Although directors and staff in CACFP-funded centers were significantly more likely than those in nonfunded centers to engage in some supportive feeding practices, not all CACFP-funded centers trained staff in this area. In addition, not all trained staff reported appropriate supportive feeding practices. These findings reveal an important consideration when discussing strategies to prevent obesity in low-income children: lack of training of child care staff about feeding children. If child care centers are to engage in obesity prevention (1
), anyone involved with feeding children must be trained. Feeding practices that support healthy weight should be stressed, whereas practices that could increase the risk of obesity should be discouraged. The latter include restrictive practices, such as "no sweets before you finish your meal," improper use of praise and attention to "good eaters," and strategies to get children to eat what providers believe they should eat. Goodell et al noted that Head Start caregivers' attitudes influenced what they expected a child to consume (23
); child size was a factor in how much they served. Overweight children still need access to adequate food and nutrients for proper growth and development (15
). Without appropriate training to guide caregivers in working with overweight children, unintentional but serious consequences may result, such as inadvertently restricting access to nutritious food while trying to prevent obesity.
It is difficult to prove the effect of allowing children to self-serve on prevention of obesity (25
), but evidence suggests that children who serve themselves waste less food and eat as much as 25% less than those for whom food was plated (26
). Furthermore, when preschool-aged children were served portions double their age-appropriate size, they consumed 25% more of the entrée and increased their energy intake by 15%, compared with when they were served age-appropriate portions (26
). Alternative strategies for helping children meet their hunger and satiety needs must be created for centers where preplated food service is used or where only the minimum amount of food is prepared (24
Whereas overall training about feeding is necessary, our study suggests specific factors should be included when educating child care staff. Frequency of training may not be as important as where the information comes from and who provides it, that is, the orientation and education of the trainer. Information provided by perceived credible sources and people qualified to teach nutrition results in positive practices. Hence, we were surprised that training provided by health departments was negatively associated with practice. We speculate that health department training has more to do with environmental safety than with feeding children or that the training may be delivered by noncredentialed paraprofessionals who do not have expertise in feeding young children. Indeed, some public health department policies prohibit supportive feeding strategies such as allowing children to serve themselves from a common bowl or to participate in food preparation.
This study was limited in geographic scope, preventing generalizability to other states. Despite this limitation, our findings suggest that when trained by nutrition professionals, child care staff can learn, adopt, and operationalize guidelines for a supportive feeding environment in preventing child obesity.
We were disheartened by the number of CACFP-funded centers where staff were not trained in child feeding. The lack of training may reflect the lack of designated CACFP funding set aside for training beyond that addressing compliance and integrity. The required training is often received by the cook or director, rather than teachers. Annual mandatory training for all involved with child feeding could increase knowledge about nutrition and child development, influence caregiver attitudes about feeding, and promote positive practices. CACFP training in child feeding, either in-person, online, or via written materials, should be available to and required for center directors, staff (including cooks), and anyone in the room at mealtimes. Much of the training regarding feeding occurs during site reviews; however, required center audits are conducted a minimum of only once every 3 years and include limited center personnel (oral communication, D. Hogan, MS, RD, CACFP Programs Professional, Nevada Department of Education). CACFP monitors can implement the use of assessment tools (12
) during site visits and train centers to use these tools to improve feeding practices. External trainers and CACFP monitors need to design creative interventions to increase awareness of the role of self-service (and other feeding skills) in helping children monitor their energy needs and maintain a reasonable, healthy weight.
Findings from this study should be discussed with USDA and others concerned with the influence of CACFP in preventing child obesity. CACFP can serve as a model in developing healthy eaters and preventing childhood obesity. Nutrition regulations that include attention to feeding environments and nutrition standards should be established (4
). Specific training funds are necessary to increase awareness, demonstrate role modeling, change perceptions, facilitate acceptance of appropriate feeding strategies, and encourage use of self-assessment tools. Additionally, any center eligible for CACFP services should be encouraged to enroll. The advantage to enrolling in CACFP goes beyond reimbursement for food; it can provide exposure to, and support of, education and training to prevent childhood obesity.