Pediatricians urged to help guide better nutritional choices


A recent study investigates the quality of early childhood diets both at home and at school, and neither are where they need to be.

The foods children eat in their early years create a foundation for what they understand about nutrition. A recent study examines how early education diets rate compared with what kids eat at home, and how educators and health care providers can work together to help foster healthier choices.

The study,1 published in the Journal of the Academy of Nutrition and Dietetics, investigated the diets of children aged 3 to 4 years over a 24-hour period at early care and education centers (ECEs) in North Carolina. The 24-hour snapshot reviewed both meals and snacks at the ECE during the day, plus parent reports of what children ate at home for the remainder of the day. The data were collected between 2015 and 2016, and evaluated using the Healthy Eating Index 2015.

The goal of the report was to investigate the quality of diets at ECEs, and to see how the nutritional value of these diets compared to food provided at the children’s homes.

“Our results indicate the diet quality of children’s intake at ECEs is minimally adequate. Although not evaluated in this study, our previous work indicates nutrition education for children in the center has mixed results but is typically more effective when parents are included,” says lead author Courtney T. Luecking, PhD, MPH, RDN, assistant professor and extension specialist in health and nutrition at the University of Kentucky in Lexington. “We can and need to do better regarding the types of foods and beverages provided to children as well as the behaviors adults display around meal and snack times.”

The study authors concluded that both parents and ECEs are key influencers in a child’s diet. There wasn’t enough information included in the report to make an overall nutritional assessment, but it was clear that children in these age groups consume the majority of their daily intake outside of education facilities, but that the quality of this food may be better than what these children have at home.

“Overall, diet quality is low, but the quality of foods consumed by children at ECEs is higher than that consumed elsewhere,” the report states. “Early care and education centers remain an important source of nutrition.”

More research is needed to determine the best way to help ECEs and families create better nutritional foundations for children.

The study revealed that children consumed a total of 40% of their daily nutrition at ECEs, and the food and drinks consumed at the ECE scored higher on the Healthy Eating Index than those at home or on the weekends. Luecking says the study identified priority nutrients and food groups for increasing children’s quality of dietary intake in early care and education settings and at home.

“By taking steps to provide children healthier environments regarding the types of foods and drinks they are offered and helping caregivers work together towards common goals, we can improve the nutritional status of our children,” she says. “Nutrition during early childhood has short- and long-term impact on physical, emotional, social, and cognitive health and development.”

The 2 big takeaways of the report, she says, are that there needs to be more “big picture” consideration when teaching children about healthy foods, and that all sources of intake should be examined.

“Instead of focusing on specific foods or nutrients, we need to obtain information that creates a bigger picture of the combination of foods and drinks children consume, like diet quality,” Luecking says. “We need to consider all the settings and adults responsible for the care of young children, because they can differentially contribute to the quality of their dietary intake.”

She explains that diet quality overall was low among the children in the study, even at home—with food and drink choices only slightly better in educational settings.

“Regardless of the setting, children need to have access to healthy foods and adults who encourage consumption of these foods,” Luecking says. “Overall diet quality could greatly increase through ensuring consistent access and support to consume more vegetables, particularly greens and beans and seafood and plant proteins, less sodium and added sugars, and to substitute whole grains for refined grains and heart-healthy unsaturated fats for saturated fats.”

A multidisciplinary approach is needed for improvement, she adds, suggesting a combined effort by parents, educators, and policymakers. Adults should set the tone for a good nutritional foundation, she says, and never forget how children look to them as an example.

“Children learn by watching the adults in their lives, both early care and education providers and family members. Adults who role model consuming, and enjoying, healthy foods will set a good example,” Luecking says. “Although well-intentioned, there are some behaviors that backfire when trying to promote consumption of healthy food. Adults should avoid pressuring, bribing, or punishing children regarding specific foods or drinks. Instead, adults can encourage and offer praise around trying healthy foods and support children in paying attention to their hunger and fullness cues. These are all ways adults can help children consume and learn about a healthy eating pattern.”

Clinicians can help the entire family by providing education about healthy diets and nutritional resources, she says.

“Pediatricians can take steps to support early care and education settings and the families who utilize services by getting involved with advocacy work promoting programs to receive additional support to provide a quality setting that includes access to healthy foods and beverages,” Luecking suggests. “This could be at a local, state, or national level. Pediatricians can also speak with parents or other family members about advocating for healthier foods and beverages in their child’s care setting.”

Pediatricians should also create opportunities to screen general nutrition behaviors and educate parents about the nutritional assistance programs that are available to them if they need it, like the Supplemental Nutrition Assistance Program and local food banks.

Luecking says she hopes the study highlights the importance of a good nutritional foundation early on, and inspires pediatricians to help support families and educators on making improvements.

“Diet quality early in life affects individuals and their future generations. We hope this report provides a call to action for supporting efforts to improve childhood nutrition,” Luecking says. “Creating and sustaining healthy habits is a lifelong endeavor that requires support from people in each of the places that children live, learn, and play.”


1. Luecking C, Mazzucca S, Vaughn A, Ward D. Contributions of early care and education programs to diet quality in children aged 3 to 4 years in central North Carolina. J Acad Nutr Diet. 2020;120(3):386-394. doi:10.1016/j.jand.2019.09.018

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