Identification of factors that influence the menu at child care centers: a grounded theory approach. (Research)

Objective This study was conducted to identify factors that influence what is on the menu at child care centers.

Design Quantitative and qualitative data on menus, food preparation, and foodservice were collected during site visits to child care centers. Grounded theory methods were used to develop an explanation of child care menu planning that is "grounded" in data.

Sample and setting Three child care centers were selected in each of three communities representing different ethnic cultures in Texas.

Main outcome measure Quality of child care menus, as measured by nutrient content and variety and amount of food served, constituted the core category or main phenomenon.

Analyses Open and axial coding of the qualitative data were performed to identify significant themes and concepts and to explore their interrelationships in order to produce an explanation of the quality of child care menus.

Results The patterns of strengths and weaknesses in the menus were similar in all three ethnic/geographic regions that were visited and were similar to findings in other states. The factors that have the most direct influence on the menus are food program requirements, staff perceptions of children's food preferences, history of the food program at the center, and cost.

Applications/conclusions The data and theory support three broad conclusions: (a) child care menus need to be improved; (b) training for child care staff needs to be sensitive to the missions and cultures of different kinds of child care centers; and (c) because lack of staff knowledge has only an indirect influence on the menus, changes in program requirements and strategies for assisting and monitoring food programs in child care centers may also be needed. J Am Diet Assoc. 1994; 94:276-281.

Since 1978 when the US Department of Agriculture's (USDA) Child and Adult Care Food Program (CACFP) was made permanent, it has generally been assumed that "day-care centers usually provide nutritious food that helps children gain weight and grow more rapidly" (1, p 39-40). That assumption seems reasonable given that the CACFP provides funds, meal pattern guidelines, nutrition and foodservice handbooks, program monitoring, training, and technical assistance for child care foodservice (2)(3). by 1992 there were 24,361 centers and 161,533 regulated family day care homes participating in the CACFP (4). On a typical day in 1992, 1.9 million children ate at least one of their meals in a child care center or family day care home that participates in the CACFP.

Although the CACFP has made huge strides toward ensuring that children, especially those at high nutritional risk because of poverty, have opportunities to eat nutritious meals and snacks, there still is reason to be concerned about child care nutrition. As many as 90% of child care menus evaluated in Texas in 1988 and 1989 fell short of recommended standards (5)(6). Even though the children usually were at the center for 8 hours or longer, the menus typically provided less than 50% of the Recommended Dietary Allowance (RDA) (7) of energy and iron, and less than 67% of the RDA for niacin and thiamin. Child care licensing standards for Texas specify that for children who are at the center 8 hours, the meals and snacks should provide at least 50% of RDA (8). Standards recommended for child care programs by The American Dietetic Association state that in an 8-hour program, foods served should provide 67% of RDA (9)(10). The menus evaluated in Texas were also found to offer limited variety of food, almost never included servings of cruciferous vegetables, derived an excess of energy from fat, and exhibited other shortcomings that make them poor examples of healthful food habits (11). A follow-up investigation conducted from 1991 to 1992 showed similar patterns of problems in child care centers in seven other states (12). These findings are confirmed in studies conducted by other researchers in South Carolina (13) and in Missouri (14).

More and better training for child care personnel is one of the first solutions that recommends itself as a means for correcting problems and improving menus. Recognizing the importance of training, the Nutrition Education and Training (NET) program was established by USDA in 1977. In Texas, the NET program is administered through the Texas Department of Human Services and is largely devoted to nutrition training. Although substantial numbers of child care personnel participate in the NET program, menu problems still exist. In a series of evaluation studies conducted for the Texas NET program, menus were found to have the same patterns of strengths and weaknesses 6 and 12 weeks after staff attended menu planning workshops as they had before the workshops (15).

In an effort to identify other factors that influence child care foodservice in Texas, the Texas NET program conducted other studies to examine information about administrative structure of child care centers, the size of centers, amounts of money spent on food, personnel costs, types of training topics, and frequency of staff training (16). The only variable that proved to be useful as a predictor of compliance with program requirements was frequency of training. In another study in which menus were obtained from child care centers in seven states other than Texas, the center directors supplied information about ethnicity, size, and type of programming at their child care centers. Analyses of this larger data set indicated that none of these variables was useful as an explanation of variability …