Nutrition in family day care homes
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Transcript of Nutrition in family day care homes
recognized and how many have beenrecognized but have not been reported isimpossible to say. For instance, on September 6-9, 1979, fluoride levels in Cincinnati's municipal water exceeded thoseset by the Ohio state law.
In her letter (JNE 11: 163 and 167, 1979)V.L. Richmond indicated that a thoroughstudy of all details of 90 articles has convinced her of the desirability of fluoridation. No matter how intensive herresearch may have been, judging by thekind of references cited in her article (JNE11 :62-64, 1979) and those in her response(JNE 11:163 and 167, 1979), she could notpossibly have become aware of thenumerous fallacies, omissions, and errorswhich prevail through the extensiveliterature on fluoridation.
George L. Waldbott, M.D., 11670 Martin Rd., Warren, MI48093.
REFERENCES
1 Waldbott, G.L. Acute fluoride intoxication(monograph), Acta Medica Scandinavica,Supplementum 174, (400), 1963.
2 Waldbott, G.L. Chronic fluorine intoxication from drinking water at 1ppm concentration, A case report. International Archives ofAllergy and Applied Immunology 7:70-74,1955.
3 Waldbott G.L. Fluoridation: A clinician'sexperience. Southern Medical Journal73:301-6, 1980.
4 Waldbott, G.L. Fluoride in clinical medicine(monograph), International Archives ofAllergy and Applied Immunology, 20(Suppl. I), 1962.
5 Waldbott, G.L. Preskeletal fluorisis near anOhio enamel factory, A preliminary report.Veterinary and Human Toxicology, 21:4-8,1979.
6 Waldbott, G.L., A.W. Burgstahler, and H.L.McKinney. Fluoridation, The great dilemma.Lawrence, Kans.: Coronade Press, 1978.
7 Leland, D.E., K.E. Powell, and R.S. Andersons, Jr. A fluoride overfeed incident at Harbor Springs, Michigan. Journal of theAmerican Water Works Association72:238-43, 1980.
EDITOR REPLIES
Surveys and interviews are worthy toolsfor collection of preliminary informationand may, if appropriately designed andadministered to exclude bias, provide"evidence." There is no indication in thereport by Anderson et al. or in Waldbott'sletter that the interviews in questions wereso designed and administered. Waldbott'sopinion concerning his telephone andhotel interviews should therefore beregarded as an anecdotal account until afull report including methodology is peerreviewed and published. The phrase"epidemic of illness" is based on extrapolation of the incidence of nonspecificsymptoms among a small number of
146 JOURNAL OF NUTRITION EDUCATION
employees in a single building to the entirepopulation of a city. This extrapolationseems inappropriate, particularly when nounusual school absenteeism or use ofmedical services was reported for the area.
Overstatement of the potential dangersof fluoridation often leads to reactionaryoverstatement of the absolute safety, andvice versa. This reply to Waldbott is notmeant to condone negligence or equipment malfunction which allows perhaps 50times the recommended fluoride level intopublic water supplies. Nor does it provethat fluoridation is "safe" under all circumstances. Rational scientists, educators, and health professionals must continue to question and research both theefficacy and safety of fluoridation.
Nutrition inFamily Day Care Homes
The components of a model child nutrition program have been delineated bythe American Dietetic Association (JADA64:520-521, 1979): (a) assessing the nutritional needs of the child, (b) meeting theneeds of the child through foods servedand the environment in which it is served,(c) providing educational opportunitiesfor the child to learn about food and its relationship to life, both physically and socially, and (d) planning educational activities about food and nutrition for parentsof the children. Since day care centers mayprovide a significant portion of meals served to children of parents who are at workor school, they would seem an appropriate location for child nutrition programs. In order to assess the need for development of such programs, we carriedout an exploratory survey of licensed family day care homes in Berkeley, California,in the summer of 1978. These were privatehomes, where only a small number of children attended. The objectives of the studywere to determine: 1) the number ofmeals, the foods served, and food-relatedactivities; and 2) the extent and nature offood and nutrition education offered byproviders.
Of the 90 licensed family day carehomes operating in the area, 45 were selected randomly and were invited by mailto participate. Nine were not in operationat the time of the study, 6 declined to participate, and 5 did not respond after 2 further attempts to schedule an interview.The 25 homes in the final sample providedcare for a total of 135 children, ranging inage from 2 months to 12 years. All but 1 ofthe homes provided 8 or more hours ofcare. The majority of providers were
experienced: 16 had provided day-care forat least 5 years.
Meals, foods, and food activities. Only2 homes provided an evening meal and 12provided breakfast; but 22 offered midmorning snacks, 22 provided lunch, and23 had mid-afternoon snacks available.Individual nutrient intakes could not beassessed by the data collected in this survey; but at least 2 servings from each ofthe Four Food Groups were served eachday by 20 of the 25 homes, and childrencould have second helpings in nearly allhomes. Although 18 providers claimed todo advance menu planning, only 1 produced an example of a written menu.
The provider ate with the children in 9homes, but, in most, the children atealone. In over half of the homes, childrenwere involved with meal preparation andservice; clearing and setting the table andhelping to prepare or cook food were frequently mentioned. At 3 homes, childrenhelped wash dishes, and at 1 each theyhelped with shopping and gardening.
Food and nutrition education. Therewas little evidence of provision of food ornutrition education to the children. Attempts were made by 14 providers to introduce new foods. Information about thechild's eating pattern, food preferences,and/or foods served at home was soughtby 21 providers, but only 5 believed theparents to be concerned about these aspects. Many providers expressed resistance to the certification requirements ofthe USDA-sponsored Child Care FoodProgram for family day care homes. Providers received food and nutrition information from a variety of nonprofessionalsources; none mentioned health professionals as sources of nutrition information. Additional information on food activities, menu planning and budgeting,and food and nutrition programs or services was requested by 6-8 providers foreach topic.
Implications. In this preliminary surveywe found that a significant portion of theday's food frequently is provided at familyday care homes. This confirms the appropriateness and the need for good food andnutrition practices in these settings. In thissample, the variety and amount of foodoffered to the children appeared adequate,but this did not appear to be due to planning. Only 1 provider was able to show awritten menu, indicating a need for assistance in menu preparation and meal planning. Only in a few homes did the childreneat together with the provider, familystyle. Several homes had children involved
VOLUME 12 NUMBER 3 1980
in other food-related activities such as preparing the food and setting the table. Inthese limited nutrition-related activities,the potential exists for significant expansion of nutrition education and of reinforcement of sound food practices.
There was some interest among providers in discussing the children's foodhabits with their parents, but the parentsdid not seem that concerned. More information is needed to determine what theparents' real interest is in this area. Providers utilized limited sources of nutritioninformation, and only a few expressed aninterest in nutrition consultation. Such asituation may result in little knowledge oreven misinformation on nutrition practices.
Given this perspective, it would seemthat before a full-scale program of nutrition education is inaugurated, interest innutrition by the providers, the children,and the parents must be stimulated. Theopportunities for organized food and nutrition education in the family day carehomes are present but are not beingutilized.
It would appear, therefore, that nutrition services provided in licensed familyday care homes now need the attention ofnutritionists working in health departments, Cooperative Extension, community health centers, schools, and othercommunity nutrition projects, if day carehomes are to serve as a setting for promoting good nutritional habits for children and families.
Albert Chang, Assistant Professor, andMaryann Saffold, Nutrition Student,School of Public Health, University ofCalifornia. Berkeley, CA 94720; andKathryn Buringrud, Nutritionist, ValleyGeneral Hospital, 400 S. 43rd Street,Renton, WA 98055.
Nutrition forAlternative Education
While teaching nutrition in a nontraditional program, I found certain food andnutrition learning activities to be particularly successful. A brief description ofthese activities is offered here, since theymight be useful to other nutrition instructors in similar situations.
The students are juvenile offenders andtruants referred by the court to the community school because they cannot be orneed not be confined in a juvenile hall situation. Many are substance abusers. Alarge percentage are from single-parent,low-income, minority (primarily Mexicanand Native American) homes. The stu-
VOLUME 12 NUMBER 3 1980
dents the school receives are the maladjusted, the problem learners, the sociallyrejected, the aggressive, the passive, andthe school phobics. They are often brightbut characteristically recalcitrant youngpeople, rigidly opposed to the impositionof structure on their lives; they commonlyhave an extremely short attention span, acondition exacerbated when they feel theyare being "taught" something.
Dietary practices are poor among thesestudents, both from the nutritional andeconomic standpoints. Breakfasts aremeager or skipped entirely; high-caloriesnacks and soda are common betweenmeal items; and canned, boxed, or frozenconvenience foods usually replace cookingfrom scratch at home.
The education philosophy of the program within which this nutrition education program operates encourages theteacher to serve as a resource person andto risk involvement with the students. Thecurriculum is flexible, individualized, andresponsive to student needs and suggestions. Participatory activities as opposedto lectures or reading assignments are thepreferred approach to the teaching andlearning.
Four food and nutrition concepts andthe activities that form the basis of the instruction are described below. These havebeen selected for relevancy to the problems and interests of this particular student population and reflect the educationphilosophy of the school.
Four Food Groups. The concept of including all of the Four Food Groups inone meal was introduced via a sandwichcontest. The students were to create anoriginal sandwich using foods from all ofthe Four Food Groups. The students firsttried the sandwiches at home, then submitted recipes; the ingredients were purchased by the school, and each pupil madeseveral of their sandwiches - enough foreveryone to have a bite. They were alltasted by each student, and the top threepicked by vote: the students who madethese were awarded prizes.
Meat Alternates. Instruction aboutcomplementary proteins and legumes asan inexpensive protein source was combined with many related food and nutrition concepts during a Mexican luncheonproject. The students expressed an interestin preparing a complete meal by themselves, with Mexican food voted the favorite. Ten different legumes were brought toclass; pinto beans were washed, soaked,and cooked for use as one of the menuitems. The students were encouraged to
smell and stir the beans. Each student wasassigned a food preparation duty for thegroup meal which included chicken enchiladas, bean and cheese burritos, guacamole dip with raw broccoli, fruit salad,and milk to drink. Nutrition information,along with assistance with the cookingtechniques, was provided by the instructor. Photographs of the preparationand eating of the meal were taken andlater submitted with a press release to thelocal newspaper; the result was an articlein the paper's society section describingthe event. The students saw - and tasted the results of their efforts and were quiteproud of the article. They demonstrateduncommon enthusiasm while cooking,each person obviously proud to be incharge of an essential task.
Nutritious snacking. Alternatives to theubiquitous soda and candy bars wereshown by bringing to school examples ofnutritious snack foods; these were placedon a table, grouped according to the FourFood Groups, and offered for consumption. Discussion centered around the newand different tastes of the snack itemswhich included yogurt, cheese, raw vegetables, nuts, seeds, and dried fruits.
Food economy. To help the studentsgain skills in buying food on a limitedbudget, several of them accompanied theinstructor each time food was purchased.As they walked through the store, the instructor pointed out foods and explainedgeneric brands, unit pricing, buying inbulk, and so forth.
The focus of nutrition education at theschool has been hands-on experienceswith food, especially cooking fromscratch. Convenience foods have been deemphasized. Through using such ingredients as dry beans, rice, fresh fruits andvegetables, bread, and cheese, studentsgain an appreciation for the feel, smell,and appearance of foods in their naturalstate that is missed when highly processedconvenience foods are used. The lowercost of less processed foods, and generallyhigher nutrient content, is also of practicalbenefit to the students. It is through thesecooking experiences that students havefound a renewed interest in eating, in theirbodies, and in their overall health.
Lorin M. Hawley, Mendocino CountyCommunity School, Ukiah, CA 95482.
CORRECTION
The film, Have A Healthy Baby:Pregnancy, was incorrectly listed as HaveA Healthy Baby (JNE 12:70, 1980).
JOURNAL OF NUTRITION EDUCATION 147