academies Press, Washington, DC2010
        • US Department of Agriculture, Food and Nutrition Service
        Child and Adult Care Food Meal pattern revision: Best practices.
        (Accessed December 16, 2020)
        • Public Health Law Center at Mitchell Hamline School of Law
        Heathy child care: State-specific resources and licensing laws.
        (Accessed December 16, 2020)
        • Benjamin S.E.
        • Cradock A.
        • Walker E.M.
        • Slining M.
        • Gillman M.W.
        Obesity prevention in child care: A review of U.S. state regulations.
        BMC Public Health. 2008; 8: 188
      3. US Census Bureau. 2013-2017 American community survey 5-year estimates. Year: 2017 estimates. Accessed December 16, 2020.

        • Chriqui J.F.
        • Schermbeck R.M.
        • Leider J.
        Food purchasing and preparation at child day care centers participating in the Child and Adult Care Food Program in the United States, 2017.
        Child Obes. 2018; 14: 375-385
      4. Stata, Version 15.0, 2008. StataCorp LP, College Station, TX.

        • Schwartz M.B.
        • Henderson K.E.
        • Kenney E.L.
        • et al.
        Comparing current practice to recommendations for the Child and Adult Care Food Program.
        Child Obes. 2015; 11: 491-498
        • Poole M.K.
        • Cradock A.L.
        • Kenney E.L.
        Implementing the new Child and Adult Care Food Program’s nutrition standards.
        Prev Chronic Dis. 2020; 17: E44
        • Chriqui J.F.
        • Leider J.
        • Schermbeck R.M.
        • Sanghera A.
        • Pugach O.
        Changes in Child and Adult Care Food Program (CACFP) practices at participating childcare and education centers in the united states following updated national standards, 2017-2019.
        Nutrients. 2020; 12: 2818
        • Schermbeck R.M.
        • Kim M.
        • Chriqui J.F.
        Independent early childhood education centers’ experiences implementing the revised Child and Adult Care Food Program meal pattern standards: A qualitative exploratory study.
        J Acad Nutr Diet. 2021 Apr; 121: 678-687.e1
        • Benjamin Neelon S.E.
        • Finkelstein J.
        • Neelon B.
        • Gillman M.W.
        Evaluation of a physical activity regulation for child care in Massachusetts.
        Child Obes. 2017; 13: 36-43
        • Benjamin Neelon S.E.
        • Mayhew M.
        • O’Neill J.R.
        • Neelon B.
        • Li F.
        • Pate R.R.
        Comparative evaluation of a South Carolina policy to improve nutrition in child care.
        J Acad Nutr Diet. 2016; 116: 949-956
        • LaRowe T.L.
        • Tomayko E.J.
        • Meinen A.M.
        • Hoiting J.
        • Saxler C.
        • Cullen B.
        Active Early: One-year policy intervention to increase physical activity among early care and education programs in Wisconsin.
        BMC Public Health. 2016; 16: 607
        • Van Stan S.
        • Lessard L.
        • Dupont Phillips K.
        The impact of a statewide training to increase child care providers’ knowledge of nutrition and physical activity rules in Delaware.
        Child Obes. 2013; 9: 43-50
        • Alkon A.
        • Crowley A.A.
        • Neelon S.E.B.
        • Hill S.
        • Pan Y.
        • Viet N.
        • et al.
        Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children’s body mass index.
        BMC Public Health. 2014 1; 14: 215
        • Hasnin S.
        • Dev D.A.
        • Tovar A.
        Participation in the CACFP ensures availability but not intake of nutritious foods at lunch in preschool children in child-care centers.
        J Acad Nutr Diet. 2020; 120: 1722-1729
        • Benjamin Neelon S.E.
        • Copeland K.A.
        • Ball S.C.
        • Bradley L.
        • Ward D.S.
        Comparison of menus to actual foods and beverages served in North Carolina child-care centers.
        J Am Diet Assoc. 2010; 110: 1890-1895
        • Fleischhacker S.
        • Cason K.L.
        • Achterberg C.
        “You had peas today?”: A pilot study comparing a Head Start child-care center’s menu with the actual food served.
        J Am Diet Assoc. 2006; 106: 277-280
        • Dave J.M.
        • Cullen K.W.
        Foods served in child care facilities participating in the Child and Adult Care Food Program: Menu match and agreement with the new meal patterns and best practices.
        J Nutr Educ Behav. 2018; 50: 582-588
        • National Center for Education Statistics
        Early Childhood Care Arrangements: Choices and Costs.
        (May 2018) (Accessed May 30, 2021)


      T. Andreyeva is an associate professor, Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT.


      X. Sun is a PhD Candidate, Department of Agricultural and Resource Economics, University of Connecticut, Storrs, CT.


      M. Cannon is a research technician, Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT.


      E. L. Kenney is an assistant professor, Harvard T.H. Chan School of Public Health, Boston, MA.