Many childcare services fall short of nutrition recommendations

Many Early Childhood Education centres serving food to children do not have menus that meet nutritional guidelines, according to research from the University of Auckland's Centre for Longitudinal Research - He Ara ki Mua.

New Zealand Early Childhood Education (ECE) regulations state that where food is provided by the service, it should be of sufficient variety, quantity and quality to meet the nutritional needs of each child while they are attending. Researchers collected menus in an online survey of 257 licensed childcare centres in Auckland and Waikato. Only menus that comprised lunch plus two or more other snacks or meals each day for five days were included in the analysis. These were compared with requirements for half of a child's recommended daily intake and variety of foods across the week.

The mean score for the 57 full menus analysed was 6.8 (out of ten), however only three menus (5%) met all ten scoring criteria. The majority of privately run centres did not meet each of the scoring criteria, with the exception of daily recommendations for fruit.

Higher scores were associated with employing a cook, high or low (but not medium) neighbourhood deprivation, and participation in the New Zealand Heart Foundation Healthy Heart Award programme. There was no association with the cost of food. The results of the survey are published in the Australia and New Zealand Journal of Public Health today.

Lead author Sarah Gerritsen says that more than half of three and four-year-old children in Auckland and the Waikato attend early education centres where food is provided daily.

"The ECE environment is important for supporting both the intake of healthy foods and learning healthy eating behaviours," says Sarah.

"Half the menus did not contain sufficient quantities of grains (breads and/or cereals) and dairy (milk and/or milk products) to meet half of a pre-schooler's daily requirements, i.e. two serves of grains and one serve of dairy per day. There was also a lack of vegetables on the menus compared to fruit."

Researchers were concerned that half the menus included an "occasional" food or drink which the Heart Foundation's Fuelled4Life guidelines state should not be served at childcare centres. These foods and drinks are high in saturated fat and/or salt and/or sugar, generally do not contain vitamins and/or minerals, and provide minimal nutritional value. Examples are deep-fried foods, cakes, confectionery and soft-drinks.

More than half the menus listed too many "sometimes" foods. These foods may have some nutritional value but contain moderate levels of saturated fat and/or salt and/or sugar. Examples of "sometimes" foods are muffins, plain biscuits, ice-cream and sausage rolls. Early childhood education centre menus should be dominated by "everyday" foods, i.e. providing at least four everyday foods for each sometimes food listed.

Involvement in the Heart Foundation's Healthy Heart Award programme was statistically associated with a higher menu score, even after adjustment for all other centre characteristics. Half the cooks in participating centres did not have a recognised qualification in food safety, hygiene or food service, and only one in six had had any nutrition training. In most cases, cook's nutrition training consisted of a menu-planning workshop run by the Heart Foundation.

Food cost did not appear to be a factor in meeting the guidelines, with some very good, high scoring menus costing between two and four dollars per child per day.

"This study is the first time childcare menus have been investigated in New Zealand, and provides a baseline for monitoring compliance with nutrition guidelines," says Sarah. "Together with the information about home environments from the Growing Up in New Zealand study of child development it provides clear evidence that can be used for promoting appropriate nutrition for preschoolers and developing programmes to improve the food supplied in early education settings."

Gerritsen S, Dean B, Morton SMB, Wall C. (2017) Do childcare menus meet nutrition guidelines? Quantity, variety and quality of food provided in New Zealand Early Childhood Education services. Australian and New Zealand Journal of Public Health DOI: 10.1111/1753-6405.12667

Background to the study

Menus were collected as part of a PhD research study on nutrition and physical activity environments in childcare facilities that builds on research using data from the Growing Up in New Zealand longitudinal study.

• All licensed early education services in the Auckland, Counties Manukau and Waikato District Health Board regions (the recruitment area for Growing Up in New Zealand) were invited by email to complete an online survey in May 2014, and asked to upload, email or fax that week's menu if applicable.
• Of the 847 services invited, 30% (n=257) took part in the research. Over half of these services provided food daily to children in their care (n=145; 57%).
• 70 menus were received in the study. Only menus that listed lunch and two or more other snacks/meals per day for five days were included in the analysis (n=57).
• Menus were compared to half (50%) of a child's daily requirements as outlined in the Ministry of Health's Food and Nutrition Guidelines for Healthy Children and Young People, and the Fuelled4Life Nutrition Guide for ECE Services for Early Childhood Education services.

About Growing Up in New Zealand

Growing Up in New Zealand is New Zealand's contemporary longitudinal study of child development, tracking the development of nearly 7000 children born in 2009 and 2010 in the context of their diverse families and environments from before their birth until they are young adults.

A key strength of the study is that the diversity of the child cohort reflects the ethnic and socioeconomic diversity of today's primary school age children. The study has collected detailed multidisciplinary information about children's early development on multiple occasions throughout their preschool years and will continue to do so every two to three years until they are adults.

The unique information collected within Growing Up in New Zealand is designed to contribute evidence to inform

• A better understanding of the causal pathways that lead to particular developmental outcomes in contemporary New Zealand, and
• The effective evaluation, development and implementation of programmes and policy to optimise: support for families; health and development of children; and equity of outcomes across and within the New Zealand population.