New Zealand Early Learning Service Menus Do Not Meet Health New Zealand Guidelines for Providing Healthy Menus and Reducing Food-Related Choking in Children.

Objective: To assess alignment of food and drinks served to New Zealand (NZ) children in early learning services (ELS) with the Health NZ (formerly known as Ministry of Health) Healthy Food and Drink (HFD) and Reducing Food Related Choking (choking) guidance.

Methods: Menus (271) collected remotely from 148 ELS from November 2020-March 2021 were analysed for their nutritional quality based on a 'traffic light' classification of 'green' (most nutritious), 'amber' (moderately nutritious) and 'red' (least nutritious) based on the guidance.

Results: Overall, 2.6% of menus met the guidance, and alignment was greater for menus for over 2-year-olds (over-2s) than under 2-year-olds (under-2s; p < 0.01). One-fifth (18.5%) of menus met the choking guidance. Services with a Healthy Heart Award (HHA) from the Heart Foundation provided more 'green' items to over-2s (p = 0.039) and under-2s (p = 0.01), and less 'red' items to over-2s (p = 0.04). Providing more green menu items was inversely correlated with providing less high choking risk foods (p < 0.01). Menu scores did not vary by service location, neighbourhood socioeconomic deprivation or type (services operating independently versus those part of an education group chain).

Conclusions: Alignment with Health NZ nutritional guidance is low, particularly in ELS caring for very young children (under-2s). Service characteristics, except for HHA status, are a poor predictor of nutritional quality of menus at ELS. Greater uptake of the HHA scheme could assist ELS to provide healthier food and drinks. Early learning services need further support from the public health sector to implement national nutritional guidelines.