Abstract

Background: The Child and Adult Care Food Program (CACFP) is the primary national program that enables child care settings to provide healthy meals for children. Associations between CACFP participation and child health and development and health care utilization are understudied.

Objective: To assess associations between children's health, development, health care utilization and food security by meal source (child care-provided versus parent-provided) among children from low-income families with a child care subsidy attending child care in settings likely eligible to participate in CACFP.

Design: The study used repeat cross-sectional surveys (new sample at successive time-points) conducted year-round.

Participants: /Setting: Primary caregivers of 3,084 young children accessing emergency departments (EDs) or primary care in Baltimore, Boston, Little Rock, Minneapolis, and Philadelphia were interviewed between 2010-2020. The sample was limited to children aged 13-48 months, receiving a child care subsidy and attending child care centers or family child care homes >20 hours per week.

Main outcome measures: Outcomes included household and child food security; child health, growth, and developmental risk; and admission to the hospital on the day of the ED visit.

Statistical analyses: Meal source and participant characteristics were analyzed using chi-square; associations of outcomes with parent-provided meals were analyzed with adjusted logistic regression.

Results: The majority of children had child care-provided meals (87.2% child care-provided vs. 12.8% parent-provided). Compared to children with parent-provided meals, children with child care-provided meals had lower adjusted odds of living in a food-insecure household (AOR 0.70, [95%CI 0.55, 0.88]), being in fair or poor health (AOR 0.61, [95%CI 0.46, 0.81]), or hospital admission from the ED (AOR 0.59, [95%CI 0.41, 0.83]), with no differences in growth or developmental risk.

Conclusions: Compared to meals provided from home, child care provided meals likely supported by the Child and Adult Care Food Program (CACFP) is related to food security, early childhood health, and reduced hospital admissions from the ED among low-income families with young children.