Mealtime best practices and infection control in early care and education centres during COVID-19

Background Most young children in the United States attend early care and education (ECE) programmes, where they consume the majority of daily calories. Best practices to support children's healthy eating include teachers sitting together with children, eating the same food, and appropriately supporting children in serving and feeding themselves. To understand how the COVID-19 pandemic changed mealtime practices in ECE, this study (1) describes what adaptations ECE directors and teachers made to mealtimes to include best practices, and (2) identifies common adaptations made to comply with COVID-19 infection control guidelines. Methods This cross-sectional, mixed-methods study utilized survey and interview questions based on the trust model and social cognitive theory. More than 7000 surveys were distributed to ECE directors and teachers in Florida. Surveys were completed by 759 directors and 431 teachers. Also, 29 follow-up interviews with teachers were completed. Participants were asked to describe their mealtimes before and during COVID-19. Descriptive statistics and frequencies were used to analyse survey data, and thematic analysis was applied to interview data. Results Less than 5% of survey respondents reported children serving themselves, a pre-COVID best practice. Interviews identified three common adaptations: (1) modification-best practices were incorporated into new routines, such as eating together but sitting farther away, (2) elimination-routines changed so that best practices were no longer possible, such as teachers wearing masks and standing during meals, and (3) minimal change-minimal changes due to COVID-19 occurred and consequently mealtime practices did not change. Conclusions Current recommendations do not allow children to self-serve, which previously was a key best practice. ECE centres that have successfully integrated COVID-19 modifications and maintained mealtime best practices-perhaps in a new form-can serve as examples for others. These findings are generalizable to ECE centres in Florida and could be compared with other states.