The nutrition and physical activity levels of children who are in daycare need to be investigated, recommend Quebec researchers, who report higher levels of obesity in children being cared for outside the home.

Investigators in Montreal looked at associations between overweight and obese children, and different types of child-care arrangements, using a Quebec database on childhood development that followed 1,649 children until age 10.

"I was surprised at first to find higher prevalence of overweight or obesity among children attending specific types of child care compared with those in parental care," said the study's lead author, Marie-Claude Geoffroy, now a postdoctoral fellow at the Institute of Child Health at University College London.

Quebec Premier Pauline Marois plays with children at a daycare earlier this month. Researchers took advantage of the province's subsidized child-care program and childhood development database to examine the link between kids in daycare and excess weight. (Paul Chiasson/Canadian Press)

Compared with parental care, children who attended a centre-based child care had higher odds of being overweight/obese in childhood, the researchers concluded in the research in the Journal of Pediatrics.

In the study, mothers were interviewed about the care of children at 1.5 years, 2.5 years, 3.5 years and 4 years.

The children were grouped based on where they spent the most hours in care:

• Daycare centre: 30%.
• Family daycare: 35%.
• With a nanny: 5%.
• With parents: 19%.
• With an extended family member: 11%.

"In Canada, existing guidelines provide broad recommendations (e.g., meals and snacks in accordance with the Canadian food and nutrition guidelines, encouraging high energy output activities such as running or jumping) that may be difficult to implement," the authors wrote.

"The present study, along with previous ones, point to the need for investigations focusing on the quality of the nutrition and physical activity in child-care environments."

Greater awareness of child obesity

The researchers said they controlled for factors such as socioeconomic status, birth weight, breastfeeding, and the mother's body mass index and whether she was employed. But they can't rule out the possibility that other factors were also involved.

The children weren't randomly assigned to different child-care arrangements and no cause and effect relationships can be drawn.

Nutritional recommendations for child care tend to be vague, says Marie-Claude Geoffroy. (Nathanaël Corre/University of Montreal)

Geoffroy noted the daycares in the study took place a decade ago when there was less awareness of the importance of preventing overweight and obesity in children.

The researchers said the University of Montreal's Nutrition Reference Centre has developed a French web portal called Extenso for topics including nutrition for children in daycare.

All daycares aren't created equal when it comes to nutritional quality and physical activity, said Kristi Adamo, a research scientist at the Children's Hospital of Eastern Ontario Research Institute who studies factors leading to child obesity.

Quebec subsidizes child care. In other provinces, parents may have limited options, Adamo said.

She advised parents to:

• Visit the daycare.
• Meet with the staff.
• Look at the curriculum.
• View sample menus and take note of who is producing the food.
• Check how much physical activity the children are doing.

Don Giesbrecht worked in the child-care industry for years and is now the president and CEO of the Canadian Child Care Federation in Winnipeg.

Child-care centres must offer outdoor play but the nutrition regulations tend to be more like guiding principles, Giesbrecht said.

"It comes down to the people that are in the child-care centre or the child-care home or family day home and what their experience and knowledge is," for meeting the nutritional needs of children, he said.

Tamara Jennex, assistant director of Wee Care Development Centre in Halifax, said daycares in Nova Scotia are required to provide two-thirds of a child's nutrition requirements each day, all food groups and two periods of outdoor activity daily.

Jennex acknowledged that working parents can be pressed for time.

"By the time you pick up your child at 5:30, there's not a lot of time to prep a healthy meal choice, possibly," she said.

The study was funded by Quebec's Ministry of Health and Social Services, Quebec's health research foundation and Canada's Social Science and Humanities Research Council.

With files from CBC's Kim Brunhuber and Pauline Dakin