Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 322-330 (doi:10.1542/peds.2007-2233)

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ARTICLE

Preschool Child Care Participation and Obesity at the Start of Kindergarten

Erin J. Maher, PhD^a, Guanghui Li, PhD^a, Louise Carter, PhD^a and Donna B. Johnson, PhD^b

^a Human Services Policy Center, Evans School of Public Affairs
^b School of Public Health and Center for Public Health Nutrition, University of Washington, Seattle, Washington

OBJECTIVE. We examined the association between type of child care, participation in different types of child care in the year before kindergarten and the likelihood of obesity at the start of kindergarten.

METHODS. Using a nationally representative sample of 15 691 first-time kindergartners from the Early Childhood Longitudinal Study-Kindergarten Cohort, we used logistic regression to estimate the relationship between type of primary child care arrangement and children's likelihood of being obese at the start of kindergarten. Our models controlled for family and child characteristics associated with obesity and choice of child care. To examine differential effects of child care participation for groups at high risk for obesity, we tested interactions between children's ethnicity and income with primary type of child care.

RESULTS. At the start of kindergarten, 12% of the children were obese. Without controlling for other characteristics of children and families, children not in child care were significantly less likely and children in family, friend, and neighbor care were significantly more likely to be obese than children in other primary child care arrangements. White children were significantly less likely and Latino children more likely to be obese than children of other ethnic groups. After controlling for relevant child and family characteristics, children in family, friend, and neighbor care and non-Latino children in Head Start were more likely to be obese than children not in child care. For Latino children, however, participation in some types of nonparental child care had protective effects on their likelihood of being obese.

CONCLUSIONS. Primary type of child care is associated with children's obesity. For Latino children, who are at a greater risk of being obese, participation in nonparental child care seems to have a protective effect. These results suggest that child care settings may be an important site for policy intervention during a crucial developmental period. Efforts to help family, friend, and neighbor caregivers support children's physical health may be warranted.

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Key Words: obesity • children • child care • ECLS-K

Abbreviations: CDC—Centers for Disease Control and Prevention • ECLS-K—Early Childhood Longitudinal Study-Kindergarten Cohort • WIC—Special Supplemental Nutrition Program for Women Infants and Children

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Accepted Dec 12, 2007.

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