Cross-sectional survey findingsSample characteristics

The characteristics of participating ECEC centres are presented in Table 1. A total of 50 ECEC centres completed the online survey, representing approximately 5% of Victoria’s ECEC centres with onsite food provision (n = 1063; as at Quarter 1—From January to March 2022). Of these, about two-thirds were located in a metropolitan area, with medium or high area-level socio-economic advantage, had a for-profit service management type, had no chefs/cooks involved in breakfast food provision, and were meeting National Quality Standard (NQS) benchmarks. Total median number of children eating breakfast per centre was 19, representing 15.8% of centre enrolments. The mean number of staff available during breakfast was 3.

Table 1 Demographic characteristics on Early Care and Education (ECE) services who completed the online survey (n = 50)Frequency of provision of breakfast food items

Breakfast cereal, bread, and milk were more likely to be “Always” offered, with fruits, yogurt, cheese, and porridge more likely to be “Never” or “Sometimes” offered at breakfast. Notably, vegetables were the most likely to be “Never” provided at breakfast (Fig. 2).

Fig. 2

Frequency of provision of breakfast food items based on core food groups (i.e., grains, dairy products, fruit, and vegetable) in ECE services (n = 50)

Quality of breakfast provision

Of 50 centres, the majority of ECEC centres (over 80%) offered medium and low-quality breakfasts, with 16% and 10% meeting the criteria for high-quality breakfasts based on the HEAS ‘Healthy Choices Food and Drink Classification Guide’ (traffic light system) and HEAS ‘Breakfast Menu Recommendations for ECEC Services, respectively (Table 2).

Table 2 Breakfast quality for ECE services that participated in the online survey (n = 50) based on HEAS breakfast menu recommendations a) and healthy choices food and drink classification guide (Traffic light classification) b)

Based on the HEAS guidelines, ECEC centres that offered fruits and vegetables received higher quality scores, and centres that provided muffins, banana bread, or vegemite (a high salt yeast extract spread) received lower quality scores. Overall, ECEC centres in high socio-economic advantaged area had higher odds of offering a high-quality breakfast (OR: 3.04, 95% CI: 1.00, 9.16). However, the quality of breakfast did not significantly differ based on other centre characteristics, including location, centre management type, and nutrition training, as shown in Table 3.

Table 3 Multivariable logistic regression between ECE services characteristics with the quality breakfast provision (high vs low) by HEAS Breakfast Menu Recommendations a) and Healthy Choices Food and Drink Classification Guide (Traffic light classification) b) (n = 50 sample size)Observational on-site visit findings

Four ECEC centres were purposefully recruited for the observational study, with two located in metropolitan areas and two in regional areas. In terms of management type, three centres were 'for-profit,' while one was 'not-for-profit'. On-site breakfast provision appeared to be consistent across all centres, regardless of location or management type.

During the on-site observations, it was evident that the timing of breakfast provision was consistent among all four ECEC centres. Specifically, three centres offered breakfast between 7 am and 8:30 am, while one centre extended its breakfast service hours from 6:45 am to 8:30 am. This adjustment was made in response to children expressing hunger during these early hours, demonstrating the centres’ adaptability in meeting the needs of the children.

Observations also revealed that each centre typically began breakfast service when around 2–3 children gathered (usually at 7 am) with two educators present. Around 8 am, the number of children having breakfast increased significantly, reaching nearly 15–20 children, irrespective of their age group, all participating in breakfast in the same room. At this time, an additional educator would arrive, resulting in a total of three educators coordinating on-site breakfast provision. One educator was responsible for welcoming and greeting the children as they arrived, another assisted in serving breakfast, and the third managed the cooking and preparation tasks, such as toasting bread and pouring cereal. It appeared that no staff were specifically available to supervise the children who had already finished their breakfast. Children who finished breakfast stayed in the same room, engaging in free play with toys or books until additional educators or children arrived.

In terms of breakfast service style, all observed ECEC centres adopted a progressive meal provision approach. A progressive mealtime is characterised by an extended period during which food is made available to children, and the decision about when and how long to participate in the breakfast time is driven by the children themselves. Three of the ECEC centres offered breakfast cereals such as Weet-Bix ™, Nutri-Grain ™, Rice Bubbles ™, and Cornflakes ™, with one centre providing cooked oats porridge. All observed ECEC centres provided wholegrain or multigrain bread options, with no provision of white bread. Full-fat milk was served exclusively, with no options for reduced-fat milk, skim milk, or plant-based milk alternatives. No fruits or vegetables were included in the breakfast meal options at any of the centres. Also, breakfast provision typically consisted of a simple menu and a small group of children, allowing educators to easily manage and be aware of any specific food allergies. Educators were informed of children's allergies and took appropriate precautions. However, for children with allergies, there was often a lack of alternative breakfast options, and allergy-related foods were simply excluded from their meals rather than replaced with suitable substitutes.

Qualitative interview findings—enablers and barriers to providing healthy breakfast at ECEC services

A total of eight ECEC staff, responsible for breakfast provision, were recruited for interviews across the four ECEC centres (2 from each centre; M1-M4 and R1-R4) involved in on-site observational visits. Findings from the qualitative analysis and example quotes are presented in Table 4 and described below. Two main enablers were identified – the potential of a government-funded breakfast program and consistent nutrition guidelines. Four main barriers were identified – time constraints, budgetary limitations, limited awareness of nutrition guidelines, and insufficient staffing.

Table 4 Enablers and barriers to providing healthy breakfast across Victoria, Australia from semi-structured interviews with 8 directors and staff from 4 ECE servicesEnabler 1: Government funded breakfast provision

One interviewee highlighted government-funded breakfast provision as a crucial enabler in these ECEC settings, ensuring that children received nutritious breakfasts, including options such as sandwiches and a variety of vegetables, yogurt, and fruit, all in accordance with the guidelines (R1). This interviewee also noted that this initiative could reduce stigma related to food insecurity in ECEC centres, leading to a significant improvement in the overall well-being and the assurance of a healthy breakfast for the children. Two interviewees (R1, R2), both working in Regional ECEC services, described families at their ECEC services struggling to provide healthy foods to their children. These two interviewees emphasised that government support in providing a healthy breakfast could significantly help these children and families (R1, R2). However, a clear challenge existed. This funding appeared to be primarily directed at Kindy attendees (aged 3–5years), unintentionally overlooking a significant portion of children under the age of 3 years attending LDCs who could equally benefit. One interviewee emphasised that it was challenging for LDCs to ensure a nutritious breakfast for their children (R2).

“I think with the government funded breakfast provision in kindy, it's taken away the stigma. There's a number of families that have food security issues and actually can't provide a healthy lunch box or enough food for their children to eat. So, if they know that the children are going to be provided with sandwiches and yogurt and fruit in the morning, then it doesn't matter so much if they don't have healthy options for breakfast at home. So that's been a positive thing for our families that are vulnerable that just don't have the money to feed their children adequately (R1)”

“We operate two ECEC centres within the same building: one for Kindy and the other for LDC. We successfully applied for government funding for breakfast provision at Kindy, but unfortunately, there was no opportunity to do the same for the LDC………While children in Kindy have nutritious and delicious government-funded breakfast provided, children in LDC were all looking at them and smelling the yummy breakfast, and kept asking us to be able to have that breakfast, instead of what they had, such as bread and milk. It is such a shame and a challenge for us to ensure a nutritious breakfast for children at LDC. Sometimes, we've seen also some families with financial struggles to provide a healthy breakfast at home to children, but here in LDC, we don't have any options to provide healthy breakfast options like Kindy (R2).”

Enabler 2: The use of nutritional guidelines

Interviews highlighted the significant role of nutrition guidelines in shaping the breakfast practices within ECEC settings. One interviewee emphasised the Nutrition Australia guidelines as a primary source of nutrition knowledge (M1). By utilising this knowledge, this interviewee aimed to provide well-balanced and nutritious meals to meet the children's dietary needs (M1). Additionally, one regional staff member shared that they had created their own tailored recipes based on these guidelines (R2).

“When I first started, it was Nutrition Australia……. I always go back to those sorts of guidelines because it contains your five groups, how many portions they need per day, and how many grams within those portions. So that's my big thing to go to. This is what they need for their day, and this is how we can provide it for them (M1).”

“It [nutrition guideline book] helped me a lot in creating healthy menus for the kids. I even made my own recipe book using it, which has been incredibly useful in my daily work! (R2)”

Barrier 1: Time constraints

The breakfast service showed similarity in start time, with breakfast potentially beginning from 7 am, although some children arrived a little earlier, leading to flexibility in the actual start time based on their arrival (M3). However, this flexibility was limited by the need to provide breakfast before the start of daily curriculum activities. The desired closing time for breakfast was approximately 8:15 am (R3). Nevertheless, there were instances when parents requested a slightly later breakfast service. In such cases, only toast was offered, and cereals were not available at that time (R3). This variability in breakfast service utilisation is intentionally designed to accommodate the diverse needs and schedules of the children and their families, ensuring that breakfast is available to as many children as possible. However, because of these time constraints, the selection of breakfast items becomes prioritised for convenience and ease of preparation.

“Breakfast can start from 7.00 am but sometimes some kids come a little early, so depending on the arrival (M3)”

“If children come after 8:15am, that's when breakfast ideally closes. But sometimes if parents come around 8:20am and request us, that's fine. However, at that time only toast is available. No cereals (R3)”

Regarding specific breakfast food items, a few interviewees indicated that the menu was designed to be easy and quickly prepared, with a focus on using readily available ingredients (R3, M4). Additionally, one interviewee emphasized that the aim was to provide convenient and practical options during the busy morning time at ECEC centres without compromising on the quality and nutritional value of the breakfast served (M4).

“We have cereals, toast, milk and spreads such as vegemite and margarine. That’s all about it. The reason why we have a simple breakfast option is because we need to make it easier. Also, children like toast (M4)”

Barrier 2: Budget limits

Budgets are crucial for ensuring that breakfast provision includes a diverse menu and maintains nutritional balance. Several interviewees underscored the considerable challenge posed by budget constraints when it comes to providing a healthy breakfast (R1, R2). One interviewee highlighted that adhering to a budget was particularly difficult for the large ECEC centre, as it had to prepare all the children's daily needs, including breakfast, morning tea (snack), lunch, afternoon tea (snack), and late snacks, with limited financial resources (R1).

Furthermore, services reported that these budget constraints for food provision directly influenced the availability of various food items, especially during breakfast, which is considered optional for children. One of the interviewees mentioned that fruits like watermelon and strawberries were not feasible options for the breakfast menus due to their expense (R2). As a result, the ECEC centre's ability to provide a diverse range of items that children typically enjoy was constrained.

“Finance. Because it's sticking to the budget. That's the really hard part. And you know, we're a very big center here ensuring that we meet all of their daily needs throughout the whole day, plus breakfast, plus, morning tea, lunch, afternoon tea, late snack, all the other meals that we provide. Budget is a big constraint that makes it harder sometimes to have everything we need. (R1)”

“Because when you look at watermelon, it's like some 30 Australian dollars a kilo. So obviously that's not even an option. Strawberries also aren't an option. So having more money would be a larger variety of fruits. And we'd be able to have a lot more cheese and stuff like that, that children love or even like sliced meats or something that you can have with it. But budget doesn't allow for that sort of expansive variety. (R2)”

Barrier 3: Inadequate staffing for individual child supervision

Regarding breakfast environment, educators sat with the children, sharing breakfast together, and engaging in conversations about food or their activities, fostering a sense of connection and trust before the busy morning. One interviewee emphasised that breakfast time provided the opportunity to promote individualised attention and support, creating a welcoming and communal atmosphere (M1).

“I think sitting with them and enjoying their breakfast, you know, just it's like a meeting place. So, they come, and they discuss food or what they did last night. So, it's a communal type thing (M1).”

The morning routine at the centre typically involves gathering approximately 20–22 children together in one room between 8 am and 8:30 am, irrespective of age. After breakfast children are separated into their respective classrooms by age (M3, R3).

“We often do all the breakfast in one room. About eight o'clock we have about 22 kids in one room for breakfast. At that time, we have to separate them (M3).”

“On average, we have 20 to 22 children eating breakfast together regardless of the age of children and classroom of them (R3).”

Staff highlighted a need for additional staff to help with management until children finished breakfast and returned to their respective rooms. One interviewee mentioned taking the initiative to cut the toast into smaller pieces, making it easier for the children to handle, while others attend to the children during breakfast (M4). Furthermore, it was emphasized by another interviewee that only full-time educators or breakfast experienced staff were allowed to serve the foods and supervise the children during breakfast time due to concerns about allergies and the need to have full awareness of each child's details (R4).

“In the morning when the staff comes to the centre, they ensure that the breakfast trolley is ready. That trolley should also have enough plates, enough bowls, enough spoons, tongs to serve. And chopping board should be ready for the toast. Educators cut the toast into pieces for them, just to make it easier for them to have a shorter piece. So, we cut one bread into six pieces. To effectively manage all the tasks associated with the morning routine, there is a need for additional staff who are well-versed in the specific responsibilities during this time (M4).”

Barrier 4: A lack of confidence in interpretation and application of nutrition guidelines

One interviewee expressed uncertainty about whether Vegemite is healthy and the appropriate serving amount for children based on the guidelines when children continuously request it (R1). Another interviewee mentioned challenges arising from a lack of interpretation of the nutritional guidelines when children brought unhealthy breakfast items like packaged hash browns or chips (R2). While the interviewees wanted to teach children about healthier breakfast options, their confidence of interpretation or practical application of nutritional guidelines seemed limited.

“I’m not confident about how much to provide when children continue to request Vegemite and I’m not sure if I’m following the guidelines (R1).”