Reducing child overweight and obesity is an international priority(1). In England, 22 % of 4- to 5-year-olds were overweight or living with obesity in 2023/24(2), comparably high levels are reported across Scotland, Northern Ireland and Wales(3–5). Notably, children living in the most deprived areas are more likely to be living with obesity in England and Wales(2,5) . Therefore, promotion of healthy weight in early years children (0–5 years) is a public health priority in all four UK countries (England, Scotland, Northern Ireland and Wales)(6–8).
Dietary intake during early childhood is a modifiable risk factor for obesity(Reference Liberali, Kupek and Assis9). Unhealthy dietary patterns, high in energy-dense foods and low in fibre, are associated with increased adiposity and obesity risk in childhood and adolescence(Reference Ambrosini, Emmett and Northstone10–Reference Magriplis, Farajian and Panagiotakos12). Studies have also shown that healthy dietary patterns in early childhood have long-term protective effects against stroke and cancer risk and are associated with better cognitive outcomes(Reference Maynard, Gunnell and Emmett13–Reference Tandon, Tovar and Jayasuriya16). Despite this, recent evidence has indicated that dietary intake in young children in the UK often does not meet nutritional recommendations for fibre, Zn and vitamin C(Reference Evans, Hutchinson and Christian17,18) .
In Scotland, 79 % of households with early years children used some form of childcare in 2019(19), and on average children aged 0–4 years spent 22·5 h a week in formal childcare in England in 2023(20). Formal childcare refers to early childhood education and care (ECEC) settings such as nurseries, preschools and childminders that provide daytime care for children before they reach school age (4–5 years). Food consumed during ECEC comprises 11 % of total eating occasions among early years children in the UK(Reference Porter, Toumpakari and Kipping21). ECEC could therefore be a pivotal setting to influence dietary behaviours and nutritional intake in early years children to help mitigate impacts of obesity and diet-related outcomes in children.
Scotland, Wales and England have government-funded schemes where parents can claim up to 30 h of free childcare to make childcare more economically feasible for parents(22). Northern Ireland also supports parents through The Northern Ireland Childcare Subsidy Scheme (NICSS) and the Tax-Free Childcare (TFC) scheme(23,24) . Recent increases (2024) to the funded childcare hours in England and the NICSS scheme are estimated to increase demand for childcare by 15 %(Reference Wainwright and Clarke25,26) . The impact increased demand for childcare could have on feeding practices and food provision in ECEC is unknown as funding for meals is not included within the free childcare hours scheme in England(27). However, meals are free to children attending ECEC in Scotland(28). The upcoming changes to childcare provision in England may also have a disproportionate impact in the most deprived areas, where ECEC already face chronic underfunding, and children have poorer dietary outcomes(Reference Molcho, Gabhainn and Kelly29–Reference Procter, Clarke and Ransley31). Thus, the aim of this scoping review was to draw together all current UK-based evidence on food policy, practice and provision in ECEC to identify gaps that will inform future policy development and research. Our review will address the following research questions: (i) how is food policy and guidance used by ECEC settings?; (ii) what food practices are used in ECEC settings in the UK?; and (iii) does food provided and consumed within ECEC settings meet nutritional recommendations for children of 0–5 years old?
The secondary aim of this review was to map findings from the included studies to the socio-ecological model (SEM) to identify how food policies, feeding practices and food provision in UK ECEC have been explored in research. The SEM is based on the ecological systems theory(Reference Brofenbrenner32) which hypothesised that individual, interpersonal, organisational, environmental and governmental contexts should be considered to fully understand individual outcomes(Reference Ohri-Vachaspati, DeLia and DeWeese33,Reference Pereira, Padez and Nogueira34) .
Methods
This scoping review was conducted in accordance with the JBI methodology for scoping reviews(Reference Aromataris, Lockwood and Porritt35) and was reported using the PRISMA extension for scoping reviews checklist (available in Appendix 1)(Reference McGowan, Straus and Moher36,Reference Tricco, Lillie and Zarin37) . A protocol for this scoping review was pre-registered on Open Science Framework (DOI 10.17605/OSF.IO/Q2RPH) and remained unaltered throughout the review process.
Search strategy
A search strategy was developed using terms for key concepts of the review: ‘early years care’, ‘nutrition’, ‘feeding practices’, ‘food events’ and ‘nutrition policy’. The terms were combined using ‘OR’ and then grouped using ‘AND’ to link the concepts. Limits were applied to restrict results to the English language and research published after 1990, as childhood obesity prevalence in the UK had a marked increase after 1994(Reference Chinn and Rona38); therefore, research published before this time may have less relevance to current public health policy. After a pilot search was carried out, the strategy was reviewed by a subject librarian to ensure the search retrieved all relevant studies. The search was performed in MEDLINE, EMBASE, PsycINFO, Scopus and CINAHL databases, in May 2024. The search strategies used are available in Supplementary material 2.
Eligibility criteria and study selection
The inclusion criterion for this scoping review was based on the Population, Concept, Context framework(Reference Aromataris, Lockwood and Porritt35). Studies were eligible for inclusion if (i) the population included early years children aged 0–5 years, parents, early years practitioners and/or staff; (ii) they explored the concept of food policy, feeding practices and/or food provision in ECEC (Table 1); and (iii) and if they were conducted in the context of UK ECEC.
Concepts of food policy, practice and provision eligible for inclusion in the review grouped by SEM level
SEM, socio-ecological model; ECEC, early childhood education and care.
Articles were excluded if they were:
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1. Conducted outside the four UK countries (England, Scotland, Wales and Northern Ireland).
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2. Review articles, protocols, commentaries, opinion pieces and grey literature.
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3. Focused on food in afterschool, breakfast or holiday clubs.
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4. Focused on children with chronic or medical conditions and/or special feeding requirements.
All titles and abstracts retrieved from the database searches were exported into EndNote to remove duplicate records and then uploaded into Rayyan screening software for screening(Reference Ouzzani, Hammady and Fedorowicz39). Three reviewers (AT, JP and JC) independently screened all titles and abstracts for inclusion in full-text screening. All full texts were then screened independently by the first reviewer (AT), and a random 50 % were independently screened by a second reviewer (JP), as previously deemed adequate(Reference Taylor-Phillips, Geppert and Stinton40). Discrepancies were discussed with the research team. Reference lists of the included studies were identified using CitationChaser and screened by the first reviewer (AT). Reasons for exclusion of articles at the full-text screening stage are reported in Figure 1.
PRISMA 2020 flow diagram representing identification of articles from database searching and screening process.
Data charting
A data extraction form was created in Excel and was designed to capture methodological characteristics of the studies and outcomes related to the target population, concept and context. The data extraction form was piloted with five studies by two reviewers to assess suitability. After appropriate adjustments were made, the first reviewer (AT) independently extracted all relevant data from the studies, and a second reviewer (JP) extracted a random selection of 50 % of the studies to ensure consistency. Discrepancies were discussed and resolved by the two reviewers.
Data synthesis, analysis and presentation
Characteristics of the studies such as type of participant, geographical information and type of setting were extracted and summarised in Table 2. Key findings identified from the studies were summarised and categorised based on relevance to the key concepts of the review: food policy, practice or provision. Additionally, results from studies were grouped according to SEM levels (individual, interpersonal, organisational, environmental and governmental). A narrative summary approach was used to discuss findings from the studies, and this did not include assessment of methodological quality of the included studies, as appropriate with the scoping review design(Reference Aromataris, Lockwood and Porritt35).
Summary of study characteristics
ECEC, early childhood education and care.
* Other types of participants included non-government organisations (NGOs), member organizations, local authority stakeholders, health visitors and researchers.
Summary of recommendations and actions for policy and research identified by study authors
Results
Out of 10 688 articles retrieved, 1964 duplicates were removed, and 90 full-text articles were assessed for eligibility after title and abstract screening. Following full-text screening, twenty-three articles were included (Figure 1). One additional article was identified from the reference lists of included articles.
Characteristics of studies
The majority (n 20, 83 %) of included studies were conducted in England, and the remaining studies were conducted in Scotland (n 2, 8 %) or were UK wide (n 2, 8 %); there were no studies conducted in Northern Ireland or Wales (Table 2).
Thirteen studies (54 %) utilised qualitative methods such as semi-structured interviews. Studies also utilised cross-sectional study designs (n 11, 46 %), and three studies (13 %) used experimental designs, two of which were mixed-method evaluations of interventions(Reference Langford, Jago and White41,Reference McLeod, Haycraft and Daley42) , and one was a cluster randomised controlled trial(Reference Nekitsing, Blundell-Birtill and Cockroft43).
The majority of studies included ECEC staff (n 12, 50 %), followed by parents (n 9, 38 %) and then ECEC managers (n 7, 29 %). Despite the greatest proportion of participants being early years children, only five studies (21 %) included children as participants(Reference McLeod, Haycraft and Daley42–Reference Marr, Breeze and Caton46). Most commonly, studies were based in nurseries (n 16, 67 %) (Table 2).
Figure 2 displays the proportion of studies that addressed each SEM level. The most frequent SEM level addressed was the organisational level (n 22, 92 %); these studies often investigated staff feeding practices within ECEC, such as knowledge and use of food guidance, serving style and staff role modelling. The second most frequent SEM level addressed was the interpersonal level (n 14, 58 %), explored through parent–provider relationships, such as parental input into menu planning or parent engagement with food provided in ECEC. Most frequently, studies addressed two SEM levels, and no studies addressed all five SEM levels.
Number of studies that investigated each SEM level. SEM, socio-ecological model.
The narrative summary of results was explored further by ‘Policy’, ‘Practice’ and ‘Provision’ concepts. Furthermore, this review identified and summarised study author recommendations for food provision-related policy development and future research for each concept (Table 3).
Policy
Food policy was the least investigated area compared to practice and provision. Fourteen studies (58 %) presented findings related to food policy.
Early childhood education and care food policies
Nine studies (38 %) investigated the implementation and adherence of ECEC food policies. The proportion of ECEC that had food policies differed between studies; two studies reported that 68–77 % of ECEC had a food policy(Reference Alderton and Campbell-Barr47,Reference Parker, Lloyd-Williams and Weston48) , whereas other studies reported much lower proportions of 13–17 %(Reference Buttivant and Knai49,Reference Lloyd-Williams, Bristow and Capewell50) . ECEC food policies reported in the studies included policies on staff roles during mealtimes or on the provision of ‘treats’(Reference Buttivant and Knai49,Reference McSweeney, Rapley and Summerbell51) . However, ECEC food policies tended to have varying formats and content between settings(Reference Buttivant and Knai49,Reference Moore, Nelson and Marshall52) . Alderton and Campbell-Barr (2005) reported that settings which did not have a food policy tended to exhibit less positive food practice and provision outcomes, such as involving children in serving food and catering for special dietary needs(Reference Alderton and Campbell-Barr47). Additionally, there were often varying degrees of policy enforcement from both providers and parents(Reference Goldsborough, Homer and Atchinson53). Policies surrounding ‘treats’ and celebrations were reported as difficult to enforce, and parental demand was a key influence upon adherence to policies(Reference McSweeney, Rapley and Summerbell51,Reference Moore, Nelson and Marshall52) . The process evaluation of a dietary intervention in ECEC identified that the management structure and financial barriers can prevent ECEC from developing food policies(Reference Langford, Jago and White41).
Availability of support and guidance to develop food policies
Several studies reported that there was less support and guidance available to private nurseries than local authority-funded nurseries(Reference Buttivant and Knai49,Reference Lloyd-Williams, Bristow and Capewell50,Reference Bristow, Povall and Capewell54) . According to findings from a qualitative study, staff from private nurseries felt they were more isolated from healthy eating information and policy guidance(Reference Bristow, Povall and Capewell54). It was also reported that private settings relied on the Office for Standards in Education (Ofsted – government regulation body for educational settings in UK) requirements to guide feeding practices and food provision(Reference Lloyd-Williams, Bristow and Capewell50) and did not receive the same support available to some local authority-funded nurseries(Reference Buttivant and Knai49).
Impact of government-level food policy and schemes
Limited findings addressed the use or impact of local and national governmental policies or schemes. Studies that evaluated government-level policy were mostly qualitative and generally reported negative, critical, views of their impact in ECEC. Moore et al. (2005) reported that the introduction of Government Ofsted monitoring of childminders in England was viewed as damaging to relationships between childminders and the local authority and contributed to an increased reliance on food provided by parents, rather than by childminders(Reference Moore, Nelson and Marshall52). Similarly, another qualitative study reported that ‘free childcare hours’ funded by government in England had put additional financial strain on ECEC, resulting in some ECEC relying on food provided by parents, or raising prices for parents not using the subsidy(Reference Warren, Williams and Knai55). It was also reported that there was a low uptake of free milk provided as part of ‘The Nursery Milk Scheme’ to nurseries in England and Wales due to a preference from children for drinks brought from home(Reference Albon44).
Recommendations for future policy development
Authors of the studies identified a need for authoritative, accessible guidance for food provision in ECEC and the implementation of a standardised food policy for ECEC in the UK(Reference Parker, Lloyd-Williams and Weston48,Reference Goldsborough, Homer and Atchinson53,Reference Williams, Warren and Knai56) . Additionally, authors recommended promotional campaigns that target portion size guidance in ECEC(Reference Quirke-McFarlane, Carstairs and Cecil57) and an increase in support and investment in the ECEC sector by UK governments(Reference Warren, Williams and Knai55).
Practice
The majority of findings from the studies related to feeding practices in ECEC (n 20, 83 %).
Feeding practices employed in early childhood education and care
Studies frequently reported the use of positive feeding practices in ECEC to support children throughout mealtimes, including giving gentle encouragement to try foods served and prompting children to eat their vegetables at mealtimes(Reference Lloyd-Williams, Bristow and Capewell50,Reference Goldsborough, Homer and Atchinson53,Reference Elford and Brown58) . It was reported that one nursery enabled staff to eat for free with the children to promote role modelling(Reference Langford, Jago and White41). Three studies reported that children were often encouraged to self-serve their food or involved in food preparation(Reference Alderton and Campbell-Barr47,Reference Lloyd-Williams, Bristow and Capewell50,Reference Quirke-McFarlane, Carstairs and Cecil57) . Child-sized tableware was used to guide appropriate portion sizes in ECEC, as one qualitative study reported that staff felt generally less aware of portion size guidance than parents(Reference Quirke-McFarlane, Carstairs and Cecil57).
There was also evidence of feeding practices in ECEC which are not recommended by early years guidance. For example, 21 % of providers who responded to a questionnaire said that they used treats to incentivise children to eat their meal and encourage good behaviour(Reference Elford and Brown58). Neelon et al. (2015) found that nurseries located in areas with the highest Index of Multiple Deprivation (IMD) score (i.e. most deprived) were more likely to report recommended practices such as allowing children to select their own food or staff accompanying children at mealtimes. However, there was generally an expectation children should finish all their food, which is not recommended practice(Reference Neelon, Burgoine and Hesketh59). Findings from the studies also indicated that ECEC rarely sought nutrition advice or approval from dietitians to support menu development(Reference Parker, Lloyd-Williams and Weston48,Reference Lloyd-Williams, Bristow and Capewell50) .
Barriers to healthy feeding practices
A common theme identified in seven studies was the lack of nutrition training and education of ECEC staff and cooks(Reference Alderton and Campbell-Barr47,Reference Buttivant and Knai49,Reference Lloyd-Williams, Bristow and Capewell50,Reference Moore, Nelson and Marshall52–Reference Warren, Williams and Knai55) . There was evidence that providers had some general healthy eating knowledge but often relied on ‘common sense’ or diet knowledge gained from personal experiences(Reference Goldsborough, Homer and Atchinson53). A process evaluation of an ECEC intervention found that there were small increases in ECEC staff healthy eating knowledge and motivation post-intervention, indicating that lack of healthy feeding training and education is a modifiable barrier(Reference Langford, Jago and White41). Other barriers to healthy feeding practices identified in the studies included limited time, lack of kitchen facilities, lack of staff supporting mealtimes, and budgetary constraints(Reference Langford, Jago and White41,Reference Alderton and Campbell-Barr47) . Insufficient funding and budgetary concerns were prominent barriers to accessing training and support towards healthy feeding practices for ECEC(Reference Warren, Williams and Knai55), and this was most evident in settings in more deprived areas(Reference Langford, Jago and White41).
Use of early years food and drink guidance
Warren et al. (2024) reported that providers were more likely to be aware of healthy eating guidance than to use it in practice(Reference Warren, Boadu and Exley60). The most frequent sources of healthy eating information cited in the included studies were childminding magazines, ‘Change4Life’ materials, national reports and advice from parents(Reference Buttivant and Knai49,Reference Goldsborough, Homer and Atchinson53,Reference Neelon, Burgoine and Hesketh59) . Two studies found that the ‘Eat Better, Start Better’ voluntary food and drink guidelines for ECEC in England were a key source of information used by providers(Reference Neelon, Burgoine and Hesketh59,Reference Warren, Boadu and Exley60) . Notably, it was reported that providers frequently referenced feeding guidance aimed for school-aged children rather than early years children(Reference Goldsborough, Homer and Atchinson53). Barriers to the use and implementation of guidance in ECEC included the length and complexity of reports, and guidance not being culturally inclusive(Reference Warren, Williams and Knai55). A quantitative study identified that settings with larger numbers of children were more likely to use guidelines(Reference Warren, Boadu and Exley60).
Recommendations for feeding practice-related policy development and future research
Three studies identified that further support and training for menu development, healthy food preparation and use of portion size guidance would be beneficial for ECEC(Reference Parker, Lloyd-Williams and Weston48,Reference Lloyd-Williams, Bristow and Capewell50,Reference Quirke-McFarlane, Carstairs and Cecil57) . It was also suggested that providers should actively engage with parents about feeding practices and seek opportunities to learn from a range of health professionals(Reference Albon44).
Recommendations for future research included understanding the factors influencing the use of healthy feeding guidance and improving methods to more accurately capture feeding practices in a range of ECEC(Reference Buttivant and Knai49,Reference Warren, Boadu and Exley60) .
Provision
Fifteen studies (63 %) reported outcomes related to food provision in ECEC.
Food provided in early childhood education and care
Fruit and vegetables were frequently provided in ECEC(Reference Parker, Lloyd-Williams and Weston48,Reference Neelon, Burgoine and Hesketh59,Reference Burgoine, Gallis and Penney61) ; however, ECEC did not often meet the oily fish recommendations (at least two portions per week)(Reference Er, Dias and Papadaki45,Reference Parker, Lloyd-Williams and Weston48,Reference Neelon, Burgoine and Hesketh59,62) . The provision of plant-based protein sources was also generally insufficient in ECEC, although nurseries in the most deprived areas were more likely to provide foods containing wholegrains, legumes, pulses and lentils(Reference Neelon, Burgoine and Hesketh59,Reference Wall and Pearce63) . Milk provision varied between ECEC, some settings provided semi-skimmed milk and some provided whole milk(Reference Albon44). Studies reported that ECEC were likely to rely on processed foods or dried fruits, high in sugar, for snack foods(Reference Lloyd-Williams, Bristow and Capewell50,Reference Goldsborough, Homer and Atchinson53) .
The provision of food brought from home in ECEC, referred to as ‘packed lunches’, was dependent on the setting type. Moore et al. (2005) reported that 25 % of childminders and 8 % of private nurseries relied on parents bringing food from home, whereas parents never provided food in the local authority-funded settings included in the study(Reference Moore, Nelson and Marshall52).
Nutritional quality of food in early childhood education and care
A secondary data analysis using UK National Diet and Nutrition Survey (NDNS) data found that meals provided in nurseries and preschools were lower in added sugars and were less energy-dense than food provided by parents, wider family or other childcare(Reference Marr, Breeze and Caton46). There were conflicting findings reported regarding energy and carbohydrate content of food provided in ECEC(Reference Parker, Lloyd-Williams and Weston48,Reference Wall and Pearce63) ; however, studies consistently reported that food provided in ECEC exceeded the Caroline Walker Trust (CWT) and ‘Eat Better, Start Better’ (EBSB) recommendations for fat and salt and was deficient in fibre, Fe and Zn(Reference Parker, Lloyd-Williams and Weston48,Reference Wall and Pearce63) . Frequent provision of cakes and biscuits was identified as contributing to excess sugar provided in ECEC(Reference Wall and Pearce63).
Two studies reported that portion sizes served in school-based nurseries were more compliant with school food standards than ECEC recommendations(Reference Wall and Pearce63,Reference Pearce and Wall64) . Another study reported that settings in more deprived areas had better nutrition index ratings(Reference Alderton and Campbell-Barr47).
Barriers to healthy food provision
Findings from the included studies highlighted several barriers to providing healthy foods faced by ECEC including financial constraints, time capacity, type of ECEC and source of food. Three studies identified that time constraints impacted what food was provided in ECEC(Reference Lloyd-Williams, Bristow and Capewell50,Reference Goldsborough, Homer and Atchinson53,Reference Bristow, Povall and Capewell54) . Childminders felt strongly that their limited time capacity negatively impacted food provision and resulted in a reliance on processed convenience foods(Reference Goldsborough, Homer and Atchinson53). Similarly, another study reported that the quality of ingredients used for food preparation in ECEC was largely governed by financial and time capacity(Reference Bristow, Povall and Capewell54).
The type of ECEC was also a factor that impacted food provision. School-based nurseries had little to no control over what food could be purchased, as the budget for consumables was controlled by management in the associated primary school(Reference Bristow, Povall and Capewell54). In addition, parents held more power over menu choices in private nurseries, as they were considered customers to a ‘business’(Reference Buttivant and Knai49). Consequently, private nurseries in less deprived areas were able to provide good quality foods, as parents had greater financial responsibility(Reference Lloyd-Williams, Bristow and Capewell50). Nurseries that prepared food on site with a dedicated cook had more autonomy over menu development than settings that relied on an external catering company(Reference Buttivant and Knai49). Additionally, nurseries with the farthest distance to the nearest supermarket were more likely to serve fruit and vegetables less than 2–3 times per week(Reference Burgoine, Gallis and Penney61).
Recommendations for food provision-related policy development and future research
The authors of the studies had minimal recommendations for policy development related to food provision in ECEC. One study recommended that there should be increased support for schools and caterers providing food for multiple age groups to ensure that appropriate portion sizes and nutrient requirements are served to the respective age group(Reference Wall and Pearce63).
Moore et al. (2005) identified a need for future research to explore the nutritional quality of food served in ECEC(Reference Moore, Nelson and Marshall52). After concluding that offering vegetables to children at breakfast time was feasible, one study recommended that a future randomised controlled trial should be undertaken to explore this intervention further(Reference McLeod, Haycraft and Daley42).
Discussion
This is the first review of studies to explore food policies, feeding practices and food provision in UK ECEC. We used the SEM to synthesise key findings and recommendations for further research. Twenty-four studies were identified, and the majority used qualitative methods or were of cross-sectional design. Most of the studies were conducted in England in a nursery setting and included ECEC staff as participants, with no studies undertaken in Northern Ireland or Wales. Studies most frequently focused on food practices in ECEC, followed by provision and then policy. The majority of research was at the organisational SEM level, and very few studies targeted governmental and individual levels.
The focus on UK countries was important to clearly see the scope of research within the UK and compare to international studies. Reviews of studies undertaken internationally have focused on synthesising ECEC nutrition interventions(Reference Bell and Golley65–Reference Yoong, Lum and Wolfenden71), whereas our review identified only three studies that used experimental methods, indicating a stark difference in the type of evidence that characterises the UK ECEC research landscape. Despite differences in study design, international literature reviews generally reported that barriers to food policy implementation, healthy feeding practices and nutritional quality in ECEC were consistent with those identified from UK literature(Reference Matwiejczyk, Mehta and Scott68,Reference Willemsen, Wiggins and Cromdal72) . Ultimately, the gaps in research and policy highlighted in international literature reviews support our recommendations for future research that targets all five SEM levels(Reference Matwiejczyk, Mehta and Scott68–Reference Wolfenden, Jones and Williams70) and for increased food-related ECEC policies(Reference Lucas, Patterson and Sacks67).
Policy
Our findings suggested that food policies and the way they are implemented are likely to be highly variable across ECEC in the UK, with differences most evident between private and local authority-funded settings. A recent report by Nourishing Our Future found that 81 % of settings in Essex, England, have a food policy, which is higher than findings reported within literature and further highlights the wide variability in food policy use across the UK(73). The variability in the content of ECEC food policies is expected, as ECEC are advised to adapt policies to reflect the individual setting(74). However, providing a more specific policy framework and support for policy development, such as those provided by Australian States/Territories to ECEC, would be beneficial for UK ECEC to develop more specific and comprehensive food policies(Reference Lucas, Patterson and Sacks67). Furthermore, it was evident that ECEC struggled to fully adhere to food policies once they were in place. Previous evidence from settings based in Australia has shown that implementation and adherence to food policies in ECEC could be improved with active support from ECEC managers, parents and accessible resources(Reference Wolfenden, Finch and Nathan75).
This review found that there was poor implementation of government schemes in UK ECEC(Reference Albon44,Reference Warren, Williams and Knai55) . Government schemes have been effective in the school environment. The School Food Standards and Universal Infant Free School Meals (UIFSM) have improved dietary intake at lunchtimes, with particularly beneficial impacts for low-income children(Reference Adamson, Spence and Reed76,Reference Parnham, Chang and Millett77) . Similarly, government legislation in Sweden entitles all children in preschool and primary school to a free and nutritious meal, which has been effective in ensuring school meal quality and beneficial feeding practices(Reference Patterson and Elinder78,Reference Persson Osowski, Göranzon and Fjellström79) . The evident success of government schemes in the school environment and in international settings suggests that similar schemes could be beneficial for food quality and feeding practices in UK ECEC if implemented universally, and with sufficient support and resources for ECEC staff (Reference Lucas, Patterson and Sacks67).
Practice
This review found that staff role modelling was a common practice reported in UK ECEC. Role modelling is a widely recommended practice to promote healthy eating and young children’s acceptance of unfamiliar foods(Reference Harper and Sanders80). Our review also found that it was common practice to allow children to self-serve, which evidence suggests is beneficial for reducing energy intake(Reference Fisher, Rolls and Birch81). Similarly, the involvement of children in food preparation has positive impacts on vegetable intake in children(Reference van der Horst, Ferrage and Rytz82). Whilst this practice is common within ECEC in countries such as New Zealand, it was not frequently reported in UK ECEC(Reference Gerritsen, Wall and Morton83). Diluting fruit juice with water was a practice reported in more deprived ECEC. This practice reflected previous recommendations that have since been revised; current guidance recommends only water or milk in ECEC(84,85) . This was an important practice given the high proportion of sugar found in juice drinks marketed to children and subsequently high intake of sugar from sugar-sweetened beverages in UK children(Reference Boulton, Hashem and Jenner86,Reference Seferidi, Millett and Laverty87) .
Although this review found that feeding practices were generally positive, providers also displayed practices that were not recommended such as using ‘treats’ as rewards for good behaviour or expecting children to finish their meals. The use of ‘treats’ such as sweets or desserts as rewards during childhood has associations with dietary behaviours later in life, as well as negative outcomes related to physical and mental health(Reference Fedewa and Davis88,Reference Puhl and Schwartz89) . Similarly, we found that some settings in more deprived areas expected children to finish all their meals(Reference Neelon, Burgoine and Hesketh59), which is not encouraged as this can affect awareness of hunger and fullness cues, important for self-regulation of energy intake(Reference Johnson90). However, children in deprived areas are more likely to face food insecurity, and therefore staff may want to ensure children have had sufficient intake during their care(Reference Stanley, Hadi and Newbold91). Our review also found that ECEC staff tended to cite sources of information that were not official healthy eating guidance, such as advice from parents or childminding magazines(Reference Buttivant and Knai49). Previous evidence has shown that parents of early years children are also generally unaware of portion size guidance, indicating that ECEC staff should not be reliant on parents for feeding practice advice(Reference Porter, Langford and Summerbell92). Findings from the Nourishing Our Future report identified that settings found guidance resources too complex and overwhelming, or not visual enough, which is consistent with findings from this review(73). This therefore highlights a need for intervention to promote effective use and awareness of nutrition guidance resources.
Notably, the majority of findings related to feeding practices in UK ECEC came from qualitative interviews or self-reported questionnaires by providers. A previous study found that there were disparities between reported practices by caregivers and actual practices observed by researchers(Reference Erinosho, Hales and McWilliams93). There is therefore a need for improved methodology to accurately capture feeding practices in the ECEC environment.
Provision
On average, the lunches provided in UK ECEC had excess fat, sugars, protein and salt and were deficient in Fe and Zn(Reference Parker, Lloyd-Williams and Weston48,Reference Wall and Pearce63) . These findings are similar to those found in primary schools in England before the introduction of The School Food Standards in 2008, where children consumed excess fat and deficient amounts of energy, carbohydrates and Fe from school lunches(Reference Rogers, Ness and Hebditch94). Additionally, the excess energy and protein and inadequate Fe intake is a widespread observation across European countries for early years children and in ECEC(95,Reference Goldbohm, Rubingh and Lanting96) . We identified cost as a barrier to healthy food provision in UK ECEC, which is an unsurprising consequence of the chronic underfunding faced by ECEC in the UK(30,Reference Lawler97) . This was most evident in settings in more deprived areas, which have been disproportionately affected by funding changes(Reference Langford, Jago and White41,Reference Stewart, Gambaro and Reader98) .
Our findings also showed that school-based nurseries served inappropriately large portion sizes that were more suitable for primary school-aged recommendations than early years(Reference Wall and Pearce63,Reference Pearce and Wall64) . These findings could partly explain why a previous study found that eating occasions were larger in childcare than in the home setting(Reference Porter, Toumpakari and Kipping21). The consumption of such large portion sizes could have negative health implications for early years such as an increased risk of high body weight and blood pressure due to excess energy and salt intake(Reference He, Marrero and MacGregor99,Reference Swinburn, Jolley and Kremer100) . It could be postulated that the inappropriate portion sizes in ECEC could be a result of lack of training and nutrition education that was reported in ECEC staff and cooks, or the limited awareness and use of ECEC-specific feeding guidance.
The effect of deprivation
This review found that ECEC in the most deprived areas adhered to more recommended feeding practices and provided more nutritional foods than settings in less deprived areas. For example, one study reported that settings in the most deprived areas were more likely to dilute juice with water (Reference Neelon, Burgoine and Hesketh59). Whilst diluting juice is typically a practice to reduce sugar consumption, it is more likely that ECEC in deprived areas comply with this practice to reduce costs as ECEC may face significant budgetary constraints in more deprived areas(30). Alternatively, these findings could reflect the differences found between ECEC types, as children from more deprived areas are more likely to attend local authority-funded settings(Reference Gambaro, Stewart, Waldfogel, Gambaro, Stewart and Waldfogel101), which have more support to assist food policy development and healthy feeding practices.
Our findings contrast a previous study that found greater socio-economic deprivation was associated with poorer nutritional quality of food in English secondary schools(Reference Gould, Russell and Barker102). More generally, it has been established that lower household income and socio-economic deprivation are associated with poorer diet quality in children(Reference Nelson103). The findings in this review therefore present promising evidence that ECEC could act as key mitigators to improve dietary intake of children in deprived areas and indicate that further research is needed to explore food provision and practice in ECEC that face deprivation.
Implications
This scoping review found that the majority of research on food policy, practice and provision in UK ECEC was at the organisational SEM level. This is problematic as it continues to place the responsibility on providers that are typically overstretched and underfunded(30). Future research should therefore aim to develop and evaluate governmental programmes and policies to ensure that they are effective at supporting and improving child health. Given the success of previous interventions that have targeted ECEC in other countries(Reference Davis, Sanders and FitzGerald105–Reference Puder, Marques-Vidal and Schindler107), there is also scope for more healthy eating interventions in UK ECEC. Furthermore, interventions in ECEC may be more impactful if they use a multi-level approach, targeting a range of SEM levels. Our findings highlighted a need for quantitative research that more accurately captures the nutritional quality of food provided and consumed, as well as further exploring the impact of cost on food provision in the current economic climate.
The most striking finding from this review is the urgent need for research in Wales, Northern Ireland and Scotland. The ongoing National Institute of Health and Care Research (NIHR) ‘Growing Well Study’ (GWS)(Reference Cade, Threapleton and Greenwood108), whilst important to explore food and nutrient intake in English preschool children, further perpetuates this lack of research conducted in the three other UK countries. Similarly, more research is needed that represents a range of deprivation levels to effectively identify barriers faced by ECEC across the UK.
The findings from this review provide an evidence base to support policy change needed in UK ECEC. Our findings indicate that the introduction of the statutory nutrition requirements in English ECEC from September 2025 will be beneficial for ensuring adequate nutritional quality in food provided to early years children(22). Similar nutrition requirements should also be in place for ECEC in Wales and Northern Ireland. The Early Years Foundation Stage (EYFS) nutrition guidance was published in May 2025 to support ECEC with the new statutory nutrition requirements. This provides more accessible and succinct advice for ECEC on food groups, food policy development and menu planning than previous guidance. However, the EYFS guidance lacks clarity on portion sizes and feeding practices, which we have established as areas requiring further support for ECEC(74). Increased governmental support for the implementation of nutrition requirements is important to ensure additional burden is not placed on ECEC providers.
Additionally, our findings indicated that nutrition education and practice training should be made more accessible to ECEC staff through government-funded schemes and should be monitored by Ofsted to ensure recommended feeding practices are upheld. Finally, the findings from this review, coupled with the success of UIFSM scheme, support the proposition for universal-free meals in ECEC, which would alleviate cost as a barrier to nutritional food provision and help reduce inequality between ECEC types and deprivation levels.
Strengths and limitations
Strengths of this scoping review include the comprehensive and systematic search of peer-reviewed literature and inclusion of a breadth of study designs, thereby ensuring all relevant, available evidence has been collated to scope what is known about the food policy, provision and practice in UK ECEC. Using a socio-ecological approach was also a strength of this review, as it informed where gaps in research lie and highlighted how a multi-level approach for future studies would provide impactful insights on food policy, practice and provision in ECEC.
There were also a number of limitations to this review. For example, this scoping review did not include grey literature which may have provided further context of food provision and practices in ECEC, as well as evidence that supports the need for policy changes. However, this review can be used alongside a published grey literature review of early years portion size guidance resources in the UK and Ireland(Reference Porter, Kipping and Summerbell109) and grey literature reports from early years advocacy organisations to call for policy change. Another limitation of this review is that five of the studies were published before 2012(Reference Albon44,Reference Alderton and Campbell-Barr47,Reference Parker, Lloyd-Williams and Weston48,Reference Lloyd-Williams, Bristow and Capewell50,Reference Moore, Nelson and Marshall52) , which predates the publication of CWT, EBSB and EYFS guidelines(74,84,110) and therefore the studies do not evaluate food practices and provision against these current ECEC guidelines. There have also been recent geopolitical and economic changes since many of the studies were published, and therefore findings may not reflect current food policy, practices or provision in UK ECEC.
Conclusion
Overall, we found that UK ECEC had generally poor adherence to food policies, and government schemes were not implemented effectively in the ECEC environment. Although feeding practices reported were mostly positive, a lack of nutrition training and awareness of guidance was apparent in ECEC staff. Barriers to healthy food provision included financial constraints, time capacity, type of ECEC and source of food. Our findings show that there is an urgent need for an increased focus on research and policy addressing the food environment in UK ECEC, specifically in Scotland, Northern Ireland and Wales. Future research should aim to capture a range of influences affecting food policy, practice and provision in UK ECEC to ensure that responsibility is not placed solely on providers and to inform future policy development.
Supplementary material
For supplementary material accompanying this paper visit https://doi.org/10.1017/S1368980025101298
Acknowledgements
The authors would like to thank Rachel Bath from Public Health Wales, Ruth Campbell from NHS Ayrshire & Arran, Caoimhe Gowran from Bristol City Council and others for their assistance in developing the scoping review protocol. The authors would also like to thank Sarah Herring, a subject librarian at the University of Bristol for reviewing our search strategy.
Authorship
A.T: conceptualisation, methodology, investigation, project administration, data curation and writing – original draft. A.P: conceptualisation, methodology, supervision and writing – review and editing. M.M: conceptualisation, methodology, supervision and writing – review and editing. J.P: investigation, data curation and validation. J.C: investigation, data curation and validation. R.K.: conceptualisation, methodology, supervision and writing – review and editing.
Financial support
This study is funded by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number NIHR 204000). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests
There are no conflicts of interest.
Ethics of human subject participation
Not applicable.
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