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Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks "every day", "most days (four to six days per week)", "some days (one to three days per week)", or "never or less than once a week". We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance. ; These activities were partially funded through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of Noncommunicable Diseases. The authors gratefully acknowledge support from the Danish Ministry of Health, the Italian Ministry of Health and Italian National Institute of Health, the National Institute for Health Development in Estonia, the Health Service Executive in the Republic of Ireland, the Ministry of Health in Bulgaria, the Poland National Health Program (grant no. 6/1/3.1.12/NPZ/2016/106/1401, the Czech Republic (grants AZV MZCR 17-31670 A and MZ ˇ CR—RVO E ˇ Ú 00023761), and the Ministry of Health in Latvia. The Spanish study was funded by the Spanish Agency for Food Safety and Nutrition (AESAN). COSI Austria was supported by a grant from the Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Republic of Austria. COSI Turkey gratefully acknowledges the World Bank for the survey credit. COSI Lithuania gratefully acknowledges the WHO representative in Lithuania, Ingrida Zurlyte, for printing the COSI questionnaires. The study in Kazakhstan was funded by the Ministry of Health of the Republic of Kazakhstan within the scientific and technical program. ; info:eu-repo/semantics/publishedVersion