Research Report Laying foundations for health: food provision for under 5s in day care Helen Moore a, * , Pauline Nelson a , Joyce Marshall a , Mary Cooper b , Helen Zambas b , Kevin Brewster c , Karl Atkin a a Centre for Research in Primary Care, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PL, UK b Department of Nutrition and Dietetics, Leeds Community Nutrition, St Mary’s Hospital, Green Hill Road, Leeds, LS12 3QE, UK c Leeds City Council Childcare and Early Development Service, 9th Floor West Merrion House, Merrion Centre, Leeds, LS2 8DT, UK Received 15 April 2004; revised 15 June 2004; accepted 21 October 2004 Abstract This study investigated the food offered to children under 5 years of age in UK day care, the influence of the childcare providers on a child’s diet and their attitudes towards this role. A postal survey of a randomised quota sample of childcare providers enquired after the range of food on offer and explored attitudes towards the role of food in health and the role of promoting health. Themes emerging from these data were explored by in-depth interviews with a sample of 18 childcare providers and 7 Local Authority Early Years Service staff. We received 194 (56%) responses to 345 copies of the questionnaire. Half (46%) of nurseries and 23% of childminders provided a fruit or vegetable with the main meal 5 days a week. Only 14% of nurseries and 21% of childminders provided a dairy food (i.e. calcium-rich) at the main meal every day. Almost all the childcare providers saw themselves as responsible for promoting healthy diet, but it was rare for them to have had any formal training in nutrition, while current dietary guidance was perceived as too vague to be useful. The study also highlighted tensions on the issue of food provision between those delivering childcare and parents; further research should explore the parents’ perspectives. Nursery staff and childminders should have access to carefully designed advice on nutritionally appropriate food and drink services for under-fives. q 2005 Elsevier Ltd. All rights reserved. Keywords: Nutrition; Preschool children; Childcare; Food services; Health promotion Introduction The increase of overweight and obesity in childhood is of major public health significance across the world. Diet and exercise patterns established early in life appear to determine those of adulthood, so that today’s overweight children are likely to become tomorrow’s overweight adults (Freedman et al., 2004). Recent work suggests that increased rates of obesity and overweight in UK primary schools are established prior to school entry (McDougal & Crum, in press). Children consume a greater proportion of their calories from fat, and eat fewer fruits and vegetables than previous generations, a dietary pattern linked with early onset of type 2 diabetes (Rosenbloom, Joe, & Young, 1999) and increased risk of cardiovascular disease, breast and colon cancer in adult life (Law, 2000). UK government policy emphasises the need to lay foundations for healthy living in early childhood (Depart- ment of Health, 1999) but there is a lack of coherence in their approach to this. One policy area that has been largely neglected is the provision of food to children in day care. Increasing numbers of UK pre-school children spend a large amount of their time in nurseries or with childminders—a trend supported by government policy (Caroline Walker Trust, 1998). Despite the fact that childcare providers play a major role in the feeding of children, very little attention has been paid to the quality and appropriateness of food provided. Little nutritional guidance or recognised training is available for UK childcare providers and the National Standards for under-8 s day-care says no more than that food should be ‘nutritious’, with no attempt to define the concept (Department for Education and Skills, 2003). There is a lack of published work on food provision in the UK under-fives day-care sector. An audit conducted in Dundee, looked at the intake of about 6 children from each 0195-6663/$ - see front matter q 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.appet.2004.08.009 Appetite 44 (2005) 207–213 www.elsevier.com/locate/appet * Corresponding author.