Most children in the United States spend about 33 hours a week in early child care and education settings, where they receive up to two-thirds of their daily nutrition. A new study from the University of Washington School of Public Health suggests these environments provide a valuable opportunity to improve young children’s diet and support long-term child health.

The study, published online Jan. 27 in the Journal of the Academy of Nutrition and Dietetics, explored the factors that influence child care providers’ food decisions—the sort of food they purchase and serve to kids in their care.

“We looked at the system as a whole and tried to really understand how individual factors were working together to enable providers to make food purchasing and service decisions,“ said lead author Jennifer Otten, assistant professor of environmental and occupational health sciences and core faculty member of the Nutritional Sciences Program at the School. “It is a complex system, but we were surprised at the extent to which food storage and kitchen equipment came up as drivers in the quantities of food that could be purchased and the types of dishes that could be prepared.”

Otten and her research team conducted in-person interviews with 16 providers in the Puget Sound region of Washington state between June and September 2014. Researchers asked participants a series of 30 open-ended questions and toured the sites to note observations.

“It was evident that providers used a patchwork of vendors and suppliers to meet all their price, convenience and quality needs, and they described this as time consuming,” Otten said. “Providers also emphasized the high prevalence of food allergies and intolerances. While this should be taken very seriously, providers described spending a considerable amount of time maneuvering through it daily.”

The study highlighted 10 main themes that influenced providers’ food decisions. They were:

• Regulations
• Suppliers and vendors, including stores
• Organizational mission, budget and structure
• The facility itself
• Professional networks
• Peers
• Site-specific parent and child community
• Providers’ skills, behaviors, motivations, attitudes, knowledge and values
• Child food preferences
• Child allergies

The influencers were grouped into four categories: macrolevel environments, physical environment and settings, social environments, and individual factors at both provider and child level. A framework was then developed to identify potential pathways of intervention.

“If we want to improve nutrition in early child care and education settings, we need to take a look at the system as a whole,” Otten said. “How might we take advantage of the opportunities and overcome the barriers in a way that improves the entire system?”

Many dietary behaviors that lead to obesity and chronic disease begin during the pre-kindergarten years, according to the study. “Generally, sites that participate in federally reimbursed U.S. programs that incorporate meal pattern requirements, such as Head Start and the Child and Adult Care Food Program, serve children more nutritious meals and snacks than sites that do not participate,” the researchers wrote.

Twelve of the sites studied were early child care and education centers, 10 received U.S. Department of Health and Human Services subsidies and seven participated in the Child and Adult Care Food Program.