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This study explores sustainable healthy diet adherence among 958 Chilean pre-schoolers (3–6 years) using the Planetary Health Diet Index for children (PHDI-C). Results show low adherence (median score: 50/150), driven by insufficient consumption of nuts, legumes, vegetables, and whole grains, alongside excessive intake of dairy, red meat, and added sugars. Maternal age and education were significant factors influencing adherence, with older, more educated mothers positively impacting scores. The findings underscore the need for targeted interventions to promote healthy eating patterns early in life.