The Child and Adult Care Food Program is the primary national program that enables child-care settings to provide healthy meals for children. Associations between Child and Adult Care Food Program participation and child health and development and health care utilization are understudied.

To assess associations between children’s health, development, health care utilization and food security by meal source (child-care–provided vs parent-provided) among children from low-income families with a child care subsidy attending child-care in settings likely eligible to participate in Child and Adult Care Food Programs.

The study used repeat cross-sectional surveys (new sample at successive time points) conducted year-round.

Primary caregivers of 3,084 young children accessing emergency departments or primary care in Baltimore, MD; Boston, MA; Little Rock, AR; Minneapolis, MN; and Philadelphia, PA, were interviewed between 2010 and 2020. The sample was limited to children aged 13 to 48 months, receiving a child care subsidy and attending child-care centers or family child-care homes ≥20 hours per week.

Outcomes included household and child food security; child health, growth, and developmental risk; and admission to the hospital on the day of the emergency department visit.

Meal source and participant characteristics were analyzed using χ² tests; associations of outcomes with parent-provided meals were analyzed with adjusted logistic regression.

The majority of children had child-care–provided meals (87.2% child-care–provided vs 12.8% parent-provided). Compared with children with parent-provided meals, children with child-care–provided meals had lower adjusted odds of living in a food-insecure household (adjusted odds ratio 0.70, 95% CI 0.55 to 0.88), being in fair or poor health (adjusted odds ratio 0.61, 95% CI 0.46 to 0.81), or hospital admission from the emergency department (adjusted odds ratio 0.59, 95% CI 0.41 to 0.83), with no differences in growth or developmental risk.

Compared with meals provided from home, child-care–provided meals likely supported by the Child and Adult Care Food Program are related to food security, early childhood health, and reduced hospital admissions from an emergency department among low-income families with young children.