INTRODUCTION: Directors of Head Start (HS) and non-Head Start (non-HS) child care centers were surveyed to compare health consultation and screening for and prevalence of health risks among enrolled children. METHODS: Directors of licensed centers from five states were surveyed from 2004 to 2005. Data were analyzed using cross-tabulation and logistic regression techniques. RESULTS: A total of 2753 surveys were completed. HS centers were more likely than non-HS centers to consult health professionals (P < .0001). More than 90% of HS centers screened for health problems compared with 64.9% of non-HS centers (P < .0001). Almost all HS centers provided parents with child health information. Children at HS centers were at high risk for dental problems. Less than 3% of HS center directors, versus 11.3% of non-HS directors (P < .0002), reported TV viewing for more than an hour a day. DISCUSSION: Children in HS centers were more likely to receive health consultations and screenings, were at higher risk for dental problems, and watched less TV compared with children in non-HS centers. HS centers promoted health significantly more frequently than did non-HS centers.