The amount of time children spend in child care each week has increased in recent years. The aim of this cross-sectional study was to describe the nutritional quality of foods served and the mealtime environment in 24 child care centers in Georgia. Methods: Data were collected between April 2010 and September 2010. Each child care center provided a sample 5-day menu (breakfast, lunch, and an afternoon snack) at baseline. Energy and nutrient contents of the menus were analyzed using NutriKids Menu Planning & Nutritional Analysis software (LunchByte Systems, Inc., Rochester, NY). Foods and beverages on the menus were compared to MyPlate food group standards for preschoolers. The child care environment was assessed in each center over 1 full day using the Environment and Policy Assessment and Observation instrument. Results: Menus met one half to two thirds of the recommended levels for energy, carbohydrate, protein, and vitamins A and C. However, the menus were high in saturated fat and sodium content and did not meet the recommendations for iron or fiber. The majority of the centers did not meet the recommendations for MyPlate food group standards for preschoolers. On the day of the observation, seven centers did not serve a vegetable and more than half of the centers (n=13) did not serve any whole grains. Nineteen centers served high-sugar and/or high-fat foods and 11 did not have visible water indoors. Conclusions: This study identified determinants of the child care environment and nutritional characteristics of the combined meals and snacks offered to children. Findings from this study could inform child care centers how to provide healthier nutrition environments to preschool children. (author abstract)