Table 3.
Best Practices from Nutrition and Physical Activity Self-Assessment for Child Care and Algorithm for Meeting Best Practices Based on Environment and Policy Assessment and Observational Data and/or Provider-Reported Survey Data
| Domain | Best practice | Requirement to meet best practice |
|---|---|---|
| Water | Make drinking water available for children at all times. | Observer indicates that children have self-service access to water in the FCCH (including from filled cups that are always accessible). |
| Water | Prompt children to drink water during each indoor and outdoor playtime. | Observer indicates that provider reminds children to drink water at least once during every outdoor play time and every active indoor play time. |
| Juice | Limit 100% fruit juice to no more than two, 4–6 oz servings per week. | Observer indicates that the total amount of 100% fruit juice served to a single child across the 2 days of observation does not exceed 12 oz; AND the amount of 100% fruit juice that the provider reports serving the children does not exceed 12 oz per week. |
| Juice | Only serve 100% fruit juice that has no sugar added. | Observer indicates that provider does not serve juice that is <100% fruit juice at any meal or snack time. |
| Milk | Children aged ≥2 should only be served skim or 1% milk. | Observer does NOT indicate that provider serves 2% or whole milk at any meal or snack time. |
| Milk | Never serve flavored milk (milk with chocolate or strawberry syrup, or with added sugar). | Observer does NOT indicate that provider serves flavored milk at any meal or snack time. |
| Sugary drinks | Never serve sugary drinks. | Observer does NOT indicate that provider serves sugary drinks (e.g., fruit flavored drink, lemonade, sports drink, soda, sweetened tea, or homemade drink with added sugar) at any meal or snack time. |
| Vegetables | Offer children vegetables two or more times a day. | Observer indicates that provider offers vegetables at more than one meal or snack time on each observation day. |
| Vegetables | Don't prepare vegetables with added fat. Small amount of vegetable oil is the healthiest option. | Observer does NOT indicate that vegetables are fried or prepared with lard, butter, margarine, or cheese sauce at any meal or snack time. |
| Fruit | Offer children fruits two or more times a day. | Observer indicates that provider offers fruit at more than one meal or snack time on each observation day. |
| Fruit | Never serve fruit in syrup or with added sugar. | Observer does NOT indicate that fruit served at any meal or snack time was canned in syrup or sweetened with added sugar. |
| Whole grains | Offer children high-fiber, whole-grain foods two or more times a day. | Observer indicates that FCCP offered a whole-grain food (including whole-grain breads, pastas, cereals, crackers, and granola bars) two or more times daily on both observation days (at any combination of morning meal, morning snack, lunch, and afternoon snack). |
| Snack foods | Limit offering children sugary, salty, or fatty foods to less than one time per week or never. | Observer indicates that the provider does NOT serve crackers, pretzels, chips, dessert items, sugary cereal, granola bars, pastries, or Pop-Tarts at any meal or snack time; AND the provider reports serving such items less than once per week. |
| High-fat meats | Limit serving high-fat meats to less than one time per week or never. | Observer indicates that the provider does NOT serve bacon, ham, hot dogs, bologna, salami, regular sausage, or other high-fat meat at any meal or snack time; AND the provider reports serving such items less than once per week. |
| Fried and prefried foods | Limit offering children fried or prefried foods to less than one time per week or never. | Observer indicates that the provider does NOT serve fried meat, fried potatoes, or other fried foods at any meal or snack time; AND the provider reports serving such items less than once per week. |
| Mealtime environment | Always sit at the table and eat with the children. | Observer indicates that FCCP sat with the children “a lot” at every observed meal on both days (morning meal, morning snack, lunch, and afternoon snack). |
| Mealtime environment | Teach children how to serve themselves or, in the case of older children, allow them to serve themselves. | Observer indicates that “children served themselves most or all foods, and decided what size portions to take” at every observed meal and snack time. |
| Self-regulation | Always ask children if they are full before removing an unfinished meal or snack plate. | Observer indicates that provider never removes an unfinished plate without asking a child if he or she is full at any observed meal and snack time. |
| Self-regulation | Always ask children if they are hungry before serving more food. | Observer indicates that provider does the following behavior “a lot” at every observed meal and snack time where seconds are served—serves seconds only after a child requests them and after asking if child is still hungry. |
| Self-regulation | Never pressure children to eat more food than they want. | Observer indicates that provider never required a child who ate less than half of a meal or snack to sit at the table until they cleaned their plate at any observed meal or snack time. |
| Self-regulation | Do not use food or sweets as a reward or reward children for finishing their plate. | Observer indicates that provider never uses food or sweets as a reward or rewards children for finishing their plate at any meal or snack time. |
| Role modeling | Enthusiastically role model eating and drinking healthy foods. | Observer indicates that provider enthusiastically role models eating and drinking healthy foods at least a little at ≥75% of observed meal and snack times. |
| Encouragement | Always prompt and praise children for trying new or less preferred foods. | Observer indicates that provider prompts and praises children for trying new, less preferred, or healthy foods at least a little at ≥50% of observed meal and snack times. |
| Nutrition education | Lead a planned nutrition education lesson one or more times per week. | Provider reports leading a planned nutrition education lesson at least once per week. |
| Nutrition education | Talk with children informally about nutrition and healthy eating as often as possible. | Observer indicates that provider talks with children informally about nutrition at least a little at every observed meal and snack time. |
| Parent communication | Provide families with information on child nutrition to help them continue healthy practices at home. | Provider reports sharing information with families about child nutrition topics, including (1) types of foods and drinks children should eat, (2) recommended serving sizes, (3) the importance of serving a variety of foods, and (4) a healthy mealtime environment. |