Objectives: To describe time trends in the availability of healthier children's menu items in the top selling quick service restaurant (QSR) chains.
Methods: We used Technomic Inc.'s MenuMonitor to construct a data set of side and beverage items available on children's menus from 2004 to 2015 at 20 QSR chains in the United States. We evaluated the significance of time trends in the average availability of healthier fruit and nonfried vegetable sides and nonsugary beverages offered as options and by default in children's meal bundles.
Results: Healthier sides and beverages offered as options increased by 57.5 and 25.0 percentage points, respectively, from 2004 to 2015 but leveled off starting in 2013. Healthier items bundled by default also increased during this time frame, with most adoption occurring after 2010. However, these items remain relatively uncommon, with less than 20% of meal bundles including healthier items by default. All tests evaluating time trends in the availability of healthier items in meal bundles were significant at P < .001.
Conclusions: The QSRs evaluated made improvements in the quality of sides and beverages offered on children's menus from 2004 to 2015. Additional efforts are needed to increase the percentage of healthier options offered by default.