The main finding of this study was children attending school virtually consumed more water than those attending school in-person. Furthermore, there were positive relationships between parent and child water and SSB intake. Previous studies have shown children may drink less water during school due to classroom policies, lack of hydration education, and poorly maintained restroom facilities (9–11). We took advantage of the pandemic where many children attended virtual school at home and found that these children consume more water compared to those attending school in-person.
Children may have consumed more water attending school virtually as compared to in-person due to perceptions of school water sources. In one study, 30% (n = 3211) of middle school children indicated they were unlikely to consume water at school, 59% indicated the fountains were unclean, 48% cited poor taste, and 24% that the fountains were contaminated (13). Since school water intake data in the current study was collected during the COVID-19 pandemic, perceptions of drinking fountain sanitation were likely worsened. Furthermore, early in the pandemic it was recommended by the Centers for Disease Control and Prevention (CDC) to restrict public water fountain access (14). This may have contributed to reduced water consumption at school in the current study.
Parental influence may have also played a role in the discrepancy between water intake during virtual school as compared to in-person. Higher parental water and SSB intake was associated with higher child water and SSB intake. These data suggest the hydration habits of parents influenced the habits of their children. It has been suggested dietary profiles of children are influenced by parents (15–17) and that children’s dietary profiles away from home are unfavorable as compared to at home (18, 19). Although these associations have been shown particular to diet, data supporting parental and environmental influence on water intake are scarce (6). A report by the National Hydration Council compared hydration habits of 1,000 parents and their children indicated a 38% increase in frequency of water intake in households whose parents drank water often. Furthermore, cross-sectional data from 1187 children and their children indicate stricter parental attitudes towards SSB intake were associated with higher child water intake (20). In the current study, parental attitudes may have affected child water and SSB intake while attending school virtually. Since many schools shifted to virtual instruction, parental influence may be more relevant due to increased time around children.
Aside from family income, there were no differences in child water intake based on other demographic factors. Previous studies have shown water intake to be lower in non-Hispanic black males, which contradicts the current findings (21). This could reflect the limited diversity of people enrolled in the current study. Lower family income was associated with higher child water intake, which contrasts previous data indicating a positive association (3) or no association (22). This could reflect that only 17% of people enrolled were classified as low income.
This study has some strengths specifically the inclusion of a comparison group and congruent demographics between children attending school virtually and those attending school in-person. However, limitations include use of self-reported data from children and not recording water content of food. Parents were explicitly asked to assist their child when completing the questionnaire, but these data may be subject to reporting errors. Lastly, the questionnaire did not account for water content of food, which could affect the variability of total water intake. However, the main purpose of this study was to examine water intake from fluids specifically.
To conclude, drinking habits of children may be affected by in-person school setting. Specifically, the current study showed that water intake was higher in children attending virtual school compared to in-person school. These data support previous studies indicating school setting and policies may discourage children from drinking adequate water while attending school.