In this review, state regulations for child-care facilities varied widely regarding menus. For child-care centers, 10 states (20%) did not have any regulations related to the five menu standards, 13 states (25%) had regulations for four of the five menu standards, and only seven states (14%) included all five standards. For family child-care homes, 27 states (53%) did not have any regulations for the five standards for menus, four states (8%) had regulations for four of the five menu standards, and only three states (6%) had regulations for all five menu standards. Thus, great discrepancies were found between model child-care menu policies from CFOC and current regulations in most states.
Menus are a source of information for parents, regulators, and researchers. Accurate, specific menus can communicate nutrition information to parents and facilitate discussions about nutrition among child-care providers, parents, and children. Unless parents supply food for their preschool-aged children, the menu provided by the child-care facility often serves as the main way parents know what their children are eating at child care. Several researchers have also used menus to assess dietary in-take of children in child care (9
), or to identify opportunities for nutrition intervention (9
). There is some evidence, however, that menus rarely matched foods served to children (15
State and federal regulators also rely on menus as a proxy for actual food served in child care because menu review is often the most cost-effective method to monitor and assess foods served in child care. CACFP is a federal entitlement program that provides nutrition education and reimbursement for meals and snacks to eligible child-care facilities (8
). This program governs meal patterns and portion sizes, sets some minimal nutrition standards, and offers sample menus to help child-care providers develop comprehensive, accurate menus. Centers that participate in CACFP, which include all Head Start Program (16
) centers, must provide copies of menus to ensure compliance with CACFP program requirements. Participants are required to date their menus and to ensure that menus reflect actual foods served. Therefore, in states without regulations reflecting these two CFOC standards, child-care facilities participating in CACFP should be engaging in these practices. In some cases, state regulations defer to CACFP guidelines for participating facilities. Utah, for example, requires their child-care facilities to either use menus provided by CACFP or use other menus approved by a registered dietitian. Given that not all child-care providers qualify for CACFP or choose to participate in it, the most comprehensive way to ensure that menus meet CFOC standards is to include those standards in state regulations.
There are several limitations to this review. First, this review may already be outdated if states have recently revised their regulations. A second limitation is that cities or other geographic areas within a state have the power to regulate child-care facilities in their jurisdiction. New York City, for example, recently enacted nutrition and physical activity regulations that were more stringent than those for the state of New York. A review of state regulations, therefore, may not capture all regulations governing child-care facilities in the United States. In addition, states often license more than two types of child-care facilities. For the purposes of this study, facilities were grouped as either a child-care center or a family child-care home. Various groupings of facilities may yield results that are different from those found in this review.
This review addresses regulations, not actual practice. The existence of a regulation does not necessarily ensure that child-care facilities are operating in accordance with the regulation. To assess compliance with regulations, state regulatory agency representatives visit child-care facilities in their state to ensure that child-care providers are adhering to state regulations. Twenty-nine states visit centers for routine inspections at least once per year, 16 visit every 2 years, and six visit every 3 or more years. For family child-care homes, states assess compliance less frequently (range: every 6 months to 10 years). Some states do not require routine inspections of family child-care homes unless a formal complaint has been filed. It seems likely that states who visit child-care facilities more often will have better adherence to their regulations, although no data are available. Additional or more stringent regulations may not be effective unless states have the capacity to enforce them. Child-care providers, however, are typically a compliant group because their livelihood and the health of the children depend on their adherence to regulations.