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Nutrition and feeding

Supporting healthy nutritional habits

Child care providers can help children develop lifelong healthy nutritional habits while providing a safe eating experience. Food gives children the energy and nutrients they need during a crucial time of rapid growth and development. Sometimes children may require special planning and support around food and nutrition.

Healthy eating habits can have good benefits that add up over time. When deciding what children should eat as part of their nutrition plan, choose foods full of nutrients to make every bite count.

A nutrition plan should have a variety of:

  • Fruits
  • Vegetables
  • Grains
  • Dairy or fortified plant-based milk alternatives (ex: almond, coconut, oat)
  • Lean protein
Food CategoryExamples
FruitsBlueberries, bananas, apples, oranges, mango, pineapple, strawberries, watermelon, kiwis
VegetablesSpinach, carrots, broccoli, garlic, brussels sprouts, kale, green peas, beets, asparagus, and red cabbage
GrainsWhole wheat cereal or bread, wild rice, sorghum, oats, barely, buckwheat, millet, quinoa, bulgur
Dairy or Fortified Plant-Based Milk AlternativesLow-fat cow’s milk, fortified oat, soy, or almond milk. Plain Greek yogurt, natural cheese
Lean ProteinsFish, beans, peas, lentils, skinless chicken breast, lean beef

MyPlate.gov has helpful information when deciding which food options to offer to eat or drink.

When menu planning for snacks and meals, keep in mind some of the following:

  • Offer a variety of foods and beverages that are rich in vitamins, minerals, and other nutrients.
  • Respect personal family preferences and cultural traditions and be mindful of each family's budget.
  • Focus on having items from each food group and staying within the recommended calorie limits.
  • Limit foods and beverages with added sugars, saturated fat, and sodium.

Some families may have special dietary requests. It is important to discuss with the parents and caregivers to help meet the child's nutritional needs while in your care. Families may be exclusively vegetarian or vegan or have dietary limitations due to religious practices or medical reasons.

Some children may have medical conditions that require special dietary modifications. A written care plan from the primary health care provider should be on file, clearly stating the food(s) to be avoided and food(s) to be substituted.

The decision to continue breastfeeding, chest feeding, or supplying human milk to a child while in daycare is a personal decision for parents. However, some parents may face barriers when they return to work or school. Childcare centers and staff should remain supportive and non-judgmental regardless of a parent's decision to breastfeed, offer human milk, or not.

Some steps childcare providers can take to support parents:

  • Take trainings that help you better understand the benefits of breastfeeding and how to support parents who want to continue breastfeeding their children. In addition, learn the proper handling, storing, and feeding techniques for breast milk.
  • Have a quiet and comfortable space for a parent/caregiver to breastfeed or pump milk.
  • Work closely with parents/caregivers on how best to feed their infant at daycare and offer support, information, and guidance, as necessary.

For more information on breastfeeding, breastmilk, and lactation visit the Lactation accommodation, breastmilk and formula feeding webpage.

A healthy menu plan is one that:

  • Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk products.
  • Includes lean meats, poultry, fish, beans, eggs, and nuts.
  • It is low in saturated fats, trans fats, cholesterol, salt, and added sugars.

When creating a nutrition plan, remember to:

  • Choose a variety of different food options in each category.
  • Practice safe food handling during preparation, serving, and storing.
  • Keep the kitchen and food areas clean and sanitized.
  • Have a plan and keep a record of special dietary needs and specific food allergies of children.

When creating a meal plan, it is important to think about children’s:

  • Developmental readiness
  • Physical skills
  • Ability to swallow solid foods.

How childcare providers can promote healthy nutritional habits

  • Providing children with opportunities to try foods made in several ways (raw carrot snacks vs. steamed carrots).
  • Preparing food appropriate for the age and development of the child
  • Have a friendly, comfortable place to eat, and make mealtimes a fun experience.
  • Make children feel good about their healthy food choices.
  • Do not rush children to eat. Give them time to finish eating.
  • Observe eating behavior and talk with their parent/caregiver if they have concerns.
  • Be a good role model – show children you enjoy eating various food options.
  • Bottle feed infants whenever they are hungry.
  • Offer food or snacks every 2 to 3 hours to prevent children from feeling hungry.

What and how much to feed children in childcare?

  • At about six months, most children will be ready to integrate some solid foods, for example, infant cereal, alongside breast milk. Be sure to work alongside parents on their child’s progress.
  • Older children (over 2 years old) should be encouraged to serve themselves if they’re able. It is ok if children do not eat everything they put on their plate.
  • Sometimes a child’s appetite will fluctuate. This is normal. Do not try to force feed or reward them for eating. If the child wants more, it's okay to serve more.
  • Offer and encourage variety in types of foods. Children may need 20 or more opportunities, free from pressure and force, to learn to like new foods.
  • Alternatives
    • Instead of a hot dog, try a tofu or oven roasted turkey breast.
    • Instead of sugary drinks like soda or sweet juice, try milk or water.

When to feed children in child care?

  • Establish routine times for eating breakfast, lunch, dinner, and two snacks between meals. Eat every couple of hours throughout the day.
  • Limit beverages (like juice) in between meals that could hinder appetite. Stick to water.
  • For young infants, pay attention to hunger cues, such as sucking on their hand or light fussing.

Where and how to feed children in child care?

  • Feeding should occur family style in a communal area, such as the dining table.
  • Distractions should be limited. No TV or games
  • Everyone should be seated.
  • Eating is a time to learn both feeding skills and social skills.
  • Offer new foods for kids to try, but don't pressure or force them to eat it if they don't want it. Continue to offer these foods to help them gain familiarity.
  • Be patient, help them to enjoy eating and learning how to serve themselves and behave at the table.
  • Involve older children in the process of food preparation and serving.
    • Be a role model.
    • Don’t cater to preferences (everyone eats the same thing) but allow them the choice of whether or not to eat something.
    • Use phrases that help, not hinder.
    • Instead of “Eat that for me”, try “This is kiwi fruit; it’s sweet like a strawberry.”
    • Instead of “No dessert until you eat your vegetables,” try “We can try these vegetables another time. Next time would you like to try them raw instead of cooked?”

Division of responsibility in feeding

In some childcare settings, the provider buys, prepares, and serves food. Children are responsible for what and how much they eat. Healthy children will tend to eat what they need and should not be forced to eat more than they want. Overfeeding will cause children to override their own hunger and fullness cues. If the child wants more, it's okay to serve more.

To help prevent under-feeding or over-feeding, providers must be sensitive to hunger and fullness cues.

For infants, hunger cues may include:

  • Crying, excited arm movements, smiling, cooing, or gazing at the caregiver during feeding show a desire to continue.
  • Moving forward as the spoon approaches, swiping food towards the mouth, moving the head forward to reach the spoon.
  • Hungry toddlers may point at, ask for, or reach for food or beverages.

Infants' satiety (fullness) cues may include:

  • Falling asleep
  • Becoming fussy during feeding
  • Slowing the pace of eating
  • Stopping sucking
  • Spitting out the nipple
  • Refusing the spoon, batting the scoop away or closing the mouth as the spoon approaches
  • Toddlers may slow their eating pace, become distracted or notice surroundings more, play with food, throw food, want to leave the table or chair, or leave food on the plate.

Tips to prevent choking

Childcare providers must supervise children while they eat to help keep them safe:

  • Children should eat slowly not with mouthfuls too large and not storing food in cheeks.
  • Children need to stay seated in their own chair and not disturb another’s space.
  • Foods should be cut or chopped into small, manageable sizes.
  • Foods for babies should be cut in small pieces no larger than 0.6 centimeter (1/4 inch) cubes.
  • For toddlers, food pieces should be no larger than 1.3 centimeters (1/2 inch) cubes.
  • For children under 4 years old skip hard, small, whole foods like:
    • Hot dogs and other meat sticks (unless cut smaller)
    • Raw carrot rounds
    • Whole grapes
    • Hard candy
    • Nuts
    • Seeds
    • Raw peas
    • Hard pretzels
    • Chips
    • Peanuts
    • Popcorn
    • Rice cakes
    • Marshmallows
    • Spoonfuls of peanut butter
    • Chunks of meat larger than can be swallowed whole
  • Serve age-appropriate foods, bear in mind children’s teeth (or lack thereof).
  • Cook harder foods like vegetables to make softer and more edible.
  • Make sure solids and liquids are not consumed at the same time.
  • Do not allow children to run, play, lay down, or fall asleep while attempting to feed themselves.

Food allergies and dietary restrictions

Children with food allergies and other dietary restrictions require careful planning and extra attention to help ensure their nutritional needs are fully and safely met. Some of the common foods that can cause allergies are:

  • Eggs
  • Peanuts
  • Tree nuts
  • Cow's milk
  • Soy
  • Shellfish
  • Wheat
  • Fish

Children's food allergies can range in severity from mild to life-threatening. Staff should know what procedure to follow for a life-threatening allergic reaction and must understand their designated roles during an emergency.

Childcare providers must work closely with the child's family to:

  • Gather clear information about the allergy or dietary restriction.
  • Develop a plan of care and make the necessary modifications to the childcare center to reduce potential exposure to the specific food allergen or restricted food.

Caring for Our Children (CFOC) – A collection of national standards that represent the best practices, based on evidence, expertise, and experience, for quality health and safety policies and practices for today’s early care and education settings.

UCSF Child Care Health Program - Trains professionals on health and safety issues related to early care and education settings, supports a statewide childcare health consultation network, and conducts research.

Child Care Center General Licensing Requirements, Title 22, Division 12 – California Department of Social Services Community Care Licensing Regulations.

Family Child Care Home Regulations, Title 22, Division 12, Chapter 3 - Manual of Polices and Procedures from Community Care Licensing Division.

  • 5 Keys to Raising a Healthy Happy Eater – printable PDF that explains the division of responsibility during mealtimes and recommends behaviors to improve mealtime provided by Santa Clara County Public Health, Valley Health Plan, and The Childhood Feeding Collaborative (English | Spanish | Vietnamese).
  • The division of responsibility – Raise a healthy child who is a joy to feed—a webpage with detailed information on childhood feeding behaviors provided by the Ellyn Satter Institute (ESI).
  • Child feeding ages and stages Division of Responsibility – An informational webpage with a variety of materials and videos on feeding behaviors and the Division of Responsibility by ages provided by the Ellyn Satter Institute (ESI).
  • Childhood feeding problems and solutions – An informational webpage with tips for a variety of feeding problems such as: picky eaters, children who eat too little or too much, etc... provided by the Ellyn Satter Institute (ESI).
  • Tips for happy mealtimes – The CDPH’s Women, Infant & Children (WIC) program’s printable PDF with tips about improving mealtimes for young children.
  • Tips for picky eaters – The CDPH’s Women, Infant & Children (WIC) program’s printable PDF with tips on what to do if your child is a picky eater.
  • NEEDS for tots nutrition resource page – Learn about and practice the Satter Division of Responsibility in Feeding and the USDA Core Nutrition Messages for Child Feeding.

References

  • Choices For Children - 5 Keys to Raising a Happy, Healthy Eater in Child Care 
  • My Plate: www.choosemyplate.gov 
  • The Satter Eating Competence Model
  • WIC – Feed me! Birth to 6 months 
  • My Plate – Phrases that HELP and HINDER 
  • AAP – Reducing Choking Risks: Tips for Early Education and Child Care Settings 
  • Global Healthy Child Care – Choking Hazards