Family Style Meal Service is Associated with Reduced Plate Waste in Nebraska Family Child Care Homes

Abstract

Background:

Family style meal service is a nationally endorsed best practice. However, implementation in family child care homes (FCCHs) is low because child care providers are worried that it could increase plate waste. To examine this perceived barrier, the study aims to investigate the association between family style meal service and plate waste in FCCHs in Nebraska.

Methods:

In this cross-sectional study, the participants included FCCH providers (n = 46) in Nebraska and 3–5-year-old children attending these FCCH settings (n = 146). Providers were given a family style meal service score using 11 items from the Mealtime Observation in Child Care tool. Children’s plate waste data over the observed lunchtime were collected using the Dietary Observation in Child Care method. We conducted multivariate, multilevel regression analyses in SAS (v9.4) to assess the relationship between family style meal service score and children’s plate waste, while controlling for child-level characteristics and accounting for FCCH setting-level effects (ICCs 11.3%–31.2%).

Results:

Increase in family style meal service score was associated with a decrease in vegetable waste (B = −4.7, p = 0.03), fruit waste (B = −3.6, p = 0.03), and protein waste (B = −4.2, p = 0.02). Dairy and grain waste were not associated with family style meal service score.

Conclusions:

A higher family style meal service score was associated with a 3%–5% reduction in plate waste for three food groups. These findings warrant further research examining the effect of interventions promoting family style meal service in child care on improving children’s dietary intake and reducing plate waste.

Introduction

Family style meal service is an evidence-based strategy in which children select their own portions and serve themselves from common platters and pitchers placed on the table.^1–3 This strategy encourages child care providers to support children’s autonomy and competence during mealtimes while being responsive to their hunger and fullness cues.^3,4 Previous research demonstrated that family style meal service is positively associated with children’s healthful dietary intake¹ and overall mealtime emotional climate.⁵ Additionally, this approach leverages children’s inherent ability to regulate their intake based on their internal hunger and satiety cues by allowing them to determine their own portions.^3,4,6

The evidence supporting the benefits of family style meal service has led to its widespread endorsement in child care settings by national agencies such as Head Start and the Child and Adult Care Food Program (CACFP).^2,3,7,8 Head Start’s standards advocate for family style meals as a way to create structured learning opportunities, enhance staff–child interactions, and promote communication and socialization, encouraging programs to use this approach when developmentally appropriate.⁹ Family style meal service is also highly encouraged by CACFP guidelines as it aligns with the program’s nutritional goals, encouraging a pleasant eating environment, promoting mealtime as a learning experience, and providing educational activities that are centered around food.¹⁰

Despite its benefits and endorsement by Head Start and the CACFP, adoption of family style meal service in child care settings remains surprisingly low across the country.^11–13 A study investigating mealtime practices at child care centers across four US states—California, Colorado, Idaho, and Nevada—revealed that only 38% of the child care centers served meals family style.¹² Implementation is even lower in family child care homes (FCCHs), which are small, licensed child care settings that serve 4–12 children of mixed age groups, often in the provider’s own home.^11,14 A state-wide survey in Nebraska revealed that family style meal service was the least implemented best practice, adopted by only about 22% of FCCHs in the state.¹¹

Suboptimal implementation of this evidence-based strategy is influenced by several implementation barriers, with plate waste being a primary concern.^10,13,15 FCCH providers worry about plate waste when children serve themselves and, as a result, prefer to serve preplated meals.^13,15 Plate waste concerns are intensified in FCCHs because of their lower income levels and the dual role of the FCCH providers as caregivers and business owners, making them highly sensitive to costs.^14,15 As a result, the perceived barrier of plate waste creates a disconnect between research and policy recommendations related to family style meal service and their practical application in FCCHs.

Concerns about plate waste present a persistent challenge to implementing family style meal service in FCCHs. To examine the validity of these concerns empirically, we investigated the association between family style meal service and plate waste for the five MyPlate food groups (whole grain, vegetable, fruit, dairy, and protein) in FCCHs in Nebraska. We hypothesized that family style meal service will be associated with lower plate waste due to children’s natural ability to regulate their intake based on their internal hunger and satiety signals.^3,4,6

Materials and Methods

Study Design

This cross-sectional study used observational data collected as a part of the pilot project for the Ecological Approach To Family Style intervention.^16,17 The protocol and procedures of this study were approved by the University of Nebraska-Lincoln Institutional Review Board (IRB#20211221401EP).

Participant Recruitment

The research team recruited CACFP-participating licensed FCCH providers in Nebraska by distributing recruitment invitation flyers through emails, newsletters, and surface mail. Eligibility criteria for FCCH providers included the following: being a licensed FCCH provider; CACFP participation; serving lunch to the children; and caring for 2 nonsibling preschool-aged children (3- to 5-year old) full time. Interested FCCH providers followed instructions on the flyer to fill out an online screener survey to assess their eligibility to participate in the study and provided their contact details for follow-up. FCCH providers who agreed to participate in the study helped connect researchers to parents of typically developing 3- to 5-year-old children. Children were identified as “typically developing” by the child care providers if the child did not have any diagnosis of developmental delays or food allergies. We did not include children with developmental delays and food allergies, as these factors could potentially influence what and how they eat as well as the plate waste, which was the outcome of this study. Although no dietary data were collected for these children, they could still participate in all aspects of the mealtime, just like the children who were included in the study. Prior to study participation, written informed consent was obtained from all FCCH providers and parents, and children provided verbal assent.

Data Collection

Data were collected for the current study from April 2022 to February 2023. The research team scheduled data collection visits at the participating FCCH settings on a regular, noncelebratory day at the provider’s convenience. Trained research assistants (RAs) (n = 8) conducted the visits. Because all participating providers were licensed and CACFP-participating, they maintained records of children’s demographic information. RAs asked the FCCH providers to report participating children’s names and demographic information (age, sex, race, and ethnicity) and noted the information on printed data collection forms. Each child was assigned a unique ID, which was matched to their demographic data, and the data were de-identified. The RAs also recorded children’s height and weight before lunch was served. Height was measured using a Seca 417 Portable Stadiometer following a validated protocol to the nearest 1 mm. Weight was measured using a Seca 874 Portable Weight Scale (Seca Corporation) following a validated protocol to the nearest 0.1 kg. Children were measured without bulky jackets or shoes to ensure accuracy. These values were immediately documented on the data collection forms. Later, the research team calculated the BMI and determined age- and sex-specific percentiles using the CDC child BMI calculator, categorizing “overweight” as at or above the 85th percentile and “with obesity” as at or above the 95th percentile.¹⁸

Family Style Meal Service

The RAs video-recorded one lunchtime during the visit to the FCCH. Trained observers (n = 2) then coded the video recordings using the Mealtime Observation in Child Care (MOCC) checklist.¹⁹ MOCC is an observational tool that measures providers’ feeding practices and was developed based on previously validated measures.^20–22 The MOCC includes nine sections: mealtime environment; style of meal service; role modeling (sitting together, eating together, and verbal communication); sensory exploration; peer modeling; pressure-praise-rewards-threats; self-regulation; providers’ response to food refusal; and feeding style. The tool shows high interrater reliability (Fleiss’s Kappa, K = 0.85) and convergent validity (r = 0.40 [p < 0.001]).¹⁹

For this study, we used the MOCC section “Style of Meal Service.” This section comprises 18 items that assess providers’ adherence to features of family style meal service. Since we used video recordings instead of live observation, we were unable to observe 7 items for all FCCHs. Hence, we excluded these 7 items and included only the 11 items for which data were available for all FCCHs in the final analysis. The items assessed whether the provider allowed children to serve themselves and provided an environment that supported children’s autonomy throughout the meal, beginning with mindful silence and ending with clean-up. For each item, the FCCH provider was given a score of 0 for the less favorable option and 1 for the more favorable option. For example, for the item “Did the provider use subtle physical prompts to encourage the children to serve themselves?” the provider was given a score of 0 if the option selected was “no, not observed,” and 1 if the option selected was “yes, sometimes” or “yes, regularly.” Scores for the 11 items were added, divided by 11, and multiplied by 10 to obtain the focal predictor of our study—a family style meal service score out of 10 for each FCCH provider.

Plate Waste

The RAs directly observed and recorded the amount of food and beverages that children were served (self-served and/or plated by provider) and consumed at the same lunchtime using the Dietary Observation for Child Care (DOCC) method.^23,24 A trained RA entered the consumed and served food into ESHA Food Processor Nutrition Analysis Software version 11.9 to analyze the quantity that the children consumed and were served for each of the five MyPlate food groups (whole grain, vegetable, fruit, dairy, and protein). The quantity of the food group wasted was calculated by subtracting the quantity consumed from the quantity served. Plate waste was calculated for each food group as the percentage of food wasted to the food served.²⁵ $Plate waste for each food group (%) = (Quantity of food group wasted / Quantity of food group served) \times 100$

Data Analysis

Descriptive statistics were used to characterize participating FCCHs and children (median, interquartile range [IQR], and percentages). To test the association between family style meal service and plate waste, we used multivariate, multilevel regression analyses, controlling for child-level characteristics (age, sex, race, ethnicity, and BMI percentile). These covariates were selected based on evidence demonstrating their influence on children’s dietary intake and, consequently, plate waste.^26–28 Statistical significance was set at α = 0.05 (two sided). P values were adjusted for multiple comparisons using the Benjamini–Hochberg procedure,²⁹ and a false discovery rate cutoff of 0.05 was used as the statistically significant threshold. SAS (version 9.4) was used for data analyses.

Results

The present study included observational data for 146 children who attended 46 different FCCHs in Nebraska; 18 FCCHs (39.1%) were in rural counties and 28 (60.9%) were in urban counties. The proportion of female and male children was nearly equal (49.3% and 50.0%) (Table 1). Most of the children were White (91.1%) and non-Hispanic (95.2%). Almost a third (27.4%) of the children were classified as living with overweight or obesity and 69.2% were in the healthy weight category. The median age of the children was 3.9 years.

Table 1.

Demographic Characteristics of Children (n = 146) Attending Family Child Care Homes (n = 46) in Nebraska

Demographic characteristics	n (%)
Sex
Female	72 (49.3)
Male	73 (50.0)
(Missing)	1 (0.7)
Race
White	133 (91.1)
African American	1 (0.7)
Asian	2 (1.4)
Mixed	9 (6.1)
(Missing)	1 (0.7)
Ethnicity
Non-Hispanic	139 (95.2)
Hispanic/Latino	6 (4.1)
(Missing)	1 (0.7)
Weight status (CDC classification)
Underweight (<5th percentile)	2 (1.4)
Healthy weight (≥5th and <85th percentile)	101 (69.2)
Overweight (≥85th and <95th percentile)	23 (15.8)
With Obesity (≥95th percentile)	17 (11.6)
(Missing)	3 (2.0)
	Median (IQR)
Age (years)	3.9 (3.4,4.6)

IQR, interquartile range.

FCCH providers were scored on 11 items of the MOCC section “Style of Meal Service” (Table 2). Children were allowed to serve themselves in one-fifth (19.6%) of the FCCHs. The components of family style meal service that were implemented in the fewest FCCHs were “taking a moment to settle before eating” and “using verbal communication to maintain hygiene/safety” (15.2%). In all the FCCHs (100%), the food units, that is, the size of the food served, were developmentally appropriate. Developmentally appropriate food units mean that the size of the food prepared and presented to the children supports their ability to self-serve, select portions, hold, and eat based on their hunger and fullness.^30,31 Additionally, children find it easier to consume such food units safely and conveniently. For example, diced peaches are easier for children to scoop and fit in their mouth compared to peach halves, and hamburgers are easier for children to handle when served as halves rather than as a whole.³⁰

Table 2.

Proportion of Family Child Care Homes (n = 46) Implementing the 11 MOCC Components of Family Style Meal Service, Listed in Ascending Order

Family style meal service components implemented in less than 50% FCCHs	n (%)
A moment is taken to settle before eating	7 (15.2)
Provider uses verbal communication to maintain hygiene/safety	7 (15.2)
Children serve food themselves	9 (19.6)
Provider encourages self-service with subtle physical prompts	10 (21.7)
Provider encourages self-service with verbal assists	15 (32.6)
Serving bowls remain close by for second servings	16 (34.8)
Provider involves children in clean-up	17 (36.9)

Family style meal service components implemented in more than 50% FCCHs	n (%)
There is a tub provided for food waste	29 (63.0)
Provider reduces messes at mealtime by keeping cleaning supplies such as paper napkins nearby	31 (67.4)
Provider maintains hygiene at mealtime by keeping extra helpings of food nearby given contamination	34 (73.9)
Food units^a are developmentally appropriate	46 (100)

A food unit is the size of the food presented to children. Offering smaller, developmentally appropriate food units to children supports their ability to self-serve, select portions, hold, and eat based on their hunger and fullness.^30,31 Additionally, children find it easier to consume such food units safely and conveniently. For example, diced peaches are easier for children to scoop and fit in their mouth compared to peach halves, and hamburgers are easier for children to handle when served as halves rather than as a whole.³⁰

FCCH, family child care home; MOCC, Mealtime Observation in Child Care.

Median waste was the highest for vegetables (28.2%, IQR: 0%, 70.9%), followed by dairy (4.9%, IQR: 0%, 39.3%) (Table 3). An increase in family style meal service score was associated with a decrease in vegetable waste (B = −4.7, p = 0.03), fruit waste (B = −3.6, p = 0.03), and protein waste (B = −4.2, p = 0.02). Dairy and grain waste were not associated with family style meal service scores, although the association with dairy waste showed a trend toward significance (B = −3.8, p = 0.07).

Table 3.

Relationship Between Family Style Meal Service Score of Family Child Care Home Providers (n = 46) and Children’s Plate Waste (n = 146)

Plate waste by food group (%)	Median (IQR)	Unadjusted regression results			Adjusted regression results^a
Plate waste by food group (%)	Median (IQR)	Estimate	95% CI	p-value^b	Estimate	95% CI	p-value^b
Grain waste	0 (0, 34.5)	−1.5	−4.2, 1.2	0.27	−1.6	−4.6, 1.5	0.33
Vegetable waste	28.2 (0, 70.7)	−4.8	−8.7, −0.9	0.03*	−4.7	−8.6, −0.9	0.03*
Fruit waste	0 (0, 16.2)	−3.7	−6.3, −1.1	0.02*	−3.6	−6.5, −0.8	0.03*
Dairy waste	4.9 (0, 39.3)	−3.7	−7.4, 0.0	0.07	−3.8	−7.5, −0.1	0.07
Protein waste	0 (0, 25.3)	−4.2	−6.9, −1.5	0.02*	−4.2	−6.8, −1.5	0.02*

Adjusted for child’s age, sex, race, ethnicity, and BMI percentile.

p-values were adjusted for five comparisons using the Benjamini–Hochberg correction.

Indicates statistically significant difference at p < 0.05.

BMI, body mass index; IQR, interquartile range.

Discussion

This study examined the association of family style meal service with plate waste among FCCHs in Nebraska. To our knowledge, while previous studies have explored the relationship between family style meal service and children’s dietary intake,¹ none have specifically investigated its association with plate waste in FCCHs, where the provider, as the business owner, faces distinct economic pressures related to food costs and waste management. We observed that a higher family style meal service score was associated with lower plate waste. These findings have important implications for researchers and policymakers focused on improving the adoption of family style meal service in child care settings.

Consistent with previous literature, our findings revealed that family style meal service does not significantly increase plate waste, contrary to common perceptions. A study by Branen et al. in preschools found no significant difference in plate waste between preportioned meals and family style meal service, indicating that the latter does not significantly increase plate waste.¹ A similar finding was observed in a study that compared the effects of restrictive feeding and family style meal service where the plate waste of preschool children who were allowed to self-select their portions did not significantly differ from children who were given predetermined portions.²⁸ Our study advances the literature further by suggesting that not only is there no significant increase in plate waste associated with family style meal service but there is a significant decrease. A one-unit increase in family style meal service score was associated with a 3%–5% reduction in vegetable, fruit, and protein waste. There was also a reduction in dairy waste which showed a trend toward significance (p = 0.07), indicating that future studies with larger sample sizes or more statistical power are needed to explore this relationship further. The reduction in plate waste was the highest for vegetables, which was also the food group with the highest median waste in our study. Vegetables are one of the most wasted food groups, particularly in child care, according to the Study of Nutrition and Activity in Childcare Settings in USDA’s CACFP.²⁵ Our findings highlight the potential of family style meal service in tackling plate waste for the food group with the greatest need for waste reduction.

The discrepancy between our study, which found a significant decrease in plate waste associated with family style meal service, and previous studies that reported no such association, may be attributed to differences in how family style meal service is operationalized across studies. In previous studies, “family style meal service” referred to allowing children to serve themselves and was defined as “allowing children to pass the serving dishes and to determine how much food they took from the serving dishes” or allowing “children to eat as many portions as they wanted.”^1,28 Only about 20% of the FCCHs in our study met this definition (which is similar to the previously identified prevalence of 22% in Nebraska).¹¹ Contrary to previous studies, however, we operationalized family style meal service using CACFP benchmarks as a comprehensive mealtime environment scale, where it is not just about letting children serve themselves but also about creating an environment that encourages and supports them in doing so.² Therefore, our study observed lower plate waste in FCCHs that implemented more family style meal service components. Family style meal service is more effective when the provider actively facilitates the process using physical and verbal prompts, ensures that sanitary and safety procedures are in place to manage inevitable spills or accidents, and offers food in developmentally appropriate portions that make it easier for children to serve themselves.^1,2 Our findings have substantial implications for training programs about family style meal service aimed at child care providers, highlighting the need to consider it as a comprehensive mealtime environment approach rather than a discrete practice. Future research should compare the effectiveness of family style meal service as a discrete self-service practice and as a comprehensive mealtime approach in improving children’s dietary intake and reducing plate waste.

Although plate waste is often perceived as a barrier to initiating family style meal service, a qualitative study of child care providers in Illinois found that those who had already initiated the practice believed it reduced food waste, citing their confidence in children’s ability to self-regulate.⁴ It is important to involve such peer role models and coaches to mentor other providers in encouraging the effective implementation of family style meal service.

Our findings help address the pressing concern regarding the plate waste associated with family style meal service. There is a need to develop this evidence base further and address the other concerns that hinder the adoption of this best practice. Other concerns regarding family style meal service for future research include perceptions that it would be messy and unhygienic, that it is resource intensive, and that children are unable to self-regulate and select accurate portion sizes, or are too young to serve themselves.⁴

The study’s strength lies in the use of rigorous data collection methods, such as the validated DOCC and MOCC that enhance the study’s reliability. However, the generalizability of our findings is limited by the small sample size. The sample also has narrow ethnic and racial representation, although it is reflective of Nebraska’s ethnic and racial composition. Plate waste was assessed using DOCC over only one lunchtime, making the dietary observation data subject to biases. The cross-sectional nature of the study restricts our ability to draw causal inferences about the relationship between plate waste and family style meal service.

Nevertheless, the findings carry significant implications for policy and research. This study serves as an important step toward building a solid evidence base that addresses FCCH providers’ concerns about plate waste during mealtimes at the FCCH. In addition, incorporating these findings in resources related to family style meal service for child care providers is essential to alleviate plate waste concerns. For instance, the current CACFP training materials could emphasize that there is evidence to suggest that family style meal service is linked to less plate waste, challenging the widely held perception that it causes more waste. Future research could then examine whether such messaging improves adherence to CACFP recommendations, especially regarding serving vegetables—the most wasted food group, and consequently, one that providers who view plate waste as a barrier tend to serve less frequently.³² Existing resources either briefly touch upon the issue of plate waste or overlook it completely, highlighting the dire need to fill the gap between policy recommendations and practical considerations.² There is also a need to emphasize the importance of practicing family style meal service as a comprehensive mealtime environment approach with equal emphasis on all its constituent components. The implementation of best practices, such as family style meal service, must be facilitated in FCCHs to fully harness their obesity-preventing potential, beginning with addressing the practical concerns of the providers.

Conclusions

Family style meal service is associated with lower plate waste, a finding that addresses a key perceived barrier to the adoption of this best practice in FCCHs. While further research is needed to study causal relationships, our findings highlight the necessity of including the link between family style meal service and reduced plate waste in resources for FCCH providers.

Impact Statement

This study reveals that practicing family style meal service as a comprehensive approach is associated with lower vegetable, fruit, and protein waste in FCCHs in Nebraska. Findings need to be highlighted in resources for child care providers to alleviate plate waste concerns that hinder adoption of the best practice.

Footnotes

Acknowledgments

The authors acknowledge all research assistants, study participants, and Nebraska Extension for their time and support in this project. The authors thank Naveta Bhatti for her assistance with data entry. The authors appreciate the feedback received at the ISBNPA conference and from the reviewers, which helped improve this article.

Authors’ Contributions

R.M.G.: Conceptualization, investigation, data curation, formal analysis, writing—original draft, and writing—review and editing. D.A.D.: Conceptualization, methodology, funding acquisition, writing—review and editing, and supervision. A.M.: Data curation and formal analysis. S.H.: Methodology, investigation, data curation, and writing—review and editing. C.H.: Methodology, investigation, data curation, and writing—review and editing. J.S.: Methodology, investigation, data curation, and writing—review and editing. S.B.S.: Writing—review and editing. A.T.: Writing—review and editing.

Author Disclosure Statement

The authors declare no conflict of interest. The funders had no role in the design of the study, in the collection, analysis, or interpretation of data, in the writing of the article, or in the decision to publish the results.

Funding Information

This research was funded, in part, by the Administration for Children and Families/Office of Planning, Research, and Evaluation (grant no. 90YE0252-01-00) program and Buffett Early Childhood Institute Graduate Scholars Program.

References

Branen

, Fletcher

, Myers

. Effects of pre-portioned and family-style food service on preschool children’s food intake and waste at snacktime. J Res Child Educ, 1997; 12(1):88–95; doi: 10.1080/02568549709594719

U.S. Department of Agriculture. Family Style Meal Service With Children in the Child and Adult Care Food Program. U.S. Department of Agriculture; 2024.

Benjamin Neelon

, Briley

, American Dietetic Association. Position of the American Dietetic Association: Benchmarks for nutrition in child care. J Am Diet Assoc, 2011; 111(4):607–615; doi: 10.1016/j.jada.2011.02.016

Dev

, Speirs

, McBride

, et al. Head Start and child care providers’ motivators, barriers and facilitators to practicing family-style meal service. Early Child Res Q, 2014; 29(4):649–659; doi: 10.1016/j.ecresq.2014.07.004

Smith

, Saltzman

, Dev

. Mealtime emotional climate and child health: A systematic review. Eat Behav, 2022; 44:101582; doi: 10.1016/j.eatbeh.2021.101582

Dev

, McBride

, Harrison

, et al.; STRONG Kids Research Team. Academy of nutrition and dietetics benchmarks for nutrition in child care 2011: Are child-care providers across contexts meeting recommendations? J Acad Nutr Diet, 2013; 113(10):1346–1353; doi: 10.1016/j.jand.2013.05.023

Institute of Medicine. Early Childhood Obesity Prevention Policies. The National Academies Press: Washington, DC; 2011.

U.S. Department of Health and Human Services. Head Start Policy and Regulations. 1302.44 Child Nutrition. n.d.

U.S. Department of Health and Human Services. Head Start Policy and Regulations. 1302.31 Teaching and the Learning Environment. n.d.

10.

U.S. Department of Agriculture (USDA). Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act of 2010. USDA; 2016.

11.

Dev

, Garcia

, Dzewaltowski

, et al. Provider reported implementation of nutrition-related practices in childcare centers and family childcare homes in rural and urban Nebraska. Prev Med Rep, 2020; 17:101021; doi: 10.1016/j.pmedr.2019.101021

12.

Sigman-Grant

, Christiansen

, Branen

, et al. About feeding children: Mealtimes in child-care centers in four western states. J Am Diet Assoc, 2008; 108(2):340–346; doi: 10.1016/j.jada.2007.09.006

13.

Nicklas

, Baranowski

, et al. Family and child-care provider influences on preschool children’s fruit, juice, and vegetable consumption. Nutr Rev, 2001; 59(7):224–235; doi: 10.1111/j.1753-4887.2001.tb07014.x

14.

Nebraska Department of Health and Human Services. Chapter 1: Family Child Care Home I. In 391 Children’s Services Licensing. Nebraska Department of Health and Human Services; 2013.

15.

Jiang

, Tovar

, Risica

, et al. Ethnic differences in family childcare providers’ nutrition- and activity-related attitudes and barriers. J Obes, 2021; 2021:6697006; doi: 10.1155/2021/6697006

16.

Dev

, Padasas

, Hillburn

, et al. Ecological approach to family-style, multilevel child care intervention: Formative evaluation using RE-AIM framework. J Nutr Educ Behav, 2022; 54(8):728–744; doi: 10.1016/j.jneb.2022.03.005

17.

University of Nebraska-Lincoln. Ecological Approach to (EAT) Family Style. n.d. Available from: https://childpd.unl.edu/index.php?menu=EAT [Last accessed: December 7, 2024].

18.

Centers for Disease Control and Prevention (CDC). About Body Mass Index (BMI). 2024. Available from: https://www.cdc.gov/bmi/about/index.html [Last accessed: October 11, 2024].

19.

Dev

, Hasnin

, Sisson

, et al. P28 validation of an observational measure to capture feeding practices in child care centers. J Nutr Educ Behav, 2020; 52(7):S28–S29; doi: 10.1016/j.jneb.2020.04.073

20.

Tovar

, Vaughn

, Fisher

, et al. Modifying the Environment and Policy Assessment and Observation (EPAO) to better capture feeding practices of family childcare home providers. Public Health Nutr, 2019; 22(2):223–234; doi: 10.1017/S1368980018002665

21.

Swindle

, Rutledge

, Dix

, et al. Table Talk: Development of an observational tool to assess verbal feeding communications in early care and education settings. Public Health Nutr, 2017; 20(16):2869–2877; doi: 10.1017/S1368980017001896

22.

Hughes

, Patrick

, Power

, et al. The impact of child care providers’ feeding on children’s food consumption. J Dev Behav Pediatr, 2007; 28(2):100–107; doi: 10.1097/01.DBP.0000267561.34199.a9

23.

Ball

, Benjamin

, Ward

. Development and reliability of an observation method to assess food intake of young children in child care. J Am Diet Assoc, 2007; 107(4):656–661; doi: 10.1016/j.jada.2007.01.003

24.

Hasnin

, Dev

, Pitts

. Evidence for criterion-related validity of pressure-mediated reflection spectroscopy for approximating fruit and vegetable consumption among preschool children. J Nutr, 2024; 154(1):261–270; doi: 10.1016/j.tjnut.2023.11.022

25.

Logan

, Connor

, LeClair

, et al. Study of Nutrition and Activity in Child Care Settings: Summary of Findings. Prepared by Abt Associates, Contract No. AG-3198-C-14-0017. U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, Project Officer: Alice Ann H. Gola: Alexandria, VA; 2021.

26.

Jarman

, Edwards

, Blissett

. Influences on the dietary intakes of preschool children: A systematic scoping review. Int J Behav Nutr Phys Act, 2022; 19(1):20; doi: 10.1186/s12966-022-01254-8

27.

Niaki

, Moore

, Chen

T-A

, et al. Younger elementary school students waste more school lunch foods than older elementary school students. J Acad Nutr Diet, 2017; 117(1):95–101; doi: 10.1016/j.jand.2016.08.005

28.

Branen

, Fletcher

. Effects of restrictive and self-selected feeding on preschool children’s food intake and waste at snacktime. J Nutr Educ, 1994; 26(6):273–277; doi: 10.1016/S0022-3182(12)80696-0

29.

Benjamini

, Hochberg

. Controlling the false discovery rate: A practical and powerful approach to multiple testing. J R Stat Soc Ser B Methodol, 1995; 57(1):289–300.

30.

University of Nebraska-Lincoln. Ecological Approach To (EAT) Family Style Dining Series: Children Serve Themselves—Strategies: Provide Child-Friendly Food Units. n.d. Available from: https://childpd.unl.edu/index.php?menu=m13/13-5 [Last accessed: February 5, 2025].

31.

van Kleef

, Bruggers

, de Vet

. Encouraging vegetable intake as a snack among children: The influence of portion and unit size. Public Health Nutr, 2015; 18(15):2736–2741; doi: 10.1017/S1368980015001329

32.

Patel

, Butzer

, Williams

, et al. Food waste, preference, and cost: Perceived barriers and self-reported food service best practices in family child care homes. Child Obes, 2022; 18(8):548–555; doi: 10.1089/chi.2021.0251