C. Roberts-Gray

What can children learn from the menu at the child care center

As a result of studies in Texas that indicated menus in child care centers may be depriving children of nutrients, a study was conducted to determine the prevalence of similar problems in 7 states. Menus for breakfast or morning snack, lunch, and afternoon snack for 10 consecutive program days were obtained from 171 child care centers. Results of nutrient analysis of the menus were compared against the Recommended Dietary Allowances (RDA) for children aged 1 to 3 and 4 to 6. Menus typically provided at least 100 percent of the RDA for protein and the vitamins A, ascorbic acid, B12, and riboflavin. The menus offered an average of only 42 percent of the iron needed by both the younger and older children. In all 7 states the menus provided less than 56 percent of the kilocalories recommended and less than 64 percent of niacin for the 1 to 3 year olds. Mean value for kilocalories for the 3–5 year old averaged 40 percent of recommendation while niacin averaged 48 percent. These findings indicate that attention should be directed toward careful assessment of nutritional adequacy of meals and snacks actually served at child care centers, the childrens nutritional intake at the center, and the nutritional content of meals and snacks eaten away from the center.

Unbundling Outcomes of a Multilevel Intervention to Increase Fruit, Vegetables and Whole Grains Parents Pack for Their Preschool Children in Sack Lunches.

Abstract Background: Packing fruit, vegetables and whole grains in preschool childrens sack lunches is a powerful way for parents to teach their children eating habits and food preferences to support a lifetime of good health. A multilevel intervention pilot-tested in childcare settings increased servings of vegetables and whole grains, but the lunches still fell short of the intervention goals. Purpose: Secondary analyses were conducted to identify specific behavior changes underlying achieved increases in servings of vegetables and whole grains. Methods: Food records from direct observation of 769 parent-packed lunches were investigated to unbundle and measure multiple aspects of lunch packing behavior. Changes from baseline to six week follow-up for the intervention (N = 81) and comparison (N = 51) parent-child dyads were evaluated in multilevel modeling. Results: The increase for whole grains was explained by more parents packing whole grain items whereas increase for vegetables was explained by parents packing vegetables on more days. Discussion: Tailored options were identified for further strategies to increase vegetables and whole grains in parentpacked sack lunches. Translation to Health Education Practice: Linking achieved outcomes to specific behaviors can be an aid in assessing needs and designing interventions to maximize the chances for success.

Development of a Method to Observe Preschoolers' Packed Lunches in Early Care and Education Centers.

BACKGROUND As early childhood education (ECE) centers become a more common setting for nutrition interventions, a variety of data collection methods are required, based on the center foodservice. ECE centers that require parents to send in meals and/or snacks from home present a unique challenge for accurate nutrition estimation and data collection. We present an observational methodology for recording the contents and temperature of preschool-aged childrens lunchboxes and data to support a 2-day vs a 3-day collection period. METHODS Lunchbox observers were trained in visual estimation of foods based on Child and Adult Care Food Program and MyPlate servings and household recommended measures. Trainees weighed and measured foods commonly found in preschool-aged childrens lunchboxes and practiced recording accurate descriptions and food temperatures. Training included test assessments of whole-grain bread products, mixed dishes such as macaroni and cheese, and a variety of sandwich preparations. Validity of the estimation method was tested by comparing estimated to actual amounts for several distinct food types. Reliability was assessed by computing the intraclass correlation coefficient for each observer as well as an interrater reliability coefficient across observers. To compare 2- and 3-day observations, 2 of the 3 days of observations were randomly selected for each child and analyzed as a separate dataset. Linear model estimated mean and standard error of whole grains, fruits and vegetables, and amounts of energy, carbohydrates, protein, total fat, saturated fat, dietary fiber, thiamin, riboflavin, niacin, vitamins A and C, calcium, iron, sodium, and dietary fiber per lunch were compared across the 2- and 3-day observation datasets. RESULTS The mean estimated amounts across 11 observers were statistically indistinguishable from the measured portion size for each of the 41 test foods, implying that the visual estimation measurement method was valid: intraobserver intraclass correlation coefficients ranged from 0.951 (95% CI 0.91 to 0.97) to 1.0. Across observers, the interrater reliability correlation coefficient was estimated at 0.979 (95% CI 0.957 to 0.993). Comparison of servings of fruits, vegetables, and whole grains showed no significant differences for serving size or mean energy and nutrient content between 2- and 3-day lunch observations. CONCLUSIONS The methodology is a valid and reliable option for use in research and practice that requires observing and assessing the contents and portion sizes of food items in preschool-aged childrens lunchboxes in an ECE setting. The use of visual observation and estimation with Child and Adult Care Food Program and MyPlate serving sizes and household measures over 2 random days of data collection enables food handling to be minimized while obtaining an accurate record of the variety and quantities of foods that young children are exposed to at lunch time.

Temperature of Foods Sent by Parents of Preschool-Aged Children

OBJECTIVE: To measure the temperatures of foods in sack lunches of preschool-aged children before consumption at child care centers. METHODS: All parents of 3- to 5-year-old children in full-time child care at 9 central Texas centers were invited to participate in the study. Foods packed by the parents for lunch were individually removed from the sack and immediately measured with noncontact temperature guns 1.5 hours before food was served to the children. Type of food and number of ice packs in the lunch sack were also recorded. Descriptive analyses were conducted by using SPSS 13.0 for Windows. RESULTS: Lunches, with at least 1 perishable item in each, were assessed from 235 parent-child dyads. Approximately 39% (n = 276) of the 705 lunches analyzed had no ice packs, 45.1% (n = 318) had 1 ice pack, and 88.2% (n = 622) of lunches were at ambient temperatures. Only 1.6% (n = 22) of perishable items (n = 1361) were in the safe temperature zone. Even with multiple ice packs, the majority of lunch items (>90%) were at unsafe temperatures. CONCLUSIONS: These results provide initial data on how frequently sack lunches sent by parents of preschool-aged children are kept at unsafe temperatures. Education of parents and the public must be focused on methods of packing lunches that allow the food to remain in the safe temperature zone to prevent foodborne illness.

Examining How Adding a Booster to a Behavioral Nutrition Intervention Prompts Parents to Pack More Vegetables and Whole Gains in Their Preschool Children's Sack Lunches

Data from a five-week intervention to increase parents’ packing of vegetables and whole grains in their preschool childrens sack lunches showed that, although changes occurred, habit strength was weak. To determine the effects of adding a one-week booster three months post-intervention, childrens (N = 59 intervention and 48 control) lunches were observed at baseline (week 0), post-intervention (week 6), pre-booster (week 20), and post-booster (week 26). Servings of vegetables and whole grains were evaluated in repeated measures models and results inspected relative to patterns projected from different explanatory models of behavior change processes. Observed changes aligned with projections from the simple associative model of behavior change. Attention in future studies should focus on behavioral intervention elements that leverage stimulus-response associations to increase gratification parents receive from providing their children with healthy lunches.

Effectiveness of the Lunch is in the Bag program on communication between the parent, child and child-care provider around fruits, vegetables and whole grain foods: A group-randomized controlled trial

OBJECTIVE To evaluate the effectiveness of the parent- and early care education (ECE) center-based Lunch is in the Bag program on communication between parent, child, and their ECE center providers around fruits, vegetables and whole grain foods (FVWG). METHOD A total of n=30 ECE center; 577 parent-child dyads participated in this group-randomized controlled trial conducted from 2011 to 2013 in Texas (n=15 ECE center, 327 dyads intervention group; n=15 ECE center, 250 dyads comparison group). Parent-child and parent-ECE center provider communication was measured using a parent-reported survey administered at baseline and end of the five-week intervention period. Multilevel linear regression analysis was used to compare the pre-to-post intervention changes in the parent-child and parent-ECE center provider communication scales. Significance was set at p<0.05. RESULTS At baseline, parent-child and parent-ECE center provider communication scores were low. There was a significant increase post-intervention in the parent-ECE center provider communication around vegetables (Adjusted β=0.78, 95%CI: 0.13, 1.43, p=0.002), and around fruit (Adjusted β=0.62, 95%CI: 0.04, 0.20, p=0.04) among the parents in the intervention group as compared to those in the comparison group. There were no significant intervention effects on parent-child communication. CONCLUSION Lunch is in the Bag had significant positive effects on improving communication between the parents and ECE center providers around FVWG.

Maternal development experiences of women hospitalized to prevent preterm birth

OBJECTIVE To examine ways that womens experience of hospitalization with bed rest to prevent preterm birth impacts prenatal maternal development. METHOD Interviews based on the Interview Schedules for Dimensions of Maternal Development in Psychosocial Adaptation to Pregnancy were conducted at a hospital in the southwestern United States with a convenience sample of 41 women during confinement to bed rest to prevent preterm birth. The interviews were recorded, and verbatim transcripts were submitted to thematic analysis. RESULTS Five themes were mapped from the womens narratives: (1) acceptance of pregnancy, but with fears specific to elevated risks to self and baby; (2) heightened identification with motherhood and fatherhood protector roles; (3) renewal or deepening of mother-daughter closeness intensified by high-risk pregnancy; (4) enhanced couple support and collaboration; and (5) acceptance of responsibility to perform in remaining pregnant and preparing for labor, but willingness to accept help from doctors and nurses. CONCLUSIONS This study of hospitalization to prevent preterm birth showed that women experience hospitalization as a burden to be endured to meet future goals, but that it also can facilitate prenatal maternal development in psychosocial adaptation to high risk pregnancy. Implications for research and practice are discussed.

Nutrition Related Activities at Child Care Centers

Abstract LEARNING OUTCOME: To identify options for helping children to learn and practice good eating habits at the child care center. Curriculum related activities and food service management at nonprofit child care centers were evaluated in a mailed survey of 458 licensed centers in central Texas. Although 326 centers (72%) responded to the survey, only 106 said they prepare and serve meals. A total of 93 centers supplied information about their food service operations. Eighty two of the 93 centers reported they sent menus home monthly. New menus were written daily at 2 centers, weekly at 15, monthly at 36, occasionally at 35, and never at 4. New recipes were tried occasionally at 62 (67%) centers. Child care licensing personnel and other child care directors were named most often as sources of nutrition information. Forty-five of the 93 centers indicated they occasionally seek advice from a nutrition consultant. The most frequent use of food in the curriculum was as art material (88%). Cooking experiences with the children at least monthly were reported by 51 centers (55%). Only 33% of centers indicated they involve children in discussion of nutrient content of foods served. These data are being used to develop means for expanding childrens opportunities to learn and practice healthy eating habits.

Diets Of Children In Family Day Care Homes That Participate In Child And Adult Care Food Program

Abstract Site visits were made to nine FDH for three consecutive days to obtain copies of menus; weigh and measure food; instruct parents of 29 children to keep a three day diet record of foods their child ate when not at the FDH. Nutrient content of food at the FDH was analyzed and compared to 50% and 67% of the Recommended Dietary Allowances (RDA) using Professional Nutrient Calculator. Food consumed by children away from FDH was compared to 33% of RDA. The two values were combined and compared against 100% RDA. Food consumed at the FDH provided an average of 46% kilocalories; 55% niacin; 61% 85; 42% E; 42% iron; 45% copper, 42% zinc. Percent calories from fat averaged 29%. Zinc, 29%, was the only nutrient below 33% for food consumed away from the FDH. Total intake was 100% or greater for all nutrients except energy 76%; E 68%; niacin 92%; zinc 59%; copper 87%; and iron 72%. These data support the hypothesis that CACFP makes a valuable contribution to nutrient intake of young children. Continued attention is required, however, to ensure that enough food is provided to support healthy growth