A Safety Net Unraveling: Feeding Young Children During COVID-19

Illuminating Child and Adult Care Food Program Partnerships That Improved Food Access and Waiver Utilization for Feeding Young Children in Early Care and Education Programs During COVID-19: A Qualitative Study

BACKGROUND

Little is known about the partnerships formed between early care and education (ECE) programs and the Child and Adult Care Food Program (CACFP) and other organizations to continue to feed young children during the COVID-19 pandemic. Such information can provide important lessons to build ECE capacity for feeding children during future emergencies and has the potential strengthen the ECE food systems.

OBJECTIVE

This study aimed to identify the unique partnerships that CACFP state agencies established to provide nutrition to young children during the COVID-19 pandemic DESIGN: Qualitative semi-structured interviews with 24 participants representing 21 states across the United States.

PARTICIPANTS/SETTING

Virtual interviews with CACFP directors from December 2020 through May 2021.

ANALYSIS

Following the realist method, transcripts were analyzed using thematic analysis. Codes were developed inductively and grouped to identify themes and subthemes.

RESULTS

Four themes were identified: (1) CACFP partnerships that supported children and families directly; (2) CACFP partnerships that built the capacity of ECE providers to provide food to children in their own settings; (3) CACFP systems-level partnerships that improved coordination of efforts to continue to feed children in ECE; and (4) CACFP directors encouraged other CACFP state agencies to build nontraditional, diverse partnerships that can be leveraged during pandemics and other natural disasters. Within these themes (subthemes), the purpose of the partnerships focused on improving waiver utilization (eg, Department of Transportation, state health departments), improving food access (eg, Summer Food Service Program [SFSP], food banks, grocery stores, dairy councils), supporting ECE programs to participate in food reimbursement programs (eg, SFSP, CACFP sponsors), and resource sharing (eg, coalitions, CACFP sponsors).

CONCLUSIONS

The CACFP state directors reported that existing and new partnerships between CACFP state agencies and external entities successfully facilitated feeding young children in ECE during the COVID-19 pandemic. States may consider developing a road map to proactively explore potential partners in their state to meet specific needs such as accessibility, availability, and affordability for feeding young children in ECE.

Federal Nutrition Assistance for Young Children: Underutilized and Unequally Accessed

INTRODUCTION

The federal Child and Adult Care Food Program (CACFP) improves nutrition and reduces food insecurity among young children by helping cover the food costs for child care providers and families. This nationwide study evaluated the extent and predictors of the CACFP's utilization among licensed child care centers to identify opportunities for expanding CACFP nutrition support.

METHODS

Administrative data from the CACFP and child care licensing agencies in 47 states and District of Columbia were compiled and geocoded for 93,227 licensed child care centers. CACFP participation was predicted using a multivariable Bayesian spatial logistic regression model in the sample of low-income areas to target CACFP eligible child care centers. Data were collected in 2020-2021 and analyzed in 2022.

RESULTS

Of all licensed child care centers, 36.5% participated in the CACFP, ranging from 15.2% to 65.3% across states; when restricted to low-income areas, 57.5% participated (range, 15.7%-85.7%). Income differences did not explain the large variation in CACFP participation rates across states. Having at least three CACFP sponsoring agencies per state predicted a 38% higher probability of CACFP participation (OR=1.38; 95% Credible Interval=1.08-1.78).

CONCLUSIONS

Currently CACFP participation rates among licensed child care centers point to program underutilization and unequal access, particularly in some states and regions. Work at the federal and state levels is warranted to expand participation in the program, above all in low-income areas, so that more young children could eat healthfully with the CACFP.

Opportunities to Improve Access to and Retention in the Child and Adult Care Food Program: Key Recommendations From Early Childcare Providers in Illinois, December 2020-July 2021

Objectives. To identify recommendations to improve access to and retention in the Child and Adult Care Food Program (CACFP) as critical strategies to address health equity for low-income children. Methods. We conducted a qualitative key informant study of early childcare center and home providers (n = 35) in low-income urban and rural census tracts in Illinois between December 2020 and July 2021. Interviews with providers were organized and analyzed by the study team in MAXQDA Qualitative Data Analysis software. Themes were refined and finalized via member checking with an expert panel of providers and advocates. Results. Overall, providers spoke positively of the benefits of CACFP participation. Themes that centered around strategies to improve awareness of and access to CACFP included (1) conducting systematic statewide outreach, (2) improving technical assistance for enrollment, and (3) supporting positive sponsor-provider relationships. Themes related to retention included (1) alleviating procurement burdens, (2) extending reimbursement rates, and (3) expanding flexibilities. Conclusions. Policymakers looking to increase access to and retention in CACFP could consider state-level strategies such as systematic outreach and more targeted technical assistance. (Am J Public Health. 2024;113(S3):S231-S239. https://doi.org/10.2105/AJPH.2023.307433).

Gut microbiota in COVID-19: key microbial changes, potential mechanisms and clinical applications

The gastrointestinal tract is involved in coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The gut microbiota has important roles in viral entry receptor angiotensin-converting enzyme 2 (ACE2) expression, immune homeostasis, and crosstalk between the gut and lungs, the 'gut-lung axis'. Emerging preclinical and clinical studies indicate that the gut microbiota might contribute to COVID-19 pathogenesis and disease outcomes; SARS-CoV-2 infection was associated with altered intestinal microbiota and correlated with inflammatory and immune responses. Here, we discuss the cutting-edge evidence on the interactions between SARS-CoV-2 infection and the gut microbiota, key microbial changes in relation to COVID-19 severity and host immune dysregulations with the possible underlying mechanisms, and the conceivable consequences of the pandemic on the human microbiome and post-pandemic health. Finally, potential modulatory strategies of the gut microbiota are discussed. These insights could shed light on the development of microbiota-based interventions for COVID-19.

Integration of Food-based Learning With Science in the Preschool Classroom: Implementation Gaps and Opportunities

OBJECTIVE

To explore Head Start teachers' use and integration of food-based learning (FBL) with science learning in the Head Start classroom.

DESIGN

Phenomenological approach using in-depth semistructured telephone interviews.

SETTING

North Carolina Head Start preschools.

PARTICIPANTS

Thirty-five Head Start lead and assistant teachers.

PHENOMENON OF INTEREST

All interviews were transcribed verbatim. Authors coded interview data for emergent themes.

ANALYSIS

Eleven primary themes were identified during analysis and inductively organized using the Systems Thinking Iceberg Model.

RESULTS

Teachers described most frequently using FBL during mealtimes. Teachers stated they felt successful when children were engaged and willing to try a new food. However, they struggled to connect food to science concepts. Teachers reported several motivators (eg, improving health) and barriers (eg, food waste) to integrating FBL. Teachers prioritized preparing children for kindergarten, but most teachers did not see how FBL could help them achieve this goal.

CONCLUSIONS AND IMPLICATIONS

Head Start teacher professional development programs could impact all 4 levels of the Systems Thinking Model to improve teachers' perceptions, underlying structures, and mental models regarding integrative FBL. Additional research is warranted to investigate the adoption, implementation, and potential impact of FBL on academic outcomes.

Impact of coronavirus disease 2019 on food security in early childhood

PURPOSE OF REVIEW

To summarize the impact of the COVID-19 pandemic on food insecurity during early childhood, with a focus on challenges and strategies to improve access to and consumption of nutritious food in early childcare and education settings.

RECENT FINDINGS

The COVID-19 pandemic exacerbated existing gaps and inequities in the early childcare and education system, resulting in closures and decreased access to healthy foods that disproportionately impacted black, indigenous, and people of color, as well as rural and low-income communities.

SUMMARY

Closures and changes in operational capacity not only stressed the early childcare and education system and its workforce but also contributed to financial strain and food insecurity among families with young children. Increased public investment and cross-sector partnerships can support and strengthen both early childcare and education and food systems, increasing equitable access to quality care and reducing food insecurity in early childhood.

Facilitators and Barriers to Implementation and Sustainability of Nutrition and Physical Activity Interventions in Early Childcare Settings: a Systematic Review

A stronger understanding of the factors influencing implementation of interventions in community-based early childcare settings is needed. The purpose of this systematic review was to synthesize existing research on facilitators and barriers to implementation and sustainability of nutrition and physical activity interventions in early childcare settings targeting 2-5-year-old children, including considerations for equitable implementation. This review adhered to PRISMA 2020 guidelines. Peer-reviewed literature was searched in PubMed, EMBASE, CINAHL, ERIC, and PsycINFO databases up to September 2020. Primary research studies that examined facilitators and barriers (or related synonyms) to the implementation and sustainability of nutrition and physical activity interventions in early childcare settings were eligible for inclusion. The search yielded 8092 records that were screened by four analysts in Covidence software with a final review of 24 studies. Two independent reviewers conducted study selection, data extraction, and quality appraisal (Mixed Methods Appraisal Tool). A "best fit" framework was applied using the Consolidated Framework for Implementation Research (CFIR) constructs to code barriers and facilitators. The most salient constructs were (1) "Available Resources," which was composed of time, staffing, space, and staff trainings; (2) adaptability; and (3) compatibility, the latter two indicating that easily modifiable interventions facilitated a smoother "fit" and were more likely to be successful, given adequate site-level resources. Only nine (28%) reported the use of a theory, model, or framework to guide evaluation; six studies (24%) included factors related to sustainability; and nine studies (38%) conducted their interventions with low-income or minoritized groups. The findings point to the need for intervention evaluations examining nutrition and physical activity to more consistently consider (a) sustainability factors early on in design and adoption phases; (b) use of theory, model, or framework to guide evaluation; and (c) equity-related frameworks and considerations for how equitable implementation.

Experiences pertaining to child nutrition and care provision among early care and education stakeholders, sponsors, and center directors during the COVID-19 pandemic: A multi-method study

Purpose

This study used multiple methods (interviews, survey) to assess experiences of stakeholders, sponsors, and center-based early care and education (ECE) program directors pertaining to child nutrition (e.g., provision of nutritious foods, mealtime practices, CACFP administration/use) and the provision of child-care (i.e., day-to-day ECE operations and programming) during the COVID-19 pandemic.

Methods

Participants included stakeholders from 22 national and state agencies associated with the Child and Adult Care Food Program (CACFP) who also work to promote nutrition and quality child-care, representatives of 17 CACFP sponsor organizations, and 40 center-based ECE program directors who participated in interviews, as well as 100 ECE directors who completed surveys. Data were collected across four states. Thematic analyses of interviews and descriptive methods were used to analyze data collected.

Results

Six main themes emerged from stakeholders, sponsors, and ECE program directors' focusing on: experiences during the temporary closure of several ECE programs; additional responsibilities and unanticipated expenses for ECE programs; difficulty in keeping up with constantly changing COVID-19 guidance; encounters during shifts from in-person to virtual training and monitoring; changes to nutrition practices at ECE; and the need to prioritize ECE funding.

Conclusions

Findings highlight challenges and supports to ECE programs and could inform future efforts to enhance child-care quality and child nutrition in the U.S. during pandemic situations.

Mixed-method assessment of caregiver feeding practices in early care and education centres during COVID-19

OBJECTIVE

The COVID-19 pandemic changed early care and education (ECE) mealtimes. Feeding practices that support children's emerging autonomy may support children's healthy eating, but it is unknown whether and how COVID-19 changed feeding practices. This paper describes caregiver feeding practices in ECE centres in Florida during COVID-19.

DESIGN

A mixed-methods design was used to understand mealtime feeding practices. Survey and interview questions were developed based on the Trust Model. More than 7000 surveys were sent to ECE centres. Analysis included descriptive statistics for survey data and thematic analysis for interview data.

SETTING

This statewide study included teachers in all licensed and license-exempt ECE centres.

PARTICIPANTS

Four hundred and thirty-one teachers completed a survey, and twenty-nine participated in follow-up interviews.

RESULTS

Surveys showed most teachers engaged in autonomy-supportive behaviours, such as letting children eat until they were finished (90 %). The most common controlling behaviour was praising children for cleaning their plates (70 %). The most common responses about changes to mealtimes were keeping physical distance and serving healthy food. Interview themes were Autonomy Support, Controlling Feeding Practices, Interactions are the Same, Interactions are Different, Physical Distancing and Healthy Eating.

CONCLUSIONS

Mealtimes are a central part of the day for young children and teachers in ECE environments. COVID-19 continues to influence ECE routines as behaviour change remains the primary method of reducing the risk of COVID-19 in the absence of a vaccine for young children. Understanding teachers' practices and perspectives is important for reducing the risk of COVID-19 and supporting children's autonomy and healthy eating.

Child and Adult Care Food Program Participation Benefits, Barriers and Facilitators for Independent Child Care Centers in California

The Child and Adult Care Food Program (CACFP) provides reimbursements for nutritious foods for children with low-income at participating child care sites in the United States. The CACFP is associated with improved child diet quality, health outcomes, and food security. However CACFP participation rates are declining. Independent child care centers make up a substantial portion of CACFP sites, yet little is known about their barriers to participation. Researcher-led focus groups and interviews were conducted in 2021–2022 with 16 CACFP-participating independent centers and 5 CACFP sponsors across California CACFP administrative regions to identify participation benefits, barriers, and facilitators. Transcripts were coded for themes using the grounded theory method. CACFP benefits include reimbursement for food, supporting communities with low incomes, and healthy food guidelines. Barriers include paperwork, administrative reviews, communication, inadequate reimbursement, staffing, nutrition standards, training needs, eligibility determination, technological challenges, and COVID-19-related staffing and supply-chain issues. Facilitators included improved communication, additional and improved training, nutrition standards and administrative review support, online forms, reduced and streamlined paperwork. Sponsored centers cited fewer barriers than un-sponsored centers, suggesting sponsors facilitate independent centers’ CACFP participation. CACFP participation barriers should be reduced to better support centers and improve nutrition and food security for families with low-income.

Pandemic-related socioeconomic disruptions and adverse health outcomes: a cross-sectional study of female caregivers

Background

The COVID-19 pandemic and efforts to mitigate transmission resulted in sudden and widespread socioeconomic disruptions including school and child care closures, unemployment and underemployment, and housing precarity. Understanding the extent to which these disruptions may have contributed to adverse health outcomes is critical for establishing policy priorities that can mitigate further harm.

Methods

We explored the associations between pandemic-related child care, employment, and housing disruptions with depressive symptoms, self-rated health, and food security status among a sample of economically disadvantaged and racially diverse female caregivers of young children (n=464). Data were derived from the Assessing California Communities’ Experiences with Safety Net Supports (ACCESS) study, which conducted survey-based interviews with California caregivers with low-income from August 2020 – May 2021. We implemented a series of multivariable Poisson regressions with robust standard errors to assess the potency of each exposure, independently and within the context of one another.

Results

Most caregivers experienced disruptions to child care (70%) and employment (63%); few experienced major housing disruptions (8%). Women that experienced child care and housing disruptions had greater depressive symptoms, lower self-rated health, and greater food insecurity, although the relationships for housing and depressive symptoms were modified by the timing of participants’ interviews. Employment disruptions were not associated with any of the examined adverse health outcomes.

Conclusion

In the wake of socioeconomic stressors brought about by the COVID-19 pandemic, attending to structural deficits in the child care system and increasing housing supports may be critical for protecting the health of caregivers.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14287-2.

"It Made Me Feel like Things Are Starting to Change in Society:" A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions

Many healthcare organizations are screening patients for health-related social needs (HRSN) to improve healthcare quality and outcomes. Due to both the COVID-19 pandemic and limited time during clinical visits, much of this screening is now happening by phone. To promote healing and avoid harm, it is vital to understand patient experiences and recommendations regarding these activities. We conducted a pragmatic qualitative study with patients who had participated in a HRSN intervention. We applied maximum variation sampling, completed recruitment and interviews by phone, and carried out an inductive reflexive thematic analysis. From August to November 2021 we interviewed 34 patients, developed 6 themes, and used these themes to create a framework for generating positive patient experiences during phone-based HRSN interventions. First, we found patients were likely to have initial skepticism or reservations about the intervention. Second, we identified 4 positive intervention components regarding patient experience: transparency and respect for patient autonomy; kind demeanor; genuine intention to help; and attentiveness and responsiveness to patients' situations. Finally, we found patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources. Healthcare organizations can incorporate our framework into trainings for team members carrying out phone-based HRSN interventions.

How Home Child Care Providers Purchase, Prepare, and Serve Healthy Foods: In-Depth Interviews with Child and Adult Care Food Program Participants

Background: Child care settings can enhance children's access and exposure to healthy foods through participation in The Child and Adult Care Food Program (CACFP), which reimburses child care providers for purchasing healthy foods. To identify challenges and facilitators to CACFP participation, we carried out in-depth interviews with CACFP-participating home child care providers to discuss purchasing, preparing, and serving food under CACFP guidelines. Methods: We carried out 20 in-depth telephone interviews with CACFP-participating home child care providers. Transcribed interviews were coded to develop themes using a deductive approach. Results: Interviews indicated that food costs still burden CACFP-participating child care providers despite reimbursements. CACFP-participating providers who described prioritizing healthy foods and nutrition showed a greater inclination toward purchasing, preparing, and serving healthy foods to children. Conclusions: We offer recommendations for how to effectively support CACFP-participating providers in offering healthy food to their children within a food choice framework, a multilevel categorization of factors that influence food choice. Recommendations include increased reimbursement rates for food purchases under CACFP and support for peer-to-peer mentoring and health promotion programs targeting child care provider health.

Implementation of Federal Waivers for Feeding Children in Early Care and Education During the COVID-19 Pandemic

OBJECTIVE

To capture Child and Adult Care Food Program (CACFP) state directors' experiences implementing federal waivers for feeding children in early care and education (ECE) settings during coronavirus disease 2019.

DESIGN

Qualitative semistructured interviews.

SETTING

Virtual interviews with state CACFP directors.

PARTICIPANTS

Child and Adult Care Food Program directors from 21 states from December 2020 to May 2021.

PHENOMENON OF INTEREST

Implementation of state-level waivers.

ANALYSIS

Qualitative thematic analysis.

RESULTS

State directors reported that the coronavirus disease 2019 waivers allowed ECE programs to continue feeding children despite being closed or having limited enrollment. The meal pattern, noncongregate feeding, parent/guardian meal pick-up, and monitoring waivers were most frequently used by states. Challenges included maintaining integrity to CACFP meal pattern requirements, addressing the limited capacity of ECE to produce and distribute noncongregate meals, and adapting technology for virtual reviews. Suggested improvements included streamlined communication from the US Department of Agriculture, standing waivers for emergencies, ongoing flexibilities for feeding children, and strategies to increase CACFP enrollment and reduce financial viability requirements for ECE.

CONCLUSIONS AND IMPLICATIONS

Results indicate the need for the US Department of Agriculture to consider issuing and extending waivers, increasing ECE participation in CACFP, and ensuring timely communication and guidance on waiver tracking.

Group well-child care model for Latino children in immigrant families: Adapting to and learning from the coronavirus disease 2019 (COVID-19) context

INTRODUCTION

Group well-child care (GWCC) is an alternative to traditional pediatric well-child care designed to increase parental social support and peer learning. This mixed methods study explored the adaptation and implementation of GWCC to a virtual format during coronavirus disease 2019 (COVID-19 pandemic) among Spanish-speaking Latino immigrant families.

METHOD

Interviews were conducted with eight providers and 10 mothers from May through September 2020. Qualitative analyses used a priori codes based on an implementation science framework. Quantitative data included demographics, the COVID-19 Impact Scale, and virtual group attendance. Bivariate analyses identified correlates of virtual visit attendance.

RESULTS

Eighty percent of mothers reported the pandemic had moderately or extremely impacted at least one major life domain such as daily life, food security, or family conflict. Of 27 mothers offered virtual groups, 67% attended. Mothers who attended virtual groups reported lower English proficiency (p = .087) and fewer friends and family members with COVID-19 (M = 1.0 vs. 5.1, p < .05) than those who did not attend. Women described virtual GWCC as acceptable and a source of social support. Some described differences in group dynamics compared with in-person groups and had privacy concerns. Providers noted scheduling and billing challenges affecting feasibility and sustainability. They reported that visits with good attendance were productive. Mothers and pediatric providers offered recommendations to improve feasibility and privacy and address sustainability.

DISCUSSION

Competing demands for those most impacted by COVID-19 may outweigh benefits of attendance. Virtual Spanish language GWCC appears acceptable and feasible for Spanish speaking Latina mothers. Thematic analysis and recommendations identify areas of improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Informing State-Wide Coalition Efforts to Implement and Integrate Nutrition Best Practices in Early Care and Education: Focus Group Insights from Child Care Providers

A healthy diet in early childhood is an important contributor to ensuring lifelong health and in reducing risk for obesity. The child care environment is critical to supporting nutrition as a majority of young children less than 5 years of age are enrolled in out-of-home care. In order to better understand barriers to implementing and integrating nutrition best practices, we conduced focus groups with child care providers (n = 25) in Illinois. Providers from low-income communities, rural communities, and communities of color were prioritized. Focus group participants reported several challenges including the high cost of nutritious food, picky eating, and their perception that parents did not set good examples at home. Many providers identified the Child and Adult Care Food Program (CACFP) as a critical resource in helping them implement best practices. Providers discussed needing and wanting more training, more money for food, and more parental support. These results indicate support for additional resources and sustained training and technical assistance to address perceived challenges. The evidence of the importance of CACFP in helping providers engage in nutrition best practices indicates support for expansion and strengthening of the program.

Key Informant Interviews to Inform Nutrition and Physical Activity Recovery Efforts in Child Care Settings amid the COVID-19 Pandemic in the United States

Purpose

The COVID-19 pandemic created a series of challenges for children's health, including several challenges related to nutrition and physical activity in child care settings. Thus, this study explored: 1) how COVID-19 impacted nutrition and physical activity in child care settings and how to address these challenges moving forward; 2) potential best practices in child care that emerged during the COVID-19 pandemic worth continuing; and 3) future directions for accessing, implementing, and evaluating COVID-19 federal investments in child care settings.

Methods

The study utilized a qualitative content analysis approach. In June 2021, the investigators conducted 17 qualitative interviews with federal representatives (n = 4), practitioners (n = 7), and researchers (n = 6). Recruitment continued until saturation was achieved. Virtual interviews lasted approximately 45 to 60 minutes and were recorded, transcribed, and coded for themes and subthemes using thematic content analysis.

Results

Primary findings included: 1) COVID-19 likely increased stress and exacerbated prevalence of food insecurity for child care staff and participating families, and decreased diet quality among children both while in and outside of child care; 2) flexibilities to federal child care requirements, outdoor learning opportunities, and meal provision strategies implemented during the pandemic were perceived as positive and could continue post-pandemic; and 3) future efforts could utilize the recovery funds to make changes that are equitable and sustainable, such as conducting equity assessments and collaborating with community organizations, along with evaluating impacts of these efforts on food insecurity and health of child care staff and participating children.

Conclusion

Overall, recommendations focused on several social determinants of health, including addressing food insecurity among both children and staff, and infrastructure for nutrition and physical activity. Continued programmatic and public health recovery efforts aimed to mitigate the negative impacts of COVID-19 are critical to fostering health and wellbeing in child care settings.

From zero to thrive: A model of cross-system and cross-sector relational health to promote early childhood development across the child-serving ecosystem

Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.

Maintaining School Foodservice Operations in Ohio during COVID-19: “This [Was] Not the Time to Sit Back and Watch”

The COVID-19-related lockdowns led to school closures across the United States, cutting off critical resources for nutritious food. Foodservice employees emerged as frontline workers; understanding their experiences is critical to generate innovations for program operations and viability. The purpose of this cross-sectional study was to characterize COVID-19-related foodservice adaptations for summer and school year meal provision. Public school district foodservice administrators across Ohio were surveyed in December 2020. Questions related to meal provision before, during, and after COVID-19-related school closures. Results indicate the majority of districts continued providing meals upon their closure in Spring 2020 (n = 182, 87.1%); fewer did so in Summer (n = 88, 42.1%) and Fall (n = 32, 15.3%). In Spring and Summer, most districts that offered meals functioned as ‘open sites’ (67.0% and 87.5%, respectively), not limiting food receipt to district-affiliated students. Most districts employed a pick-up system for food distribution (76–84% across seasons), though some used a combination of approaches or changed their approach within-season. Qualitatively, districts reported both “successes” (e.g., supporting students) and “challenges” (e.g., supply chain). Despite being ill-prepared, districts responded quickly and flexibly to demands of the pandemic. This analysis provides insight for future practice (e.g., establishing community partnerships) and policy (e.g., bolstering local food systems).

A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial

Background

Childcare settings are important environments for influencing child eating and physical activity (PA). Family childcare homes (FCCH) care for many children of low-income and diverse racial/ethnic backgrounds who are at greater risk for poor diet quality, low PA, and obesity, but few interventions have targeted this setting. The aim of this study was to assess the efficacy of a multicomponent intervention conducted in FCCH on the diet quality and PA of 2–5 year old children in their care.

Trial design

Cluster randomized trial.

Methods

The cluster-randomized trial, Healthy Start/Comienzos Sanos (2015–2019) evaluated an 8-month nutrition and PA intervention that included four components: (1) monthly telephone calls from a support coach using brief motivational interviewing, (2) tailored reports, newsletters and videos, (3) group support meetings, and (4) active play toys. After completing baseline measurement, FCCH were randomized into intervention or comparison groups in matched pairs. Both groups received the same intervention components but on different topics (intervention: nutrition/PA vs. comparison: reading readiness/literacy). Evaluation staff were blinded to group assignment. Child primary outcome measures collected at baseline and 8-months included: 1) Healthy Eating Index (HEI-2015) scores calculated from diet observation, and 2) accelerometer measurement of PA. Process measures were collected from field data and provider surveys. Generalized Estimating Equation Models assessed changes in HEI-2015 scores and PA over time by experimental condition.

Results

Ethnically diverse FCCH providers (n = 119) and 2-to-5-year-old children in their care (n = 377) were included in the final analysis. Process evaluation showed high participation in all intervention components except for group meetings. Compared to children in comparison group FCCH, children in intervention FCCH increased total HEI-2015 scores by 7.2 points (p < .001) including improvement in component scores for vegetables (0.84 points, p = .025) and added sugar (0.94 points, p = .025). For PA, compared to children in the comparison group, children in intervention FCCH decreased sedentary time by 5.7% (p = .021).

Conclusions

The multicomponent Healthy Start intervention was effective in improving diet quality and sedentary behavior of children in FCCH, which demonstrates the promise of obesity prevention interventions in this setting. Future research could include enhancing the Healthy Start intervention to strengthen the PA component, considering virtual peer support, and determining how to best translate and disseminate the intervention into FCCH nationally.

Trial registration

National Institutes of Health, NCT02452645. Registered 5 May 2015.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01272-6.

The Child and Adult Care Food Program: Barriers to Participation and Financial Implications of Underuse

OBJECTIVE

To assess facilitators and barriers to participation in the Child and Adult Care Food Program (CACFP) and estimate foregone federal funds because of CACFP underuse.

METHODS

An online survey of food service practices and experiences with CACFP among Connecticut-based licensed child care centers (n = 231).

RESULTS

Serving meals and the center's nonprofit status predicted CACFP participation. The most common challenge among participants was collecting family income eligibility. Streamlining paperwork (mentioned by 44% of respondents) and funding for nonfood, administrative costs (40%) were recommended facilitators to increase CACFP uptake. Nonparticipating centers had limited knowledge about the program and its eligibility. Foregone federal funding due to CACFP underuse among eligible Connecticut centers was estimated at $30.7 million in 2019, suggesting that 20,300 young children from low-income areas missed out on CACFP-subsidized food.

CONCLUSIONS AND IMPLICATIONS

Improving knowledge about CACFP and reducing participation burdens through additional funding and technical assistance can help expand the program to support child nutrition.

The COVID-19 pandemic and its potential enduring impact on children

PURPOSE OF REVIEW

The COVID-19 pandemic has ushered in great and rapid change in our society. Although children are somewhat less likely to get infected or have severe symptoms from COVID-19, they are being adversely affected by this global public health emergency in many direct and indirect ways. This review focuses on the major areas in which children and adolescents are suffering, and how pediatricians can anticipate and optimize child healthcare and support as the COVID-19 pandemic and its aftermath continues.

RECENT FINDINGS

This review provides preliminary insights into the physical, psychological, educational, developmental, behavioral, and social health implications of the pandemic on the pediatric population, highlighting both the pandemic's current and potential future impact on children.

SUMMARY

The COVID-19 pandemic has and will likely continue to adversely affect many different aspects of children's health and well-being. It is important for pediatricians to be aware of these consequences of COVID-19 and take steps to help their patients now and in the future. Because the virus continues to ravage many parts of the world, continued research is needed to identify and evaluate any additional COVID-related challenges and concerns that adversely impact the growth and development of children.

The COVID-19 pandemic: Adverse effects on the social determinants of health in children and families

OBJECTIVE

To describe the impact of social determinants on the experience of the coronavirus disease 2019 (COVID-19) pandemic within the pediatric population, how this impact may influence the long-term health and security of children, and what measures can be taken to ameliorate this impact moving forward.

DATA SOURCES

Nonsystematic review of relevant literature and news sources.

STUDY SELECTIONS

Relevant literature and news sources.

RESULTS

There have been increases in housing insecurity and food insecurity during the pandemic, including global increases in poverty. Public policies such as school closures have had a disproportionate impact on those facing adverse social determinants. There has been a dramatic increase in reports of abuse-related injuries and other injuries indicative of child abuse during the pandemic. In addition, there are disproportionate impacts of COVID-19 based on race and ethnicity within the United States. It is clear that children are facing more adverse determinants as a result of this pandemic and that there are both short-term and long-term implications associated. For those living in poverty or with other adverse social determinants of health, the pandemic has made a bad situation worse. Ongoing studies are required to measure the impact of COVID-19 on those with adverse social determinants, in particular among children.

CONCLUSION

Social determinants of health must be part of pandemic research priorities, public health and vaccination goals, and economic policy implementation. The impact of the COVID-19 pandemic has further served to shed a light on the broad disparities that exist within our society and their direct and indirect impacts on health outcomes.

Connecting Families to Food Resources amid the COVID-19 Pandemic: A Cross-Sectional Survey of Early Care and Education Providers in Two U.S. States

Early care and education (ECE) settings are important avenues for reaching young children and their families with food and nutrition resources, including through the U.S. federally funded Child and Adult Care Food Program (CACFP). Researchers conducted a cross-sectional survey of ECE providers in two U.S. states in November 2020 to identify approaches used to connect families with food and nutrition resources amid the COVID-19 pandemic. Logistic regression models were used to estimate odds of sites reporting no approaches and adjusted Poisson models were used to estimate the incidence rate ratio of the mean number of approaches, comparing sites that participate in CACFP to those that did not. A total of 589 ECE sites provided responses. Of those, 43% (n = 255) participated in CACFP. CACFP participating sites were more likely to report using any approaches to connecting families to food resources and significantly more likely to report offering "grab and go" meals, providing meal delivery, distributing food boxes to families, and recommending community food resources than non-CACFP sites. This study suggests that CACFP sites may have greater capacity to connect families to food resources amid emergencies than non-CACFP participating sites.

Assessing health disparities in foods and beverages served in early care and education programs across Georgia

BACKGROUND

Obesity disproportionately impacts children who are Black and Hispanic, those who live in rural communities and those who have low income. Predisposition to obesity early in life is profoundly impacted by feeding habits during the preschool years. The early care and education (ECE) setting impacts children's health by providing daily meals.

OBJECTIVE

The goal of this study was to identify whether or not health disparities in foods and beverages served in ECE programs in Georgia exist based on socioeconomic, demographic and geographic variables.

METHODS

A random sample was drawn from 3054 ECE programs across the state of Georgia. The likelihood of serving specific foods and beverages in ECE programs in the previous day was measured. Percentages and frequencies, logistic regressions, Spearman's rho and Odds ratio tests determined outcomes.

RESULTS

A total of 974 surveys were returned. Data were stratified based on the income level of the participant families, race of enrolled children and geographic location of the ECE program. Disparities existed between programs based on race of enrolled children and geographic location. For example, although the odds of providing sweets increased by 0.6% as the percentage of Black children enrolled increased, the provision of healthier foods, such as the odds of providing fruits (P = .001), vegetables (P = .001) and protein (P = .001) also increased. However, after results were adjusted for covariates findings did not remain significant.

CONCLUSIONS

Future research focused on evaluating the foods and beverages provided in ECE programs and the relationship of how income, race and location are related may provide further understanding about the disproportionate childhood obesity rates in America.

COVID-19 and the neonatal microbiome: will the pandemic cost infants their microbes?

Mortality and morbidity from SARS-CoV2 (COVID-19) infections in children remains low, including an exceedingly low rate of horizontal and vertical transmission. However, unforeseen complications to childhood health have emerged secondary to the pandemic. Few studies to date have examined unintended complications of the pandemic in newborns and infants. In this Commentary, we discuss the impact that COVID-19 may have on inheritance of the newborn microbiome and its assembly throughout the first years of life. In the early stages of the pandemic when vertical transmission of COVID-19 was poorly understood, several studies reported increased rates of C-sections in COVID-19 positive women. Initial recommendations discouraged COVID-19 positive mothers from breastfeeding and participating in skin-to-skin care, advising them to isolate during their window of infectivity. These shifts in perinatal care can adversely impact microbial colonization during the first 1000 days of life. While obstetrical and neonatal management have evolved to reflect our current knowledge of perinatal transmission, we are observing other changes in early life exposures of infants, including increased attention to hygiene, fewer social interactions, and decreased global travel, all of which are major drivers of early-life gut colonization. Composition of the gut microbiota in adults directly impacts severity of infection, suggesting a role of microbial communities in modulating immune responses to COVID-19. Conversely, the role of the intestinal microbiome in susceptibility and severity of COVID-19 in newborns and children remains unknown. The onset of adulthood diseases is related to the establishment of a healthy gut microbiome during childhood. As we continue to define COVID-19 biology, further research is necessary to understand how acquisition of the neonatal microbiome is affected by the pandemic. Furthermore, infection control measures must be balanced with strategies that promote microbial diversity to impart optimal health outcomes and potentially modulate susceptibility of children to COVID-19.

Pregnant and hungry: addressing food insecurity in pregnant women during the COVID-19 pandemic in the United States

Food insecurity is a major social determinant of health affecting more than 10% of Americans. Social determinants of health are increasingly recognized as a driving force of health inequities. It is well established that food insecurity leads to adverse health outcomes outside of pregnancy, such as obesity, hypertension, diabetes mellitus, and mental health problems. However, limited data exist about the impact of food insecurity during pregnancy on maternal and neonatal outcomes. Food insecurity and other social determinants of health are rarely addressed as part of routine obstetrical care. The COVID-19 pandemic has only exacerbated the crisis of food insecurity across the country, disproportionally affecting women and racial and ethnic minorities. Women's health providers should implement universal screening for maternal food insecurity and offer resources to women struggling to feed themselves and their families. Reducing maternal health inequities in the United States involves recognizing and addressing food insecurity, along with other social determinants of health, and advocating for public policies that support and protect all women's right to healthy food during pregnancy.

Parent Feeding Practices in the Context of Food Insecurity

The process of feeding is complex and highly dependent on parent, child, social, and environmental factors. Given the rising rates of food insecurity and concomitant poor nutrition and health, the purpose of this article was to outline the important and complex ways in which the context of food insecurity can impact parent feeding practices. Key factors discussed here include the impact of food insecurity on: expectations for motherhood, structural constraints, stress and depression, parents’ perceptions of health and child weight, and intergenerational transmission of parent feeding practices. Future research needs are also identified and discussed.