Abstract
Children in childcare make two transitions daily between home and childcare, which are stressful for parents and children. Little is known about children's diets during these transition periods. This study compared children’s dietary intake and quality during transition periods (1 hour before and after drop-off, 1 hour before and after pickup) and non-transition periods to address this literature gap. We used 24-hour dietary intake data from 307 children attending 30 child-care centers in the Preschool Eating and Activity Study (2009-2011). We used hierarchical linear regression to test for differences in dietary quality per 1000 kcal during transition and non-transition periods. When comparing all transition periods to non-transition periods, consumption of added sugar (g) (β=13.92±2.78, p<0.001) and servings of sweet and salty snack foods (β=0.64±0.13, p<0.001) were higher, while servings of dairy (β=−0.20±0.10, p=0.04) and vegetables (β=−0.54±0.07, p<0.001) were lower. When comparing each transition period individually to non-transition periods, the hour after pickup appeared the least healthful, with higher consumption of added sugar (g) (β=21.67±3.56, p<0.001), servings of sweet and salty snack foods (β=1.10±0.16, p<0.001), and servings of sugar-sweetened beverages (β=0.48±0.10, p<0.001). Implications are that transition periods may provide a window to improve dietary quality of children attending child-care centers.
INTRODUCTION
The preschool years (ages 3-5) are a critical period for preventing childhood obesity (Cunningham et al., 2014; Nader et al., 2006) and a time in which children and families establish eating habits that persist into school years and beyond (Nicklaus, 2009; Skinner et al., 2002). Sixty one percent of US children ages 3-5 years attend child-care centers (Cui & Natzke, 2021), where the meals provided are regulated at the state (Benjamin et al., 2008) and federal (Institute of Medicine, 2011; U.S. Department of Agriculture Food and Nutrition Service, 2023) levels in an effort to provide children with healthy choices. Studies suggest that preschool-age children who attend childcare may eat more nutritiously at childcare relative to at home (Glenn et al., 2022; Robson et al., 2015; Sisson et al., 2017), but little is known about the timing of nutrient intake and whether transition periods between home and childcare could play a role.
Transition periods can be a particularly stressful time in the day, when children must adjust to a change in environment and when caregivers may be rushing to or from work or other responsibilities. Transition periods typically occur close to mealtimes (breakfast or dinner) when children may be particularly hungry and often coincide with caregiver time constraints. Caregivers may feed children in the absence of hunger, in order to comfort or placate them (Noble et al., 2005) and may provide energy dense/nutrient-poor foods because those foods are the most readily available (Dwyer et al., 2008; Hughes et al., 2010; Ling et al., 2016; Parks et al., 2016; Pescud & Pettigrew, 2014). Studies have shown caregivers may feed their child poorer nutritional value foods when they feel stressed (Hughes et al., 2010; Parks et al., 2016) or guilty (Harris et al., 2020; Hughes et al., 2010; Noble et al., 2005), have limited time (Dwyer et al., 2008; Ling et al., 2016; Parks et al., 2016; Pescud & Pettigrew, 2014; Walsh et al., 2015), or in order to avoid conflict (Harris et al., 2020; Hughes et al., 2010; Walsh et al., 2015). Poor dietary quality during these transition periods has the potential to lead to poor nutritional intake in the short term and could contribute to establishing unhealthy routines and habits, leading to obesity and cardiovascular disease in the long term. It remains unknown, however, what children eat during these potentially vulnerable transition periods, why, and to what extent transition period consumption may negatively affect children’s dietary quality.
The objective of this analysis was to compare children's dietary quality during transition periods (1 hour before and after drop-off from childcare, 1 hour before and after pickup from childcare) and non-transition periods (the remaining time periods coinciding with dinner, overnight and a possible breakfast at home, and the day in childcare typically consisting of one meal and two snacks or two meals and one snack) (Figure 1). We hypothesized that dietary quality would be higher during non-transition periods relative to transition periods.
Figure 1.
Illustration of Daily Transition Periods between Childcare and Home
METHODS
Participants and Setting
The data used for this secondary analysis were collected from 2009 to 2011 as part of the Preschool Eating and Activity Study (PEAS), a cross-sectional study of physical activity and nutrition environments in child-care centers (Copeland et al., 2016). Thirty full-time child-care centers were randomly selected from a randomly ordered list of all child-care centers in Hamilton County, Ohio. Children from 2 randomly-selected classrooms from each of the centers were offered participation in the study. Eligibility criteria included: children 36 to 72 months of age who attended the child-care center for at least 1 month, were not enrolled in kindergarten, and had no chronic disability that would prevent participation in physical activity. Participation was limited to one child per family. Children were included in this secondary analysis if there was a complete 24-hour dietary record from both childcare and home. Written informed consent was obtained from a parent of each participating child and from the directors at each child-care center. The Institutional Review Board at Cincinnati Children’s Hospital Medical Center approved the study protocol.
Measures
Participant food and beverage consumption at the child-care center was recorded using a validated visual estimation protocol (Ball et al., 2007). Participant food and beverage consumption outside of the center was reported by parents using a food record which included time, meal type (e.g. breakfast or dinner), quantity of foods consumed, and type of preparation (e.g. fried or grilled). Parents were given detailed instructions with pictures to assist in accurate estimation of food quantities. Research staff clarified food quantities, type of preparation, and potential omissions the following morning. Nutrition Data System for Research (NDSR) software (versions 2009, 2010, 2011, Nutrition Coordinating Center, University of Minnesota) was used to quantify energy intake and servings of fruits, vegetables, sugar-sweetened beverages (SSBs), and sweet and salty snack foods consumed. Sweet and salty snack foods were defined by the NDSR codes for fruit-based savory snacks; vegetable-based savory snacks; meat-based savory snacks; crackers; snack bars; snack chips; popcorn; nuts and seeds; nondairy yogurt; frozen dairy and nondairy dessert; puddings; cakes, cookies, pies, pastries, Danish, doughnuts, and cobblers; chocolate and non-chocolate candy; and miscellaneous desserts. Furthermore, we did not count fried fruits and vegetables and fruit and vegetable juices toward servings of whole fruits and whole vegetables. The 24-hour period under observation was separated into 6 time periods: 4 transition periods —1 hour before (T1) and after drop-off (T2) and 1 hour before (T4) and after pickup (T5) — and 2 non-transition periods, the rest of day at the center (T3) and at home (T6, Figure 1). The 1-hour period on either side of the transition was selected after hand-reviewing the majority of the diet records and noticing that children were having multiple eating occasions, including during this time period. Parents reported child sex, age, race, ethnicity, one- vs. two-parent household, and eligibility for subsidized meals through the Child and Adult Care Food Program (CACFP) on a demographic questionnaire.
Statistical Analysis
Descriptive statistics were used to characterize participant demographics, energy intake, and food intake. Hierarchical linear regression models fit using the lmer function in the lme4 package (version 1.1.27) (Bates et al., 2015) were used to test for differences in total kcals and measures of dietary quality per 1000 kcal during transition and non-transition periods. Models included random intercepts to account for the repeated measures within children across time points and children nested within classrooms. The Satterthwaite approximation was used to obtain the estimated model degrees of freedom using the lmerTest package (version 3.1.3) (Kuznetsova et al., 2017). The first model compared the 4 transition periods (T1, T2, T4, T5) relative to the 2 non-transition periods (T3, T6). The second model compared the transition periods in the parents’ care (the hour before drop-off and the hour after pickup; T1, T5) to the 2 non-transition periods (T3, T6). The third model compared the transition periods in childcare (the hour after drop-off and the hour before pickup; T2, T4) to the 2 non-transition periods (T3, T6). The fourth model compared the transition periods in childcare (T2, T4) to the transition periods in the parents’ care (T1, T5). Subsequent models were fit to compare each individual transition period (T1; T2; T4; T5) to the 2 non-transition periods (T3, T6). All models were adjusted for CACFP eligibility (as a proxy for household income), race (White vs. non-White), and one- vs. two-parent households. Analyses were conducted using the R software environment for statistical computing and graphics (version 4.1.1) (R Core Team, 2021).
RESULTS
Thirty randomly-selected child-care center directors agreed to participate in PEAS with a 10% refusal rate, citing time or staffing constraints. Two classrooms in each center were randomly selected with no refusals. Of the 570 potentially eligible children, 447 (77%) families consented to participate, and 307 children had complete 24-hour dietary intake data and were included in this analysis. The child participants were mean (SD) 4.3 (0.7) years of age, 46% male, 41% Black, and 41% White (Table 1). Forty nine percent lived in a two-parent household and 57% were CACFP-eligible (Table 1). Over the 24-hour period, children consumed a mean (SD) of 1472 (419) kcal, 58 (36) grams of added sugar, 1.8 (1.5) servings of sweet and salty snack foods, 0.6 (0.8) servings of SSBs, 2.2 (1.2) servings of dairy, 1.4 (1.2) servings of fruit, 1.2 (0.9) servings of vegetables, and 0.7 (1.0) servings of whole grains (Table 2).
Table 1.
Demographic characteristics of participating children (n=307)
| N (%) or Mean (SD) | |
|---|---|
| Age, in years | 4.3 (0.7) |
| Male | 140 (46%) |
| Eligible for subsidized meals through the Child and Adult Care Food Program (CACFP) a | 173 (57%) |
| Two-parent household | 151 (49%) |
| Hispanic/Latino a | 13 (4%) |
| Race b | |
| White | 123 (41%) |
| Black | 126 (41%) |
| Asian | 9 (3%) |
| Other, including mixed race | 46 (15%) |
Missing=5
Missing=3
Table 2.
Means and standard deviations for energy and food intake
| Full day (n=307) | Hour before drop-off (T1) (n=24) |
Hour after drop-off (T2) (n=158) |
Non- transition time at childcare (T3) (n=306) |
Hour before pickup (T4) (n=93) |
Hour after pickup (T5) (n=186) |
Non- transition time at home (T6) (n=295) |
|
|---|---|---|---|---|---|---|---|
| Total energy intake (kcal) | 1471.6 (418.5) | 193.0 (112.9) | 183.5 (108.1) | 502.2 (217.1) | 170.5 (138.9) | 290.2 (209.0) | 659.8 (326.6) |
| Added sugar (grams) | 57.9 (35.6) | 11.1 (12.3) | 7.7 (9.1) | 15.8 (19.0) | 9.1 (16.7) | 12.7 (14.5) | 27.9 (24.6) |
| Sweet and salty snack foods (servings) | 1.8 (1.5) | 0.1 (0.3) | 0.1 (0.4) | 0.5 (0.8) | 0.5 (0.8) | 0.5 (0.9) | 0.8 (1.0) |
| Sugar-sweetened beverages (servings) | 0.6 (0.8) | 0.1 (0.2) | 0.0 (0.1) | 0.1 (0.3) | 0.1 (0.2) | 0.2 (0.4) | 0.4 (0.7) |
| Dairy (servings) | 2.2 (1.2) | 0.3 (0.3) | 0.4 (0.3) | 1.1 (0.7) | 0.2 (0.3) | 0.3 (0.4) | 0.7 (0.7) |
| Fruit (servings) | 1.4 (1.2) | 0.2 (0.3) | 0.2 (0.3) | 0.6 (0.5) | 0.1 (0.3) | 0.2 (0.5) | 0.6 (0.9) |
| Vegetables (servings) | 1.2 (0.9) | 0.0 (0.0) | 0.0 (0.1) | 0.5 (0.5) | 0.1 (0.2) | 0.2 (0.5) | 0.6 (0.8) |
| Whole grains (servings) | 0.7 (1.0) | 0.1 (0.4) | 0.1 (0.2) | 0.1 (0.4) | 0.1 (0.2) | 0.1 (0.5) | 0.4 (0.8) |
Note. Values reflect absolute intakes of energy and foods.
n reflects the number of children that ate during each time period.
Comparison of dietary intake during transition periods vs. non-transition periods
In adjusted models comparing all 4 transition periods (T1, T2, T4, T5) to non-transition periods (T3, T6), consumption of dairy and vegetables were lower (β=−0.20 servings per 1000 kcal, SE=0.10, p=0.04 and β=−0.54 servings per 1000 kcal, SE=0.07, p <0.001, respectively), while consumption of added sugar and snack foods were higher (β=13.92 grams per 1000 kcal, SE=2.78, p <0.001 and β=0.64 servings per 1000 kcal, SE=0.13, p <0.001, respectively) (Table 3). When comparing the hour prior to drop-off and the hour after pickup (T1, T5) to non-transition periods (T3, T6), consumption of dairy and vegetables were lower (β=−0.75 servings per 1000 kcal, SE= 0.11, p <0.001 and β=−0.26 servings per 1000 kcal, SE= 0.10, p=0.006, respectively), while consumption of added sugar, snack foods, and SSBs were higher (β=20.22 grams per 1000 kcal, SE= 3.40, p <0.001; β=0.90 servings per 1000 kcal, SE= 0.15, p <0.001; β=0.40 servings per 1000 kcal, SE= 0.10, p <0.001, respectively). When comparing the hour after drop-off and hour before pickup (T2, T4) to non-transition periods (T3, T6), consumption of SSBs and vegetables were lower (β=−0.14 servings per 1000 kcal, SE=0.07, p=0.04 and β=−0.77 servings per 1000 kcal, SE=0.07, p<0.001), while consumption of added sugar, snack foods, and dairy were higher (β=8.59 grams per 1000 kcal, SE=2.91, p=0.003; β=0.43 servings per 1000 kcal, SE=0.14, p=0.002; and β=0.25 servings per 1000 kcal, SE=0.12, p=0.04, respectively).
Table 3.
Conditional mean differences in energy and food intake during transition periods versus non-transition periods
| All transition periods (T1, T2, T4, T5*) vs. Non- transition periods (T3, T6*) |
Hour before drop-off and hour after pickup (T1, T5*) vs. Non-transition periods (T3, T6*) |
Hour after drop-off and hour before pickup (T2, T4*) vs. Non-transition periods (T3, T6*) |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| Energy/food | β | S.E. | p-value | β | S.E. | p-value | β | S.E. | p-value |
| Total energy intake (kcal) | −353.84 | 15.17 | <0.001 | −300.10 | 21.61 | <0.001 | −399.25 | 18.96 | <0.001 |
| Added sugar (grams) | 13.92 | 2.78 | <0.001 | 20.22 | 3.40 | <0.001 | 8.59 | 2.91 | 0.003 |
| Sweet and salty snack foods (servings) | 0.64 | 0.13 | <0.001 | 0.90 | 0.15 | <0.001 | 0.43 | 0.14 | 0.002 |
| Sugar-sweetened beverages (servings) | 0.10 | 0.07 | 0.15 | 0.40 | 0.10 | <0.001 | −0.14 | 0.07 | 0.04 |
| Dairy (servings) | −0.20 | 0.10 | 0.04 | −0.75 | 0.11 | <0.001 | 0.25 | 0.12 | 0.04 |
| Fruit (servings) | 0.21 | 0.16 | 0.19 | 0.14 | 0.20 | 0.48 | 0.28 | 0.16 | 0.09 |
| Vegetables (servings) | −0.54 | 0.07 | <0.001 | −0.26 | 0.10 | 0.006 | −0.77 | 0.07 | <0.001 |
| Whole grains (servings) | 0.08 | 0.08 | 0.35 | 0.01 | 0.09 | 0.94 | 0.13 | 0.10 | 0.18 |
Note. Coefficients obtained using hierarchical linear regression adjusted for CACFP status, race (White/Non-White), and single vs couple status.
All estimates reflect values per 1,000 kcal (except total energy intake).
See Figure 1 for definitions of each transition period
Comparison of dietary intake during transition periods in childcare vs. transition periods in parents’ care
When comparing the hour after drop-off and hour before pickup (T2, T4) to the hour before drop-off and hour after pickup (T1, T5), consumption of added sugar, snack foods, SSBs, and vegetables were lower (β=−12.57 grams per 1000 kcal, SE=5.28, p=0.02; β=−0.51 servings per 1000 kcal, SE=0.25, p=0.04; β=−0.55 servings per 1000 kcal, SE=0.13, p<0.001; and β=−0.51 servings per 1000 kcal, SE=0.10, p<0.001, respectively), while consumption of dairy was higher (β=1.02 servings per 1000 kcal, SE=0.17, p=<0.001) (Table 4).
Table 4.
Conditional mean differences in energy and food intake during transition periods in childcare vs. transition periods in parents’ care
| Hour after drop-off and hour before pickup (T2, T4*) vs. Hour before drop-off and hour after pickup (T1, T5*) |
|||
|---|---|---|---|
| Energy/food | B | S.E. | p-value |
| Total energy intake (kcal) | −98.85 | 15.34 | <0.001 |
| Added sugar (grams) | −12.57 | 5.28 | 0.02 |
| Sweet and salty snack foods (servings) | −0.51 | 0.25 | 0.04 |
| Sugar-sweetened beverages (servings) | −0.55 | 0.13 | <0.001 |
| Dairy (servings) | 1.02 | 0.17 | <0.001 |
| Fruit (servings) | 0.06 | 0.32 | 0.84 |
| Vegetables (servings) | −0.51 | 0.10 | <0.001 |
| Whole grains (servings) | 0.12 | 0.15 | 0.40 |
Note. Coefficients obtained using hierarchical linear regression adjusted for CACFP status, race (White/Non-White), and single vs couple status.
All estimates reflect values per 1,000 kcal (except total energy intake).
See Figure 1 for definitions of each transition period
Comparison of dietary intake during each individual transition period vs. non-transition periods
When comparing the hour before drop-off (T1) to non-transition periods (T3, T6), consumption of snack foods and vegetables were lower (β =−0.64 servings per 1000 kcal, SE=0.30, p=0.03 and β=−0.86 servings per 1000 kcal, SE= 0.22, p=<0.001, respectively) (Table 5). When comparing the hour after drop-off (T2) to non-transition periods (T3, T6), consumption of snack foods, SSBs, and vegetables were lower (β=−0.31 servings per 1000 kcal, SE=0.14, p=0.03; β=−0.25 servings per 1000 kcal, SE=0.07, p=0.001; and β=−0.81 servings per 1000 kcal, SE=0.09, p<0.001, respectively), while consumption of added sugar and dairy were higher (β=6.24 grams per 1000 kcal, SE=3.07, p=0.04 and β=0.52 servings per 1000 kcal, SE=0.13, p<0.001, respectively). When comparing the hour before pickup (T4) to non-transition periods (T3, T6), consumption of vegetables were lower (β=−0.71 servings per 1000 kcal, SE=0.12, p<0.001), while consumption of added sugar, snack foods, and fruit were higher (β=13.49 grams per 1000 kcal, SE=4.24, p=0.002; β=1.75 servings per 1000 kcal, SE=0.19, p<0.001; and β=0.58 servings per 1000 kcal, SE=0.24, p=0.02, respectively). When comparing the hour after pickup (T5) to non-transition periods (T3, T6), consumption of dairy was lower (β=−0.90 servings per 1000 kcal, SE= 0.11, p <0.001), while consumption of added sugar, snack foods, and SSBs were higher (β=21.67 grams per 1000 kcal, SE= 3.56, p <0.001; β=1.10 servings per 1000 kcal, SE= 0.16, p <0.001; β=0.48 servings per 1000 kcal, SE= 0.10, p <0.001, respectively).
Table 5.
Conditional mean differences in energy and food intake during each individual transition period versus non-transition periods
| Hour before drop-off (T1*) vs. Non-transition periods (T3, T6*) |
Hour after drop-off (T2*) vs. Non-transition periods (T3, T6*) |
Hour before pickup (T4*) vs. Non-transition periods (T3, T6*) |
Hour after pickup (T5*) vs. Non-transition periods (T3, T6*) |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Energy/food | β | S.E. | p-value | β | S.E. | p-value | β | S.E. | p-value | β | S.E. | p-value |
| Total energy intake (kcal) | −391.31 | 58.64 | <0.001 | −395.18 | 23.45 | <0.001 | −406.36 | 30.77 | <0.001 | −288.21 | 22.90 | <0.001 |
| Added sugar (grams) | 11.39 | 6.62 | 0.09 | 6.24 | 3.07 | 0.04 | 13.49 | 4.24 | 0.002 | 21.67 | 3.56 | <0.001 |
| Sweet and salty snack foods (servings) | −0.64 | 0.30 | 0.03 | −0.31 | 0.14 | 0.03 | 1.75 | 0.19 | <0.001 | 1.10 | 0.16 | <0.001 |
| Sugar-sweetened beverages (servings) | −0.22 | 0.18 | 0.22 | −0.25 | 0.07 | 0.001 | 0.04 | 0.11 | 0.67 | 0.48 | 0.10 | <0.001 |
| Dairy (servings) | 0.41 | 0.30 | 0.17 | 0.52 | 0.13 | <0.001 | −0.17 | 0.17 | 0.33 | −0.90 | 0.11 | <0.001 |
| Fruit (servings) | 0.54 | 0.37 | 0.15 | 0.08 | 0.16 | 0.62 | 0.58 | 0.24 | 0.02 | 0.08 | 0.20 | 0.68 |
| Vegetables (servings) | −0.86 | 0.22 | <0.001 | −0.81 | 0.09 | <0.001 | −0.71 | 0.12 | <0.001 | −0.19 | 0.10 | 0.07 |
| Whole grains (servings) | 0.17 | 0.23 | 0.45 | 0.20 | 0.11 | 0.08 | 0.03 | 0.12 | 0.80 | −0.01 | 0.10 | 0.89 |
Note. Coefficients obtained using hierarchical linear regression adjusted for CACFP status, race (White/Non-White), and single vs couple status.
All estimates reflect values per 1,000 kcal (except total energy intake).
See Figure 1 for definitions of each transition period
DISCUSSION
We found that children consumed less healthful foods and beverages (e.g., more foods with added sugar and sweet and salty snack foods) during transition periods compared to non-transition periods. In particular, the hour after pickup from childcare seemed to be the least healthful relative to non-transition periods. Overall, children in this study consumed high daily amounts of added sugars, snack foods, and SSBs, when Dietary Guidelines for Americans recommend limiting their intake (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010).
Overall 24-hour calorie intake by children in this study (1,472 kcal +/− 419 kcal) was similar to that of children on days they attended child-care (1,524 kcal +/− 19 kcal) in a study that compared dietary intakes of children enrolled in early child-care programs on child-care days relative to non-child-care days (Glenn et al., 2022). Children’s dietary intakes in the study by Glenn, et al. were closer to dietary guidelines recommendations on child-care days relative to non-child-care days, especially related to empty calories, calories from added sugars, and calories from solid fats. Our study’s findings expand on these findings by identifying time frames of poorer dietary quality (i.e., transition periods). Additionally, consumption of added sugar, snack foods, and SSBs was lower during transition periods at childcare compared to transition periods in the parents’ care. Teachers and staff in CACFP centers are required to follow nutrition standards that are based on USDA guidance for the provision of healthy meals and snacks to children (U.S. Department of Agriculture Food and Nutrition Service, 2023), which may contribute to the differences we observed in the dietary intakes of children during transition periods at childcare compared to transition periods in the parents’ care, consistent with the findings of Glenn, et al.
Dietary quality may be poorer during transition periods due to the stress experienced by caregivers and children during these transitions. Caregivers may feed their children unhealthy convenience foods due to time limitations (Dwyer et al., 2008; Ling et al., 2016; Noble et al., 2005; Parks et al., 2016; Pescud & Pettigrew, 2014; Walsh et al., 2015), to placate or comfort the child (Noble et al., 2005), or when parents feel stressed or guilty about time spent away from their child (Harris et al., 2020; Hughes et al., 2010; Noble et al., 2005; Parks et al., 2016). Parents are often aware of the relative healthfulness of foods, but other factors (time, conflict, child’s preferences) can supersede that knowledge to influence child feeding behaviors (Noble et al., 2005). Additionally, the handoffs between caregivers and child-care staff during transition periods may not systematically include information on the child’s dietary intake, which may result in duplicate meals or snacks.
Strengths and Limitations
This analysis of dietary intake in the transition periods between home and childcare was a secondary analysis of a subset of 24-hour diet records in a study originally designed to measure the child-care environmental influences of children’s dietary intake within childcare settings (Kharofa et al., 2016). As such, it was intended to be hypothesis generating, as we did not have the ability to add measures to the secondary data already collected, for example caregiver or teacher variables such as stress, guilt, and time limitations or any additional information regarding the greater context around the child’s dietary consumption (e.g., child’s hunger level). Future studies could prospectively collect these variables as potential mechanisms for differences in dietary consumption in transition periods.
Use of a visual estimation protocol to record dietary intake in the child-care setting strengthens the study, as it allows for a more accurate estimate of intake compared to menu analysis or report from child-care providers. However, researcher observation of home meals was not feasible within this study setting. The accuracy of dietary records is limited by parental ability to prospectively record or recall their children’s intake, as well as social desirability bias. Additionally, analysis of 24 hours of nutrition data may not necessarily represent usual daily intake for all children. The dietary records from parents did not reliably differentiate between meals and snacks, which precludes our ability to know the parent’s perception of whether the food given during the transition time is a meal or snack.
The majority of child-care centers in this study provided CACFP and these centers follow nutritional quality requirements, so these findings may not be generalizable to settings that do not adhere to these standards. Furthermore, the CACFP guidelines changed in October 2017 to include more whole grains and greater variety of fruits and vegetables. Our findings suggest, then, that the difference in dietary quality of foods and beverages consumed between transition periods in parent care and the non-transition periods in childcare may have grown more pronounced. Additionally, the original data was collected approximately 10 years ago, which may limit generalizability of findings. However, we believe that these findings remain relevant, especially given that the food group patterns and macronutrient intake we observed of preschoolers at home and in child-care settings aligns with that described in a recent nationally representative study of preschooler dietary intake (Glenn et al., 2022). To our knowledge, there have not been other studies of children’s dietary intake around transition periods, so we do not have data to examine how this might have changed over time. We do not suspect children’s transition period diets have changed over time given that the likely influences on children’s intake (caregiver time constraints, stress, guilt, child hunger) during these periods has not changed. More research is needed to further understand the impact of these potentially important transition periods for children’s overall 24-hour intake.
Implications for Practice
These findings suggest that future interventions could specifically target transition periods as an opportunity to improve the dietary quality of young children. While it can be challenging to completely change dietary habits across all meals and snacks, this study suggests focusing on transition periods as one specific time period that could have an outsize positive influence on overall 24-hour dietary intake. Given that the challenges during the transition periods are often predictable, they may be amenable to evidence-based parent-training interventions, for which there is a robust literature (Sara J Sweitzer & Briley, 2010; Stark et al., 2011), or more simple behavior modification messages that could be communicated to parents (e.g., packing a healthy snack for the commute from childcare), both with potential for great impact.
Conclusion
Children consumed more added sugar, sugar-sweetened beverages, and snack foods during transition periods compared to non-transition periods. Transition periods may provide a window to improve dietary quality of preschool children attending childcare.
Acknowledgements:
The authors thank Jane Khoury and Robert Tamer for their work in putting together the datasets and performing initial analyses. The authors also thank Suzanne Summer for her work leading the data entry and cleaning in NDSR. Additionally, the authors thank the families and programs for their time and effort participating in the PEAS study.
Funding details:
This research was funded by the National Institutes of Health under grant number K23 HL088053 (PI Copeland) and a Robert Wood Johnsons Physicians Faculty Scholars program (PI Copeland). Dr. Parsons was funded under grant number T32HP10027 from the Health Research Services Administration. The content is solely the responsibility of the authors and does not necessarily represent the official views of The National Institutes of Health, the Health Research Services Administration, or any other funders.
Footnotes
Conflict of interest disclosure: The authors report there are no competing interests to declare.
Data availability statement:
Data are available for sharing upon request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are available for sharing upon request.