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(1) Background: Pediatric obesity continues to be a major public health issue. Poor food selection in the school cafeteria is a risk factor. Chocolate or strawberry flavored milk is favored by the majority of elementary school students. Previous health promotion efforts have led to increased selection of plain milk, but may compromise total milk purchased. In our study, we examined the effectiveness of small prizes as incentives to improve healthy food and beverage selection by elementary school students; (2) Methods: In a small Midwestern school district, small prizes were given to elementary school students who selected a “Power Plate” (PP), the healthful combination of a plain milk, a fruit, a vegetable and an entrée with whole grain over two academic school years; (3) Results: PP selection increased from 0.05 per student to 0.19, a 271% increase (p < 0.001). All healthful foods had increased selection with plain milk having the greatest increase, 0.098 per student to 0.255, a 159% increase (p < 0.001); (4) Total milk purchased increased modestly from 0.916 to 0.956 per student (p = 0.000331). Conclusion: Giving small prizes as a reward for healthful food selection substantially improves healthful food selection and the effect is sustainable over two academic years

Small Prizes Increased Plain Milk and Vegetable Selection by Elementary School Children without Adversely Affecting Total Milk Purchase