Obesity rates among preschool-aged children have doubled in the past 10 years, and 60 % of these children spend the majority of their day in childcare facilities. Few studies have examined the quality of nutrition and physical activity practices in childcare centers as compared to family childcare homes. The purpose of this study is to determine if a pattern of differences exist in these two settings. As part of a CDC-funded study to reduce the obesity epidemic in young children, directors of 1,140 childcare facilities (842 out-of-home and 298 in-home) in one large county completed a survey that detailed their practices related to child nutrition and physical activity. Results showed that compared with out-of-home facilities, in-home facilities were more likely to report excellent indoor physical activity (87.2 vs. 85.5 %, p = 0.059), less likely to report excellent outdoor physical activity (92.8 vs. 96.5 %, p = 0.018), more likely to serve fruit (80.3 vs. 51.2 %), and less likely to serve 1 % milk (45.2 vs. 55 %). This study's present findings revealed that ample opportunity exists to significantly improve the health of young children in both in-home and out-of-home facilities.