Multi-Level Opportunities to Improve Nutrition in Child Care Settings.

Early care and education (ECE) programs can have a positive influence on children's nutrition by ensuring that they eat a healthful diet and develop a positive relationship with food during the early years, from birth to age 5 years. Dietary habits take root early in life, carry into adolescence and adulthood, and affect immediate and long-term disease risk, including cardiovascular disease and obesity. In the United States and most other countries, ECE programs serve large numbers of children, providing care for most of children's waking hours as well as 50-75% of daily calories. Nutrition education, defined broadly as education, environmental supports, and policy, can be highly influential on children's nutrition. The "4-Ps" is a useful mnemonic when describing the multiple opportunities within ECE programs to address child nutrition, referring to provisions, practices, planned education and outreach, and policy. ECE administrators and teachers need assistance and support to improve nutrition education within their programs. An effective strategy for achieving such improvements is Go NAPSACC, an on-line suite of tools that guides ECE programs through a system for continuous quality improvement. It is critical that nutrition experts and policy makers assume a leadership role in helping ECE programs and the children and families they serve.