Article Text

Download PDFPDF

Association between childcare educators’ practices and preschoolers’ physical activity and dietary intake: a cross-sectional analysis
  1. Stéphanie Ward1,
  2. Mathieu Blanger2,
  3. Denise Donovan3,
  4. Hassan Vatanparast4,
  5. Nazeem Muhajarine5,
  6. Rachel Engler-Stringer5,
  7. Anne Leis5,
  8. M Louise Humbert6,
  9. Natalie Carrier7
  1. 1Faculty of Medecine and Health Sciences, Université de Sherbrooke, Moncton, New Brunswick, Canada
  2. 2Department of Family Medicine, Université de Sherbrooke, Moncton, New Brunswick, Canada
  3. 3Department Community Health Sciences, Université de Sherbrooke, Moncton, New Brunswick, Canada
  4. 4School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  5. 5Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  6. 6College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  7. 7École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, New Brunswick, Canada
  1. Correspondence to Dr Stéphanie Ward; stephanie.ann.ward{at}


Introduction Childcare educators may be role models for healthy eating and physical activity (PA) behaviours among young children. This study aimed to identify which childcare educators’ practices are associated with preschoolers’ dietary intake and PA levels.

Methods This cross-sectional analysis included 723 preschoolers from 50 randomly selected childcare centres in two Canadian provinces. All data were collected in the fall of 2013 and 2014 and analysed in the fall of 2015. PA was assessed using Actical accelerometers during childcare hours for 5 consecutive days. Children’s dietary intake was measured at lunch on 2 consecutive days using weighed plate waste and digital photography. Childcare educators’ nutrition practices (modelling, nutrition education, satiety recognition, verbal encouragement and not using food as rewards) and PA practices (informal and formal PA promotion) were assessed by direct observation over the course of 2 days, using the Nutrition and Physical Activity Self-Assessment for Child Care tool. Associations between educators’ practices and preschoolers’ PA and dietary intake were examined using multilevel linear regressions.

Results Overall, modelling of healthy eating was positively associated with children’s intake of sugar (β=0.141, 95% CI 0.03 to 0.27), while calorie (β=−0.456, 95% CI −1.46 to –0.02) and fibre intake (β=−0.066, 95% CI −0.12 to –0.01) were negatively associated with providing nutrition education. Not using food as rewards was also negatively associated with fat intake (β=−0.144, 95% CI −0.52 to –0.002). None of the educators’ PA practices were associated with children’s participation in PA.

Conclusions Modelling healthy eating, providing nutrition education and not using food as rewards are associated with children’s dietary intake at lunch in childcare centres, highlighting the role that educators play in shaping preschoolers’ eating behaviours. Although PA practices were not associated with children’s PA levels, there is a need to reduce sedentary time in childcare centres.

  • physical activity
  • dietary intake
  • preschool children
  • childcare educator
  • childcare center

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Contributors SW conceived the study, collected, analysed and interpreted the data. MB conceived the study and interpreted the data. NC and DD interpreted the data. HV, NM, RE-S, AL and MLH conceived the study. All authors were involved in writing the manuscript and had final approval of the submitted and published versions.

  • Funding The Healthy Start study is financially supported by agrant from the Public Health Agency of Canada (# 6282-15-2010/3381056-RSFS), aresearch grant from the Consortium national de formation en santé (#2014-CFMF-01), and a grant from the Heart and Stroke Foundation of Canada (#2015-PLNI). SW was supported by a Canadian Institutes of Health ResearchCharles Best Canada Graduate Scholarships Doctoral Award and by theGérard-Eugène-Plante Doctoral Scholarship. The funders did not play a role inthe design of the study, the writing of the manuscript or the decision tosubmit it for publication. No financial disclosures were reported by theauthors of this paper.

  • Competing interests None declared.

  • Ethics approval The HSDS study received approval from the Centre Hospitalier de l'Université de Sherbrooke, the University of Saskatchewan and Health Canada ethics review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from the Healthy Start study can be requested by emailing Professor Anne Leis;

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.