As one of USDA’s food assistance entitlement programs, the Child and Adult Care Food Program (CACFP) provides nutritious meals and snacks to 2.9 million low-income American children by reimbursing eligible childcare providers. CACFP also has suggested written feeding guideline policies to foster a supportive feeding environment, including allowing children to serve themselves. These guidelines are congruent with recommendations to prevent childhood overweight. Moreover, they support the concept of the division of responsibility between parents and children in feeding. This concept assumes that adults are responsible for selecting, preparing, and offering healthful foods and for determining when and where meals and snacks are served. Children, on the other hand, are responsible for how much they eat or whether they eat at all—that is, they control their own food intake.
Thus, in addition to being a partner in combating childhood hunger, CACFP can play a significant role in establishing healthy eating habits, promoting self-regulation of food intake, and supporting self-sufficiency. Moreover, because low-income households are at high risk for obesity, CACFP-funded centers can play a role in modulating childhood overweight.
This unique study compares reported implementation of feeding policies in childcare centers that receive CACFP funding to non-funded centers that serve low-income children.
While some information exists regarding food selection in CACFP-funded centers, little is known about the feeding environment in these centers. The study also explores issues facing CACFP-funded centers that encounter very hungry children and answers the following questions:
- Do centers that serve low-income children receive CACFP funding?
- Do staff members in centers that receive CACFP funds and training report providing more opportunities that support the promotion of healthy eating and feeding behaviors espoused to prevent childhood obesity in young children than staff in centers not CACFP-funded?
- What challenges do CACFP-funded centers face in response to feeding children coming into centers exhibiting signs of extreme hunger?
The first two questions were answered using quantitative data gathered from responses to a previously conducted survey, About Feeding Children (AFC). A stratified (by census density and State) random sampling method was used to identify 1,600 centers within California, Colorado, Idaho, and Nevada (400 from each State) to receive mailed questionnaires. Responses were received from 574 centers (470 directors and 1,210 staff). Interview data from 49 AFC staff as well as from 11 experts knowledgeable in CACFP were used to qualitatively explore the last question.
Of centers responding to the AFC survey, 61 percent reported serving low-income families. Of these, 125 centers served meals and snacks, with significantly more receiving CACFP funding (66 versus 34 percent, p<0.01). Center location stratification revealed that some centers in the poorest communities (that is, the first quartile) do not participate in CACFP (24 percent with poverty rates ranging from 14.5 to 39.6 percent and 35 percent with median incomes ranging from $20,129 to $33,193). One could speculate that, if eligible centers are aware of the program, they may not choose to enroll due to the arduous application process and/or the cumbersome record keeping required.
The quantity of CACFP foods provided may not fully satisfy the needs of some children early in the week.
A pattern emerged for very hungry children entering CACFP-funded childcare. Both providers and experts stated that some children do not receive sufficient food or food of healthful nutritional quality over the weekend. Thus, early in the week (especially Mondays), some children enter centers in an apparent state of extreme hunger. Although this study could not determine if these children lived in food-insecure households, the children displayed behaviors that reflected such a situation by acting out, being irritable, lacking concentration, and expressing an overwhelming desire to eat. Staff and experts reported that these children needed and wanted more than the one serving of food for which the center is reimbursed, resulting in unmet hunger. In some centers, these children remained hungry until the next eating occasion, as second helpings were not prepared. Other centers met the increased hunger by maintaining a stock of food provided by food banks or purchased without CACFP reimbursement.
In general, CACFP-funded centers were more likely than unfunded centers to report practices consistent with feeding guidance and with an overall environment purported to support self-regulation of food intake in children. CACFP-funded staff allowed children more involvement in determining what to eat, the order in which to eat, and how much to eat. Interestingly, staff in both funded and non-funded centers did not believe that teaching children how to serve themselves food (52 percent) was extremely important compared with teaching social skills (75 percent), conversational skills (72 percent), table manners (76 percent), or motor skills (using spoons and cups, 72 percent). This belief is reflected in the frequency of teaching certain skills: 42 percent always taught children how to serve foods compared with always teaching social skills (75 percent), conversation skills (79 percent), motor skills (83 percent), and table manners (84 percent). However, requiring self-service may not work for all CACFP-funded centers, even Head Start Centers, because some centers receive foods pre-plated.
In summary, this study suggested several strategies that CACFP could implement in response to both child hunger and overweight. For centers that serve extremely hungry children, CACFP needs to reconsider the reimbursement policy. For example, additional quantities of food could be prepared for Mondays and Tuesdays when children enter centers most hungry and on Fridays to accommodate weekends, when food is scarce. CACFP reimbursement policies also may not coincide with obesity research. Reimbursement allows for a specified amount of food per child. However, research suggests that children self-regulated their food intake. Implicit in this suggestion is that some children will eat less than the reimbursed serving size whereas others will need to eat more. In theory, for most centers, sufficient quantities of food would be available for all. In reality, this may not happen, especially in centers with very hungry children. Finally, CACFP could specify funds to be set aside to train all CACFP-funded staff, directors, and sponsors on the role CACFP can play in child overweight prevention and in setting up a supportive feeding environment. However, none of these strategies will help low-income children if eligible centers do not enroll in the CACFP program. Increased outreach efforts and reduced paperwork may entice centers, especially those in the poorest neighborhoods, to seek program benefits.