Food and Nutrition Education in

Early Childhood Centers

Status, Perceptions, and Needs in the District of Columbia

Researched and Written by

Summer 2013

Thesis/ Purpose
Exploratory investigation of the status, perceptions and needs of food and nutrition education programs of early
childhood education centers from the District of Columbia.

Project Coordinators
Beatriz Zuluaga and Sofa Bustos, CentroNa Food & Nutrition Department

Authors
Camila Idrovo, Raquel Redmond, Christian Gonzalez

Editors
Beatriz Zuluaga, Renata Claros, Esteban Morales, Patrilie Hernandez, Julia Howell-Barros

This study was conducted under the auspices of the SECDCC (State Early Childhood Development Coordinating Council).

table of contents
background & significance...........................................................................................................................................2
Objective and Research Aims........................................................................................................................................5
Research Design & Methods...........................................................................................................................................6
Protection of Human Subjects & Ethical Considerations....................................................................................8
RESULTS................................................................................................................................................................................9
discussion........................................................................................................................................................................ 14
conclusion & recommendations .............................................................................................................................. 20
references...................................................................................................................................................................... 22
appendices....................................................................................................................................................................... 23

2 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

Background & Significance

One in three low-income children in the United States is
overweight or obese before his or her fifth birthday.1 Studies
have shown that these children are not only at a greater risk
for maintaining or increasing excess adiposity through adolescence and adulthood2 but that at a young age they are
already presenting risk factors for chronic conditions such
as cardiovascular disease and diabetes.3 These facts are
concerning considering that many of these chronic diseases
are leading causes of death in the United States, with heart
disease and cancer accounting for almost half of all deaths
in 2010.4 Besides death, obesity also impacts quality of life
and can decrease productivity in affected individuals. It has
been estimated that the health-related cost of obesity for US
workers totals $73.1 billion a year and it is mainly due to presenteeism, or the decrease in productivity due to ill health.5
Obesity has also been linked to the presence of mental
health illnesses such as depression and anxiety.6 Child and
adult obesity in the United States are an increasing burden
on the healthcare system. In 2009 it was estimated that
obesity in the United States would cost $344 billion dollars
in healthcare by 2018 if trends were to remain constant,7
and although the latest statistics by the CDC have shown a
decline in rates of obesity in preschoolers of 19 states, rates
are still constant in 21 states, including the District of Columbia, and have increased in three other states.8
Due to the negative and widespread cost to individuals
and society, preventive measures to combat the obesity
epidemic in this country are a priority for policy makers and
health practitioners. Because behavior is an important and
modifiable factor of obesity9, a crucial step in controlling the
crisis has been to implement policies that seek to modify
habits in children by educating them on proper nutrition
and exposing them to physical activity at a very young age.
Currently, there are various federal and state incentives to
help schools create a healthier environment for children.
These include increased federal regulations of established
programs, such as the National School Lunch Program
and the School Breakfast Program, as well as innovative

approaches, such as the Farm to School Program and the

Fresh Fruit & Vegetable Program, which have increased the
availability of healthy foods in schools across the country.
Other incentives include First Lady Michelle Obamas Lets
Move! campaign, which combines nutrition and physical activity promotion, or USDAs HealthierUS School Challenge
which is a certification program that recognizes schools who
have been successful in improving their wellness programs.7,
8
A notable example of a state initiative is the creation of the
DC Healthy School Act of 2010, a comprehensive program
for public and charter schools in the District of Columbia,
that has put in place a set of regulations and incentives
for schools to provide a healthier environment for their
students. After its first year, the DC Healthy School Act
ensured that schools serve free breakfast to all students,
provided about $6 million in funding for schools to comply
with new requirements, granted financial incentives to serve
locally-grown produce, implemented higher standards for
foods in vending machines and school stores, and created
a stricter lunch menu criteria, emphasizing the importance
of consuming whole grains along with a variety of fruits and
vegetables in each meal served at schools.10
Despite all the efforts to improve nutrition and wellness at
schools, incentives that target children in early childhood
education programs are still lacking in comparison to those
offered for school-age children. This has created a significant gap in obesity prevention considering that about half of
obese children in the United States are already overweight
by their second birthday.11 With an increasing enrollment in
early childhood education programs, wellness initiatives for
children under the age of five could reach as many as 12.5
million children who receive child care in the United States,
that is, about 61% of young children in the country.12 Of these
children, at least 25% attend organized facilities, which
include daycare and child care centers, nursery schools,
preschools as well as Early Head Start and Head Start programs, where programs could be more easily implemented
and regulated. 11 Current initiatives include USDAs Child and

Background & Significance | 3

Adult Care Food Program (CACFP), which provides funding

for nutritious meals and snacks in child care centers that
serve primarily low-income families. Similarly, the Lets
Move! Child Care campaign, an extension of First Lady
Michelle Obamas Lets Move! wellness initiative, is intended to raise awareness on the importance of a healthy start
for children in early childhood programs. In the District of
Columbia, a jurisdiction with about 32,422 children under
the age of five13, CACFP participating centers are eligible
to apply for USDA funding through the I am Healthy, I am
Happy Challenge Grant which is designed to strengthen
the wellness environment of early childhood centers by providing funds to improve and promote nutrition and nutrition
education of children, staff, and parents.
It is especially important to include early childhood education centers in obesity prevention strategies because they
target children at the age when they are first forming their
food preferences, thus, impacting food choices later in life.
As Birch and Fisher point out in their article Development
of Eating Behavior Among Children and Adolescents published in the journal of Pediatrics: The early exposure that
children have to fruits and vegetables and to foods high in
energy, sugar, and fat may play an important role in establishing a hierarchy of food preferences and selection.14 Birch
and Fisher suggest that early childhood education centers
can provide an opportunity to increase the availability and
accessibility to a variety of foods helping young children
establish food preferences later in life. Another important
reason for increasing nutrition promotion for young children
is based on studies that have shown that children are born
with the ability to self-regulate food intake and that adult
behavior and feeding practices can affect the way children
react to internal cues of hunger and satiation.15 Programs
that promote self-regulation at an early age can help children establish healthy eating habits that will be taken into
adulthood.

In the District of Columbia, where 30.4% of children live in

poverty16 there is not enough information on whether or not
child care centers are informed about the federal and state
wellness initiatives previously mentioned or if they have the
means to achieve the standards set forth. The high rate of
poverty among children in the District as well as the prevalence of African American, Hispanic and other immigrant
families makes it essential to gather more information on
the food quality and nutrition education offered at child care
facilities that cater to low-income families, such as CACFP
participating centers, as nutrition deficits and obesity are
more common among these at-risk groups.1 Hence, this
study was devised to gauge the readiness and level of
interest of a sample of child care centers of the District of
Columbia in providing healthy food and nutrition education
for children under the age of five. The study will serve as an
exploratory investigation of the relationship between early
childhood care and current nutrition services and practices.
A survey was administered to gather information from stakeholders (directors, teachers, and parents) on improving food
quality and nutrition education in these facilities. The results
of the study may hopefully serve as a tool to promote initiatives that consolidate obesity and wellness interventions for
young children which will be instrumental in closing the gap
between early childhood care and school initiatives. Closing
this gap will strengthen child obesity prevention programs
overall and help to support child health and development
from the start.

4 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

Objective and Research Aims

The overarching goal of this study was to gather more information regarding the status of food quality and nutrition
education programs offered at early childhood centers in
the District of Columbia, as well as to survey the perceptions
of different stakeholders (directors, teachers, parents) on
the nutrition programs provided at their centers. As a result,
we hope to raise awareness of the importance of nutrition-based education interventions for young children to
better inform policy makers so that they may effectively target funds to support early childhood nutrition and improve
long-term health outcomes for the children in the District of
Columbia.
The study surveyed 15 child care centers in the District of
Columbia to assess the quality of their food and nutrition education services and to determine the perceptions and willingness of different stakeholders to improve these services.
The study focused primarily on exploring the perceptions
of different participants based on the Health Belief Model,
which is a theoretical model that states that personal beliefs
about certain health-related conditions, such as obesity,
determine health behavior in individuals. 17 The Health Belief
Model is a useful approach in nutrition services for young
children because it enables comparison between perceptions of different stakeholders, or persons responsible for
the provision of food for these children (directors, teachers,
and parents), with the actual quality of nutrition services
offered at the center. This comparison is beneficial because
it can point out the misalignments between these two
variables and guide recommendations to align perceptions
with actual quality of services. This alignment is essential
because it is the willingness and perceived need of these
stakeholders that will trigger improvements in the provision
of nutrition services in early childhood centers.

The specific aims of this study were:

1. To review the state of the nutrition and nutrition education of 15 child care centers in the District of Columbia based on the CACFP I am Healthy, I am Happy
program standards.
2. To survey the perceptions of different stakeholders (directors, teachers, parents) regarding the quality of food
and nutrition education offered to children at participating centers.
3. To evaluate the readiness and willingness of the centers
to improve the quality of food and nutrition education
provided to children at the participating centers.

Objective and Research Aims | 5

Research Design & Methods

Participants
This study included 15 licensed early childhood education
centers from the District of Columbia. Thirteen of these
centers were part of the Child and Adult Care Food Program (CACFP). Center directors, teachers, including lead
and assistant teachers, and parents were surveyed using
questionnaires. The centers were chosen based on location
and voluntary participation. All eight Wards in the District
of Columbia were represented in this study. Ward 1 had the
largest representation of centers with 23.5% of centers (four
centers). Wards 2 and 3 had the smallest representation
with 2.1% (one center each). The centers ranged in size from
25 to 185 children, serving children ages zero to five.

Measures
Through the use of three simple questionnaires we wanted
to gauge the food and nutrition education status of the
participating centers. Questionnaires were tailored for three
different stakeholders: directors, teachers, and parents.
The questionnaires used can be found in Appendix 2. Each
questionnaire, which had 14 questions in total, was divided
into three sections: Food, Nutrition Education, and Quality.
Questionnaires were made available in English and Spanish
to facilitate comprehension across different communities.

Food
Questions in the food section were directed to finding out
information about the menus, meal style, and overall opinions of food quality. Directors answered the questions in this
section to determine if centers prepared food in-house, got
their food catered, or if parents were responsible for bringing food for their children. In those cases where food was
prepared in-house or catered, the questionnaire also asked
who was in charge of creating and/or reviewing the menus.
We were also interested in knowing whether meals were
severed in family-style or as pre-plated meals. From teachers we wanted to get their opinion on the food served and

how they interact with children during lunchtime. Similarly,

we wanted to know parents opinions on the food served at
the center and gather information on what children were
being fed at home.

Nutrition Education
Questions in the nutrition education section were written
to assess curriculum needs as well as to gather information
about nutrition and wellness promotion activities at the centers. Directors were asked specifically about professional
development with regard to nutrition and wellness, nutrition
and wellness outreach to parents, and promotion within the
center. Teachers were also asked similar questions in an
attempt to determine if there were any disparities between
directors and teachers. From parents, questions centered
on their perception of nutrition education programs offered
to their children, whether they received any nutrition and
wellness information from their center, and if they had any
nutrition education activities at home.

Quality
This section was dedicated to finding out exactly what directors and teachers felt they need in order to make changes
at their center in terms of food and nutrition education. First
and foremost, we wanted to know if they were satisfied with
the current program and to assess the level of importance
the staff gives to this topic. Parents were also asked if they
were satisfied with the current food service and nutrition
initiatives at their center and if there are any changes they
would like to see implemented.

Procedures
Each center director was contacted directly through email
and by phone to arrange a meeting. At each meeting, directors were given a questionnaire to fill out on site and meetings with teachers and parents were scheduled. If meeting
times were not specified follow up emails and phone calls

6 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

were placed. Meetings with parents were generally held

during pick-up time to ensure that we would reach as
many parents as possible. Seven centers (46.67%) filled
out the teacher questionnaires without any member of the
research team present. At each parent meeting the research
team brought fruits or smoothies as an incentive for participation. There was a minimum participation of 17.3% and a
maximum of 40.0% participation from parents.

Menu Analysis
One breakfast and one lunch menu from 12 of the centers
were analyzed for nutritional content. One center was no
able to provide a menu and the other two centers where not
included because parents brought their own food for their
children. A sample weekly menu can be found in Appendix
3. The first Wednesday from each menu sample was selected for nutritional analysis. The NutraCoster Professional Program (version 2.1 revision 130, 2009, SweetWARE, Oakland,
Calif) was chosen as the tool to do the menu analysis. Each
item on the date selected was entered into the program
as one single item. The same nutrition information was
used for items that appeared multiple times on menus from
different centers.
The menu items were analyzed using portion sizes listed on
the menus. In cases where the portion size was not listed
items were analyzed using standard portion sizes. The
minimum portion sizes were as follows: cup fluid milk, 1
oz meat or meat alternative or cup cooked dry beans or
peas, cup vegetables and fruit, slice of bread or bread
alternative. Once all menu items were analyzed we calculated total calories (kCal), fat (g), saturated fat (g), sugar (g),
and sodium (mg) for breakfast and lunch, including milk,
for each center. Breakfast and lunch values were added
and compared to two thirds of recommended intakes for
children ages one to three (1,000-1,400 calories/ day, 30-40
g total fat/ day, 2,300 mg sodium/ day, and 20 g sugar/ day).
There is no recommended intake for saturated fat.

Each menu was also compared to CACFPs I am Healthy, I

am Happy award criteria, which measures wellness at early
childhood education centers. All centers were compared to
the Red Apple award level, which is the lowest qualifying
level to access more funding for implementing wellness
initiatives at the centers. If a center met the standards for
that level they were then compared to the standards for
Green Apple, the following level. Golden Apple is the
highest level for the I am Healthy, I am Happy certification
but none of the centers were eligible for this award level.
Inferences were made if the menus were not detailed based
on the names of items listed and their usual ingredients.
Snack menus were included in the analysis of centers that
were being reviewed to determine if they met the Green
Apple award level standards.

Statistical Analysis
Pivot tables were the primary data analysis tools used to
evaluate questionnaire responses. As a data summarization
tool within Microsoft Excel, pivot tables allowed for the
cross-referencing of information across director, teacher,
and parent questionnaire responses. Results were based on
questionnaire results from 15 center directors, 153 teachers,
and 233 parents.

Research Design & Methods | 7

Protection of Human Subjects & Ethical

Considerations
This study is intended to benefit the children in participating centers and other centers in the District as well as the
directors, teachers, and parents by better informing policy-makers so that they may use resources more efficiently
and create policies that have more lasting results in improving the wellness of children in early childhood settings.
A top priority of this investigation is to protect the privacy
and identity of participating centers, as well as individual
interview respondents. No private information of individuals
was collected or stored and minimal collection of demographic information was taken as to prevent disclosure of
participants identity. Participants were not discriminated
based on gender, age, race, ethnicity, or religious affiliation.
The study was intended to pose less than minimal risk to the
participants and its participation was completely voluntary
and could be terminated at any point.

8 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

Results
Food Service
Thirteen of the centers reported participating in USDAs
Child and Adult Care Food Program (CACFP). Ninety-five
percent of parents surveyed reported that their children
eat at the center. Depicted in Figure 1 is the distribution
of different types of food service offered by the sample
centers. Sixty percent of centers (9) have their food catered
while 27% centers (4) prepare their food in-house. Thirteen
percent (2) of centers reported other, in which case they
required parents to bring food from home for their children.
Additionally, fifty-three percent of centers reported that the
director reviews the menus, 47% reported that the catering
company reviews the menus, and 40% reported that staff
also played a role in reviewing the menus, including school
cooks or other staff members.

33% serve their meals pre-plated. Sixty-three percent of

teachers reported eating with children during lunchtime and
52% reported serving lunch to their students. Family style
meals are recommended because studies have shown that
children eat less fruits and vegetables and consume more
calories when they are served pre-portioned meals. 18 In
addition to eating a more balanced meal, family style meals
reinforce social skills, strengthen serving skills, give children
control over their eating, and encourage them to try new
foods if they see adults modeling for them. 19
FIGure 1: type of food service

Fifty-three percent of the centers reported serving their

meals family style which is the recommended style of food
service for children in child care settings, while

FIGure 2: level of satisfaction of different stakeholders regarding

food services offered at early childhood centers

Results | 9

Quality
Parents and teachers were asked whether
they thought the food served at the center
was healthy. Seventy-seven percent of
parents reported thinking the food was
healthy, compared to 75% of teachers.
Eighteen percent of teachers responded
that the food was sometimes healthy.
Less than 2% of teachers and parents
reported that the food was not healthy.
As seen in Figure 2, parents were the
most satisfied with the food served at
71%, compared to 63% of teachers and
53% directors. Thirty percent of teachers
were somewhat satisfied compared
to 27% of directors and 25% of parents.
Additionally, 20% of directors were not
satisfied, compared to 7% of teachers and
4% of parents.

FIGure 3: total sugar in breakfast and lunch

FIGure 4: sodium in breakfast and lunch

FIGure 5: calories in breakfast and lunch

10 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

Nutritional Content of Menus

The results of analysis of the calories, total fat,
saturated fat, sugar, and sodium of the breakfast
and lunch menus are reported in Figures 3 to 7.
It should be noted that following the established
food guidelines set forth by CACFP may not
guarantee a quality nutrition profile of meals
served overall. Also, the quality of food may be
inconsistent in these childcare centers across
weekly menus. Twelve centers provided menus
for analysis. Two centers do not serve food at the
center and one center was not able to provide a
menu.
The amounts of sugar, sodium, calories, total fat
and saturated fat of breakfast and lunch samples
for each center were compared to two-thirds
of the recommended daily intake of each for
children ages one to three. Centers that provide
breakfast and lunch should be providing about
two thirds of the daily intake that children have
for the day. As seen in Figure 3, all centers were
over the sugar limit of 13 g with the highest
intake being 79.74 g. Four centers were over
the sodium limit, shown in Figure 4. Two centers
were over the recommended calorie intake range
for two-thirds of the day, as seen in Figure 5.
Interestingly, both centers use the same catering
company. Additionally, four centers were under
the recommended calorie limit for two-thirds of
the day. In terms of total fat, four centers were

FIGure 6: TOTAL fat in breakfast and lunch

within the recommended range and eight centers were below, shown
in Figure 6. Although there is no recommended intake of saturated
fat, the highest intake was 9.72 g and the lowest intake was 2.19 g, as
seen in Figure 7.
Results of analysis of menus in relation to I am Healthy, I am Happy
award levels can be found in Appendix 1. This standard was used
because the 13 centers that catered or prepared food on-site were
eligible to apply for awards through their involvement with CACFP.
I am Healthy, I am Happy is a program that provides incentives for
centers participating in CACFP to improve and maintain their wellness
environment. Menus were analyzed based on the established criteria
for the three award levels, which grade the quality and variety of the
food offered. We found that five centers out of 13 that serve breakfast
and lunch at their centers are eligible for the Red Apple award
level. Of these five centers, none were eligible for next award level,
which was the Green Apple award.
Eight centers were not eligible for any award levels, three of which
were only missing one criterion that prevented them from being

FIGure 7: Saturated fat in breakfast and lunch

Results | 11

eligible for the Red Apple award level. These eight

centers were disqualified because they served either fried/
pre-fried meats or vegetables more than once per month.
All five centers that were eligible for the Red Apple award
level lacked a lean meat or meat alternative served as
a snack at least once per week for consideration for the
Green Apple award level. Four out of those five centers
lacked a bright orange vegetable served at least once per
week at any meal or snack. Three out of those five centers
also lacked a vegetable served at snack at least twice per
month and different whole grains served at least twice
per week. Snacks were the biggest factor that prevented
centers from achieving the Green Apple award level.

Nutrition Education
A holistic approach towards nutrition education is necessary
in order to engage key players influencing nutrition habits
in young children. This approach includes the use of
different tools such as a nutrition curriculum for children,
the establishment of a wellness policy for the centers, the
training of teachers and staff, as well as parental outreach
and involvement to promote healthy habits at home.

Nutrition Curriculum and

Wellness Policy
Sixty percent of directors reported that their centers do not
use a nutrition education curriculum while 27% reported
using their own. At the same time, 79% of teachers
reported that they teach a nutrition curriculum; 59% of
them teach it every day and 82% use it at least once a
week. Twenty percent of teachers said they never use a
nutrition curriculum. Sixty-two percent of parents reported
that their children learn about nutrition and wellness at
the center, while 32% stated that they dont know. Six
percent of parents reported that their children do not
learn about nutrition and wellness at the center. However,
most parents (86%) felt that nutrition education is very
important to have at the center, compared to 14% who felt
it is somewhat important and less that 1% who stated that
it was not at all important to have nutrition education
at the center. Forty percent of directors reported having a
wellness policy compared to 78% of teachers.

Teacher and Staff Professional

Development
One question inquired about the number of hours
of professional development for teachers and staff that was
dedicated to nutrition education each year. The Child
Development Associate (CDA) Credential, which is
a national credential for early childhood educators,
requires at least 45 hours of professional development
to be renewed every two years. 20 Of those hours, there
is no minimum requirement for time spent learning
about nutrition education. In the study, the professional
development questions were intended to gather
information of how prepared teachers were to teach
their students about nutrition. Sixty-seven percent of
directors reported having at least two hours of professional
development dedicated to nutrition a year, while 27%
having six or more hours. One center reported not including
nutrition as a component of professional development. It is
important to include that 69% of parents reported thinking
that their childs teacher was knowledgeable about food
and nutrition while 28% reported that they dont know.

Parent Outreach and Nutrition

Promotion
Directors reported that the most popular form of outreach
for parents were handouts (47%) and workshops (33%).
Three centers reported having no nutrition and wellness
outreach for parents. The most popular forms of nutrition
promotion within the centers were posters (40%) and flyers
(47%). Twenty-five percent of centers had special days for
nutrition promotion. Teachers stated that the most utilized
form of nutrition and wellness promotion for parents were
individual conversations (49%), handouts (29%) and
workshops (23%). Eighteen percent of teachers did not
participate in nutrition and wellness outreach activities for
parents. At the same time, 35% of parents reported that
they do not receive information regarding nutrition and
wellness at the centers. Parents who received information
reported that they were most likely to receive it via
handouts (32%) or workshops (19%).

12 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

Quality
As seen in Figure 8, parents were the most satisfied with the nutrition
education at their center (73%), compared to 65% of teachers and
20% of directors. Forty-seven percent of directors were somewhat
satisfied compared to 25% of parents and 23% of teachers. Thirty-three
percent of directors were not satisfied, compared with 12% of teachers
and 5% of parents.

FIGure 11: p
 arent perceptions on
wanting to see a change
in the food quality and
nutrition education

Needs and Willingness to Change

Offered Services
Seventy-three percent (11) of directors said they would be willing to
make changes to both the food quality and the nutrition education
at the center, while 13% (2) of directors were no willing to make any
changes. One director was only willing to make a change in food
quality and another director was only willing to make a change in
nutrition education offered at their center. To make changes the
directors stated they would need financial assistance (80%), materials
(73%), curriculum (67%) and equipment (47%). Likewise, 80% of
teachers felt it was very important to make a change in food quality
and nutrition education at their center. Seventy-five teachers provided
feedback on what they would need to make changes, which included
more training on nutrition, age-appropriate materials and more
parental involvement. Thirty percent of parents reported wanting to
see a change in the food quality of centers while 21% reported wanting
to see a change in the nutrition education at their center. Sixteen
percent of parents wanted to see a change in both. On the other hand,
1 in 3 parents said they would not like to see a change in either the
food quality or the nutrition education at their center.
FIGure 8: level of satisfaction of different stakeholders
regarding nutrition education offered at early
childhood centers

FIGure 10: t eacher perceptions on

the importance of making
a change to food quality
and nutrition education

FIGure 9: w
 illingness of directors
to change food quality
and nutrition education
services

Results | 13

Discussion
Food Preparation and Perceptions
A positive trend was observed between stakeholder
involvement as described by method of food preparation
(in-house, catered or brought by parents) and the
overall satisfaction of respondents with the food quality
offered at the centers. Additionally, there was a negative
trend between the method of food preparation and the
willingness of participants to change services offered at
the centers. As seen in Figure 12, 100% of directors with
in-house preparation were satisfied with the food offered
while 50% of directors from centers who used catering and
50% of directors from centers where parents brought their
own food were satisfied with the food quality. Similarly, 88%
of teachers with in-house preparation were satisfied with
the food at the center, compared to 67% of teachers from
centers where parents brought their own food and 48%
of teachers from centers that used catering. On the other
hand, parents were more satisfied with food prepared at
home showing a satisfaction level of 83%, compared to 73%
satisfaction from parents whose children went to centers

with in-house preparation and 63% satisfaction from

parents whose childrens food was catered.
The trend between food preparation and satisfaction with
both food quality and nutrition education revealed that, in
general, respondents from centers that prepared their food
in-house were more satisfied than the centers that catered
their food, as well as those centers where parents brought
their own food. Most notably, centers that catered their food
appeared to have the lowest satisfaction among the three
groups. One explanation for this trend is that participants
were more satisfied when the food was prepared in-house
because they perceived the quality to be better compared
to respondents from centers that used a catering service.
Their perceptions could be linked to the actual quality of the
food as well as to their expectations of quality as there has
been a tendency to perceive homemade foods as being
better than catered or store-bought meals. It is important
not to disregard the possibility that participants may have
over reported their satisfaction rating particularly in centers
that had in-house preparation because they were more

FIGure 12: f ood quality satisfaction rates among stakeholders

depending on food preparation method

14 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

FIGure 13: Rate of willingness to change nutrition services

by staff depending on food preparation method

directly responsible for the quality of the food and may have
felt they needed to portray a positive image of their center.
Because of this, in future investigations it may be helpful
to use a rating scale method for satisfaction questions as it
allows respondents to provide more nuanced answers.
Comparing food preparation methods and satisfaction is
important because it provides the possibility of analyzing
peoples perception of quality of food services depending
on how involved they are in the food service process.
Observing higher satisfaction of more involved participants,
such as seen in Figure 12 where parents who bring their
own food were the most satisfied with the food quality
offered to their children, highlights the importance of
creating and supporting programs that enable centers to
take charge of food preparation and overall nutrition in the
center. However, because the level of personal satisfaction
and healthiness of the food prepared may not be congruent,
it is important to properly educate all parties involved in
nutrition before they make decisions as to what should
be served. This is especially important in the long term
because, as seen in Figure 13, there was a negative trend
between involvement in food preparation and willingness

to change food quality or nutrition education at the center.

Seventy-five percent of directors with in-house preparation
were willing to change the food quality or the nutrition
education in their centers, compared to 88% of directors
who had catering and 100% of directors from centers where
parents provided the food. Similarly, 74% of teachers from
in-house preparation centers reported that it was very
important to make a change in food and nutrition education
at their center, compared to 78% of teachers from catered
centers and 95% of teachers from centers where parents
provided the food. This negative trend could be due to the
fact that centers that are more involved in food preparation
have a more developed nutrition education program.
Another explanation could again be that centers that are
more involved over report satisfaction of their services and
be less willing to change pre-established methods.

Perceptions of Food vs. Quality

There was no correlation between the nutritional value
of meals and the method of food preparation. From the
centers that prepared their food in-house (2), one was
above the recommended intake of total fat, calories,
discussion | 15

FIGure 14: Food quality satisfaction rates among stakeholders depending on implementation of a nutrition curriculum

sugar, and saturated fat. The other center was above

the recommended intake of sugar and saturated fat and
below the recommended intake of calories. Centers that
had their food catered had similar results; therefore, there
was no significant difference between foods prepared
in-house versus catering. This corroborates the idea that
respondents may perceive the food prepared in-house as
more satisfying regardless of whether the food was actually
healthier than that served by the catering companies.

adiposity. On the other hand, studies have shown that

excess sugar, especially found in beverages, has been
linked to a higher risk of obesity in children.22 Because of
this, it is important that centers monitor and reduce sugar
intake of children, particularly by limiting sugary beverages,
which includes 100% fruit juices that contain high levels of
naturally-occurring sugars.

An important note should be made about sugar and fat

content of the meals served at the centers. All centers
surpassed the recommended daily intake of 13 g of sugar,
with one center serving six times the recommended
daily value at 79.74 g. Additionally, only three centers fell
under the appropriate range of total fat while the other
centers provided less fat than recommended value. Fats
are essential for child development making it a priority
for children to be provided with adequate amounts in
their diets. 21 Nevertheless, fat intake at schools should
be balanced with estimated fats eaten at home because
surpassing the recommended value can lead to increased

A trend was also found between the level of satisfaction

with the food and nutrition education and the
implementation of a nutrition curriculum at the centers.
As seen in Figure 14, 67% of directors with centers who
reported having a nutrition curriculum were satisfied with
the food compared to 44% who did not have a nutrition
curriculum. Likewise, 74% of teachers with a nutrition
curriculum were satisfied with the food at the center
compared to 53% who did not have a nutrition curriculum.
Similarly, 83% of parents whose children attended a center
with a nutrition curriculum were satisfied with the food
compared to 57%.

Nutrition Education and Perceptions

16 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

As seen in Figure 15, in terms of nutrition education

directors presented a low level of satisfaction across
the board, with 33% of directors who implemented a
nutrition curriculum being satisfied, compared to 11% of
directors who did not have a nutrition curriculum. More
teachers and parents reported being satisfied with the
nutrition education, with 78% of teachers from centers who
implemented a nutrition curriculum, compared to 51% of
teachers who did not have a nutrition curriculum and 83%
of parents from centers that had a nutrition curriculum
compared to 57% whose children did not attend a center
that implemented a nutrition curriculum. It is important to
note however that parent responses may not fully portray
the actual status of the nutrition education at the centers
since many of them made comments about being unaware
of whether their children received this type of instruction.
This could have led them to answer randomly or over
report their satisfaction with the nutrition education at their
centers.

There was a negative trend between having a nutrition

curriculum and the willingness to change from different
stakeholders regarding the food quality and the nutrition
education at the center. While 67% of directors with a
nutrition curriculum said they were willing to make a
change, 100% without a nutrition curriculum said they
would make a change. However, teacher responses were
very similar in both cases with 78% of teachers with a
nutrition curriculum reporting that it was very important to
make a change compared to 82% of teachers who did not
have a nutrition curriculum. One possible explanation for
this negative trend could be that centers that employed
a nutrition curriculum had a more developed nutrition
program compared to centers that did not have a nutrition
curriculum and were, therefore, less willing to change their
already established programs. To confirm this explanation,
future studies should inquire about the existence and
involvement in nutrition programs at each institution
through interviews with directors.

FIGure 15: n
 utrition education satisfaction rates among stakeholders
depending on implementation of a nutrition curriculum

discussion | 17

Perceptions of Curriculum vs. Quality

As previously mentioned, directors had the lowest
satisfaction rating (20%) for nutrition education provided
at the centers compared to both teachers (65%) and
parents (73%). At the same time, most parents (86%) said
that having nutrition education at the center was very
important for their children. It should be noted, however,
that the 60% of centers that reported using a nutrition
curriculum were referring to The Creative Curriculum,
which is a comprehensive early childhood teaching
framework that is not solely focused on nutrition. The
Creative Curriculum is divided into different areas of child
development such as cognitive, emotional, social, and
motor skills, leaving it up to the directors and teachers to
incorporate nutrition into each of these areas, especially
through the introduction of new foods. Additionally, there
is no oversight in regulating nutrition education for young
children in the District of Columbia, which can create
inconsistency in levels of nutrition literacy among the
different centers.

Parental Reluctance to Change

Parental involvement is essential for successful
implementation of nutrition programs for children under
five because parents play a leading role in selecting and
providing food for their children at home, especially during
early childhood. Although only three centers reported not
partaking in nutrition promotion for parents, most of the
nutrition promotion at the other centers was done through
handouts and posters rather than workshops and handson activities. The lack of focus on interactive nutrition
promotion may help explain why many parents seemed
unaware of the food offered at their center and, most
notably, of the existence of nutrition education for their
children and the level of teachers nutrition knowledge and
training. In addition to this, and potentially because of their
lack of knowledge regarding nutrition services at the center,
one third of parents responded that they would not like
to see a change in food quality or the nutrition education.
Less than half wanted a change in the food quality of their
center (46%) while 37% stated they wanted a change in
nutrition education. A possible explanation could be that

parents related change in nutrition services with higher

costs. Another important question that requires further
exploration is the role that cultural perceptions and nutrition
literacy play on the willingness of the parents to improve
these services, as nutrition education may not have been a
priority for this sample population.

Limitations
Throughout the study various limitations were revealed.
To begin, there were two centers that did not serve food
because parents were responsible for providing the meals.
This created some problems with the results, particularly
in the food and quality sections of the questionnaire. The
answers received from these two centers may have skewed
the results slightly because some parents were filling out
this section even if their children did not eat at the center.
It is important to note that even if parents are responsible
for bringing food, the DC Child Care Licensing Regulations
require all licensed centers to provide parents with a set of
guidelines so that they meet the CACFP food requirements.
Another possible reason for skewed results, which was
mentioned earlier, is that some centers may have answered
the questionnaires wanting to depict a more positive image
of the food and nutrition services they offer. Similarly,
parents responses may have been influenced by what they
perceive their children should be eating at home rather than
what they actually eat. Some parents also had a difficult
time with the questionnaires. Many were rushed and did
not read each question in its entirety before answering.
Others had limited knowledge regarding the food and
nutrition education practices at their childs day care center.
Additionally, questions should not only be directed towards
determining the levels of satisfaction of participants but
should also incorporate statements that allow participants
to explain what factors played a role in determining their
satisfaction.
Another limitation was that there were some
misunderstandings among respondents regarding
basic concepts such as wellness policy and nutrition
curriculum. The question concerning a wellness policy
seemed to cause some confusion particularly among

18 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

teachers. While teachers were completing the survey it was

observed that many discussed what the question meant
and they generally came to the conclusion that it was a
policy regarding sick children. This led to a discrepancy
at some centers where directors stated that their center
did not have a wellness policy while teachers responded
the contrary. Another discrepancy between directors and
teachers had to do with whether their center implemented
a nutrition education curriculum and if they implemented
nutrition education as part of professional development.
In some cases directors would state that they had no
professional development for nutrition while teachers
would report that they had 6 or more hours a year. It is
important to note that professional development questions
should not only measured in time spent learning about
nutrition but should focus on the quality of the workshops
for the teachers, which should include coaching as well
as hands-on activities. Additionally, some directors stated
that they did not have a nutrition education curriculum
while teachers reported that they implemented a nutrition
education curriculum every day. From observing teachers it
seemed that some have a very loose definition of nutrition
curriculum as some counted pointing out different food
items to children during lunchtime as employing a nutrition
curriculum.
It is important to note as well that certain quality questions
asked participants whether they thought that the food
served at their center was healthy. The definition of
what healthy is can vary among individuals as their
perceptions can be affected by their level of education,
nutrition literacy, and cultural background. Although it was
not in the scope of this particular study, it would be helpful
to explore personal perceptions of a healthy diet and
compare them to a scientifically-based definition such as
the one detailed in the Dietary Guidelines for American
which was established by the US Department of Health
and Human Services (HHS) to provide nutritional guidance
for Americans. It would also be beneficial to study the
determinants that define what is healthy for individuals,
so that educational tools can be created in mind with
peoples preconceptions of health.

discussion | 19

Conclusions and Recommendations

Based on participant responses, observations made by
investigators who visited the centers, best practices from
previous school-based programs and current nutrition
incentives in early childhood programs, the following
recommendations can be made:
1. Create a needs-assessment instrument to collect
information on minimal requirements that centers
need in order to create or consolidate nutritionbased services. Provide assistance and incentives
for centers that are unable to meet those minimum
requirements, which may include financial support,
equipment as well as technical assistance for teachers
and directors.
2. Set standards for a nutrition curriculum specifically
designed for young children. For children under
five, it is important to work on repetition and handson activities so that they are better able to internalize
the importance of nutrition and acquire basic nutrition
literacy from an early age. The curriculum should
be multidisciplinary and a component of everyday
activities. It should also promote self-regulation,
which is essential for obesity prevention. This can be
accomplished by increasing training in evidence-based
curricula developed by the USDA.
3. Set a minimum standard for hours spent on nutrition
education as part of professional development for
teachers. It is essential that teachers be well trained in
nutrition literacy so that they can convey the importance
of nutrition to children and their parents. It would
also be helpful to assess and enrich the CDA nutrition
component as well as the workshops offered by the
OSSE so that teachers are better prepared to teach
nutrition to young children as part of comprehensive
wellness-based policies for child development centers
such as those that exist for schools under the Healthy
Schools Act.

4. Workshops for both parents and teachers should

encourage involvement and be made accessible by
catering to multicultural backgrounds and specific
demographics. They should incorporate pertinent
languages, provide convenient times for working
parents and offer additional child care if necessary.
Workshops should also include hands-on activities such
as cooking classes so that parents can incorporate new
practices at home more easily. Workshops should also
emphasize the importance of modeling proper eating
habits for children.
5. Encourage parental involvement in nutrition
education at childcare centers. It is essential for
parents to be engaged in nutrition programs since
they are major providers for their children and have a
significant impact on young childrens food preferences.
Parents should be offered nutrition workshops and work
closely with teachers and directors to create a wellness
policy for each center.
6. Facilitate the creation of a nutrition network for
early childhood centers. The network can serve as
a resource for improving nutrition programs at the
centers and advocate for better nutrition practices in
communities.
7. Provide more incentives for childcare centers to
participate in nutrition programs. These incentives
can be financial in nature but also through support of a
nutrition network, as well as through the extension of
school programs into early childhood settings such as
the Fresh Fruits & Vegetables Program and the Farm to
School programs.

20 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

These recommendations are aimed at consolidating a food

service and nutrition education program for young children
in the District of Columbia that is consistent across centers
and that provides a baseline for proper nutrition at an early
age. A stronger program can promote proper development
and help prevent obesity and other health complications
for children who attend day care centers. We hope that this
exploratory survey starts a conversation on the importance
of nutrition programs during early childhood and prompts
the creation of future studies, more incentives for child care
centers and the strengthening of nutrition practices for
young children in the District of Columbia and across the
country.

Conclusions and Recommendations | 21

References
1.

Obesity Among Low-Income Preschool Children. Centers

for Disease Control and Prevention. 2009. Web. August 29,
2013. PDF file.

13. 2012 Child Care in the State of: District of Columbia Child
Care Aware of America. March 2012. Web. September 16,
2013. PDF file.

2. Brisbois TD, Farmer AP, and McCargar LJ. Early markers of

adult obesity: a review. Obesity Reviews 13.4 (2012): 347367. Web. September 7, 2013.

14. Birch, Leann L. and Fisher, Jennifer O. Development

of Eating Behaviors Among Children and Adolescents.
Pediatrics 101.2 (1998): 539-549. Web. August 29. 2013.

3. Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz

WH. Cardiovascular risk factors and excess adiposity
among overweight children and adolescents: the Bogalusa
Heart Study. Journal of Pediatrics 150.1 (2007):1217. Web.
September 13, 2013.

15. Ramsay, Samantha A., Laurel J. Branen, Janice Fletcher,

Elizabeth Price, Susan L. Johnson, and Madeleine SigmanGrant. Are You Done? Child Care Providers Verbal
Communication at Mealtimes That Reinforce or Hinder
Childrens Internal Cues of Hunger and Satiation. Journal of
Nutrition Education and Behavior 42.4 (2010): 265-70. Web.

4. Xu, Jiaquan. Quick Stats: Number of Deaths from 10 Leading

Causes - National Vital Statistics System, United States,
2010. Centers for Disease Control and Prevention. March 1,
2013. Web. August 29, 2013.
5. Finkelstein, Eric A.; DiBonaventura, Marco daCosta; Burgess,
Somali M., and Hale, Brent C. The Cost of Obesity in the
Workplace. Journal of Occupational and Environmental
Medicine 52.10 (2010): 971-976. Web. September 7, 2013.

16. Children in District of Columbia. Childrens Defense Fund.

March 20, 2013. Web. August 29, 2013. PDF file.
17. Edberg, Mark. Chapter 4: Health Belief Model.
Essentials of Health Behavior. 2007. Web. September 23,
2013. PDF file.

6. Scott KM, McGee MA, Wells JE, Oakley Browne MA. Obesity
and mental disorders in the adult general population.
Journal of Psychosomatic Research 65.1 (2008): 99. Web.
August 29, 2013.

18. Harnack, LJ, JM Oakes, SA French, SA Rydell, FM Farah, and

GL Taylor. Results from an Experimental Trial at a Head Start
Center to Evaluate Two Meal Service Approaches to Increase
Fruit and Vegetable Intake of Preschool Aged Children.
The International Journal of Behavioral Nutrition and Physical
Activity 9.51 (2012): n. pag. Web.

7. The Future Costs of Obesity: National and State Estimates

of the Impact of Obesity on Direct Health Care Expenses.
Report, 2009. Web. August 29, 2013. PDF file.

19. Family Style Meal Service. National Food Service

Management Institute. February 1, 2006. Web. September 16,
2013. PDF file.

8. New CDC Vital Signs: Obesity Declines Among Low-Income

Preschoolers. Centers for Disease Control and Prevention.
August 6, 2013. Web. September 17, 2013.

20. About The Child Development Associate (CDA) Credential Council for Professional Recognition. Council for Professional
Recognition. N.p., n.d. Web. September 16, 2013.

9. What Causes Overweight and Obesity? National Heart,

Lung, and Blood Institute. July 13, 2012. Web. August 29,
2013.

21. Milner, John A., and Richard G. Allison. The Role of Dietary
Fat in Child Nutrition and Development: Summary of an ASNS
Workshop. Journal of Nutrition 129.11 (1999): 2094-105. Web.

10. DC Healthy School Act - Year One Snapshot. DC Hunger

Solutions. January 2012. Web. August 29, 2013. PDF file.
11. Lets Move! Child Care. Lets Move! Child Care. n.d. Web.
August 29, 2013.

22. Ludwig, D., K. Peterson, and S. Gortmaker. Relation

between Consumption of Sugar-sweetened Drinks
and Childhood Obesity: A Prospective, Observational
Analysis. The Lancet 357.9255 (2001): 505-08. Web.

12. Child Care an Important Part of American Life. United States

Census Bureau. n.d. Web. August 29, 2013. PDF file.

22 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

Appendices
1. Tables: Red Apple and Green Apple Criteria

appendices | 23

2. Sample Questionnaires
director
Food
1. Where is the food prepared for your center?
a. Catering
b. In house
c. Other: _____________
2. Who creates or reviews the menus?
a. Director
b. Staff (Title:_________________________________)
c. Catering company
3. How many fresh fruits and vegetables are served per
day (not including juice)?
a. 0
b. 1-2
c. 3-5

4. How do you serve meals?
a. Family style
b. Pre-plated
c. Other: ____________
5. Which meals are offered every day? (Circle all that
apply.)
a. Breakfast
b. Lunch
c. Snack
Nutrition Education
1. Do you have a nutrition education curriculum and if so,
what do you use?
a. No
b. Our own
c. Other: __________________________________
2. How many hours of professional development are
dedicated to nutrition education each year?
a. 0 hours
b. 1-2 hours
c. 3-5 hours
d. 6 or more hours

4. What kind of nutrition and wellness promotion do you

do within the center?
a. Posters
b. Flyers
c. Special days
d. Other: ___________
e. None
5. Do you have a wellness policy?
a. Yes
b. No
Quality
1. Are you satisfied with the food served at your center?
a. Yes
b. No
c. Somewhat
2. Are you satisfied with the nutrition education at your
center?
a. Yes
b. No
c. Somewhat
3. Are you willing to change the food quality and nutrition
at your center?
a. Yes, the food quality
b. Yes, the nutrition education
c. Yes, both
d. Neither
4. What would you need to make changes in terms of food
and nutrition education at your center possible?
Financial assistance

Staff training

Curriculum

Materials

Equipment

Other: __________________________________

Additional Comments:

3. What kind of parent nutrition and wellness outreach do

you offer?
a. Workshops
b. Tastings
c. Handouts
d. Other: __________
e. None
24 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

Teachers
Food
1. How do you interact with children during lunchtime?
a. I serve lunch
b. I eat with them
c. We talk about various topics
d. N/A
2.

What do you think of the food served at the center?

a. It is healthy
b. It is not healthy
c. Sometimes is healthy

3. Are children introduced to a variety of new foods at the

center?
a. Yes
b. No
c. Sometimes
4. Do you provide drinking water in your classroom?
a. Yes
b. No
5. Do you like the food served at the center?
a. Yes
b. No
c. N/A
Nutrition Education
1. Do you use any form of nutrition curriculum?
a. Yes, what is provided
b. Yes, my own lessons
c. No
2. Do you do activities to promote nutrition and wellness
with parents? (select all that apply)
a. No
b. Workshops
c. Tastings
d. Handouts
e. Individual conversations
f. Other: ____________

4. Do you follow a wellness policy?

a. Yes
b. No
5. How often do you reward children with food?
a. Always
b. Sometimes
c. Every once in a while
d. Never
Quality
1. Are you satisfied with the food served at your center?
a. Yes
b. No
c. Somewhat
2. Are you satisfied with the nutrition education at your
center?
a. Yes
b. No
c. Somewhat
3. How important is it to you to make a change in food
and nutrition education at your center?
a. Very
b. Somewhat
c. Not at all
4.

 hat would you need to make changes in nutrition

W
education at your center?

Additional Comments:

3. How often do you teach nutrition to children?

a. Every day
b. Once a week
c. Once a month
d. Once a year
e. Never

Appendices | 25

parents
Food
1. Does your child eat the food that is provided at the
center?
a. Yes
b. No
c. Sometimes
2. What do you think of the food served to your child at the
center?
a. It is healthy
b. It is not healthy
c. Can be improved

3. Do you receive any information regarding nutrition and

wellness from the center?
a. Workshops
b. Tastings
c. Handouts
d. Other: __________
e. None
4. Do you talk to your child about healthy habits at home?
a. Yes
b. No

3. How many fresh fruits and vegetables are served at

home per day (not including juice)?
a. 0
b. 1-2
c. 3-5

5. Do you think the teacher is knowledgeable about food

and nutrition?
a. Yes
b. No
c. I dont know

4. Do you introduce new foods at home to your child?

a. Yes
b. No
c. Sometimes

Quality
1. Are you satisfied with the food served at your center?
a. Yes
b. No
c. Somewhat

5. What does your child drink at home (not including milk)?

a. Water
b. Soda
c. Juice
d. Other: __________
Nutrition Education
1. Does your child learn about nutrition and wellness at
the center?
a. Yes
b. No
c. I dont know

2. Are you satisfied with the nutrition education at your

center?
a. Yes
b. No
c. Somewhat
3. W
 ould you like to see a change in the food quality and
nutrition at your center?
(Choose as many options as you want)
a. Yes, the food quality
b. Yes, the nutrition education
c. Neither

2. How important is it to you to have nutrition education

for your child at the center?
a. Very
b. Somewhat
c. Not at all

26 | Food and Nutrition Education in Early Childhood Centers | Status, Perceptions, and Needs in the District of Columbia

3. Sample Menu
sample menu of surveyed center
Monday

Tuesday

Wednesday

Thursday

Friday

Whole Grain Biscuit (2.2

oz)

Assorted Cereal (1.5 oz)

Breakfast
Whole Grain Honey &
Oats Granola Bar (2 oz)

Whole Grain Mini Bagels

(2.25 oz)

Assorted Cereal (1.5 oz)

Turkey Sausage (2 oz)

Fresh Fruit - Whole

Orange (6 oz)

100% Grape
Juice (3/4 cup)
Mixed Fruit Jelly (.12 g)

Assorted Cereal (1.5 oz)

Whole Grain Orange
Muffin (2.2 oz)
Assorted Cereal (1.5 oz)
Fresh Fruit - Whole Red
Apple (6 oz)

Turkey Sausage (2 oz)

100% Cranberry Juice
(3/4 cup)

Whole Grain Corn

Muffins (2.2 oz)
100% Fruit Juice (6 oz)

Mixed Fruit Jelly (.12 g)

Lunch
Whole Grain Chicken
Fried Steak (3 oz)

Ground Turkey Glazed

Meatloaf (3 oz)

Chicken Gravy (1/4 cup)

Natural Cut Oven
Fries (3/4 cup)

Roasted Garlic Mashed

Potatoes & Turkey
Gravy (1 cup)

Whole Grain Brown

Rice (1 cup)

Whole Grain Brown

Rice (1 cup)

100% Fruit Juice (6 oz)

Fresh Steamed Green

Beans (3/4 cup)
Fresh Fruit - Whole
Pear (6 oz)

Oven Baked BBQ Chicken

Broccoli Salad with
(3 oz)
Chicken: Fresh Broccoli,
Red Peppers, StrawberWhole Grain Brown
Rice & Red Beans (1 cup) ries, Whole Grain Rotini
Noodles, Tomatoes,
Chicken Gravy (1/4 cup)
Raspberry Vinaigrette
Dressing (1.5 cup)
Corn on the Cob (1 cup)
Fresh Fruit - Whole Peach
(6 oz)

Turkey & Swiss Slider

Sandwich on a Whole
Grain Slider Roll (2 oz

Whole Grain Cheese

Pizza (4.5 oz)
Vegetable Medley with
Carrots, Peas, Greens,
Lentils & Broccoli (3/4
cup)
Fresh Fruit - Whole
Banana (6 oz.)

Fresh Fruit - Whole

Peach (6 oz)

Appendices | 27