S TA R T
B O D Y
S TA R T
What Do the
Experts Say?
Interviews with Experts in Nutrition
and Physical Activity
by Head Start Body Start
a project of the American Alliance for Health, Physical Education, Recreation and Dance2
T
o enhance understanding of how to improve services to Head Start children, we conducted inter-views with 17 experts in the area of early childhood education and childcare with an emphasis on nutrition and physical activity. This document summarizes those interviews.Much progress has been made in improving the environments for young children outside of the home – whether in Head Start programs or other early childhood education or childcare settings. However, it is clear from our conversations with these experts and with advocates around the country that many chal-lenges and barriers still exist. Some of these chalchal-lenges and barriers are tied to federal and state regula-tions, guidance and licensing requirements; others relate more specifically to staff training, expectaregula-tions, and cultural beliefs and practices.
Many of the findings from these interviews are consistent with and support the findings from a 2008 national survey of Head Start programs across the country. In that survey, conducted as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start (SHAPES), program directors were asked about barriers to obesity prevention related to healthy eating and physical activity. Direc-tors were asked to provide information about barriers at three levels: among programs, among staff and among parents. Findings from the survey -- in which 1,583 programs (87%) responded -- are described and highlighted in a number of articles authored by Whitaker and colleagues; these articles provide an excellent overview of barriers and challenges as identified by the majority of Head Start program di-rectors, as well as possible policy and programmatic solutions to promote healthier environments and practices in Head Start – many of which are applicable to other early childhood education and childcare environments. 1,2,3
The 17 experts were asked to describe what they viewed as challenges and solutions related to nutrition and physical activity in the early childhood education and childcare environments. Specifically, experts were asked about:
• The challenges and problems related to nutrition and physical activity, and possible solutions;
• The challenges to professional development/staff training and engagement related to nutrition and physical activity, and possible solutions;
• The challenges to parent engagement and involvement related to nutrition and physical activity, and possible solutions;
• The ways early childhood educators, childcare providers, sponsors, licensing agencies, federal agencies, and parents can be effective advocates for promoting nutrition and physical activity; and
• Best practices of Head Start and other early childhood education and childcare programs that can serve as examples.
The following provides a summary of key findings from the interviews.
HSBS POLICY SERIES
What Do the Experts Say?
Interviews with Experts in Nutrition and Physical Activity
Challenges and Barriers
to Serving Healthy Foods
Interviewees were consistent in identifying a number of factors that impact the types of foods and beverages available in Head Start or other early childhood education and childcare settings. Time, financial resources, and knowledge rose to the top as the primary factors, and not surprisingly, these factors also were mentioned in relation to the factors impacting physical activity.
Time: Time constraints impact a number of areas and prevent the preparation
and delivery of healthy foods. Time constraints also limit staff training oppor-tunities regarding preparing healthy meals and snacks and regarding healthy dietary practices for young children.
Financial Resources: While interviewees felt that Head Start and other
provid-ers were interested and willing to provide a greater variety of healthy options – including more fruits and vegetables and whole grain products – limited re-sources prevent the inclusion of these foods in menus. Specifically, the current reimbursement rate for meals and snacks for programs that participate in the Child and Adult Care Feeding Program (CACFP) or the National School Lunch Program (NSLP) is viewed as too low to cover the current cost to prepare meals and snacks, much less to promote healthier options like fruits, vegetables and whole grains.
Knowledge and Attitude: There is a broad range of cultural perspectives
among Head Start and other providers when it comes to feeding young children, and there also are limi-tations in the knowledge base of what constitutes a healthy diet and eating behaviors. In addition, in the Head Start environment in particular (where there is greater emphasis on parent involvement and where many parents become Head Start providers), the cultural perspectives and beliefs that parents bring to the Head Start program related to food and feeding may not be consistent with public health recommen-dations or best practices. Given that Head Start and other providers and staff should serve as role models – modeling appropriate and health-promoting behaviors – cultural perspectives and beliefs of eating behaviors and practices are viewed as a significant barrier to integration of modeling healthy choices. Interviewees recognized the family meal service as a benefit in Head Start (and perhaps something to be replicated in other programs) but also recognized that role modeling healthy eating practices among staff was critical to the success of family meal service -- and that without appropriate modeling and encour-agement of positive eating behaviors by staff, benefits of family meal service may not be fully recognized. Other areas identified as challenges include:
• Screen time – which also was identified as a barrier to promoting physical activity – can result in excess calorie intake related to snacking.
• USDA meal pattern requirements for the Child and Adult Care Feeding Program (CACFP) do not currently promote whole grains, low-fat and fat-free milk and non-juice fruit and vegetables. In addition, the inconsis-tent application of CACFP standards results in broad variability in the types of foods and beverages served in Head Start and other settings.
• The availability of flavored milk and other beverages high in sugar in the early childhood education setting was viewed as a problem that provides excess calories and encourages young children to expect and desire sweet foods and beverages.
• Meeting the unique nutritional needs of a diverse population was cited as a challenge in promot-ing healthy options. As the population becomes more diverse, there is a need to provide a greater variety of foods and beverages – often requiring increased funding and staff training.
• While not permitted in Head Start, other programs may permit foods brought from home as part of lunch for programs. Outside food for celebrations, parties and other events was viewed as a problem in terms of excess calorie intake as well as poor modeling and negative influences on eating habits.
• Mothers need more opportunities to breastfeed, and staff and parents need more training on the introduction of solid foods. Both were viewed as challenges that influence healthy eating behav-iors.
• Providers, staff and families all need to have a basic agreement – ideally based on public health recommendations and best practices – on how to feed and educate children about nutrition. In-consistent practices within a program and between the program and the home may be confusing.
• There is currently no funded mandate for early childhood wellness policies; the policies that have been developed to date often are not based on age-appropriate public health recommendations or recognized best practices.
Solutions to Serving Healthy Foods
Not surprisingly, solutions to promoting healthy food and beverage options, as well as to ensuring that staff have the knowledge and skills to promote healthy eating practices among young children, are related to the three primary barriers identified above.
While interviewees felt that more time should be devoted to staff training and skill develop-ment to promote healthy dietary practices and behaviors, there also was recognition that time is related to both knowledge and financial resources. For example, while a program may be able to provide staff training on healthy eating practices among young children, there may not be resources available to purchase healthier food options that are recommended as part of the training. Or, it may be difficult to adjust schedules and hire substitute teachers to allow for the training. As discussed above, the cultural perspectives and ingrained behaviors among Head Start and other providers, a lack of understanding of what constitutes a healthy diet and healthy behaviors, and poor role-modeling of healthy behaviors must be addressed in order to promote healthy eating practices. Such areas are best addressed through staff training that encompasses basic nutrition knowledge as well as effective strategies to address cultural perspectives and differences. Staff involvement and education were mentioned by a number of interviewees as key components to successfully promoting healthy dietary practices among young children.
Providing incentives and enhanced accountability were raised by several as potential quality indicators that could be used to promote better nutrition. Suggestions included financial incentives such as a higher reimbursement rate for programs that exceed the current CACFP standards, and certification based on meeting additional criteria.
Policies that limit both screen time and food brought from home were cited as critical to pro-moting healthy food choices. In addition, stronger meal pattern requirements as well as better training and technical assistance for staff that work in the food service area are necessary com-ponents of all Head Start and other related settings. For example, Delaware, New York and Florida were able to strengthen the CACFP meal pattern requirements to promote healthier options for programs that were regulated by the state.
Challenges and Barriers to Physical Activity
Interviewees identified a number of challenges and barriers related to physical activity, some of which mirror those identified in the nutrition area described above.
Financial Resources: Lack of funding for equipment as well as for the promotion of nature-based
envi-ronments was identified as a hurdle to promoting age-appropriate physical activity. This lack extends to classroom-based physical activity resources such as books, games, CDs, and food models, where there are not enough of the materials to adequately meet the needs of providers.
Space: Lack of appropriate space, inside and outdoors, was viewed as a barrier to getting children to be
more physically active.
Nature-Based Play: There is a lack of understanding and incorporation of
na-ture-based play into environments (including urban); this extends to a general lack of linking physical activity and nutrition via the use of gardens (food-, butterfly-, bird-based) as well as a lack of understanding of the importance for and esthetics of nature-based elements.
Unstructured Play: A number of interviewees discussed the challenges
sur-rounding unstructured play time. While this time provides a unique opportu-nity for Head Start and other providers to observe children and ideally guide them in efforts that keep them moving, it is often used instead as a time for providers to “take a break” and connect with each other to talk and social-ize. Interviewees also recognized the stress that providers are under, and the enormous demands placed on them and their time, but felt nevertheless that unstructured play time should be viewed as an opportunity to encourage chil-dren to be more physically active. In addition, interviewees identified the need for providers to support unstructured play in safe, natural settings that help young children better connect to nature and establish an appreciation for such natural settings.
Perceptions of Physical Activity: Interviewees felt that while providers and
staff generally recognize the importance of encouraging physical activity among young children, there is a lack of understanding of how to actually encourage active play, and a lack of understanding of what physical activity really means (i.e. balance, hand-eye coordination, gross motor skill devel-opment, caloric balance). Perceptions of what constitutes physical activity, especially for young children, vary greatly. There is a need to understand more fully the “movement vo-cabulary” among providers and staff. How do they view physical activity and movement? How do they define what it means for young children to be physically active? More needs to be known both in terms of how providers view and perceive physical activity, as well as how physical activity standards can further be incorporated into the Head Start and related settings. While Head Start performance standards address age appropriateness, community awareness of this need is not always supported, as evidenced by programs simply replicating policies that exist at the school-age level.
Priority: There is a general lack of priority placed by policy makers, program administrators and
provid-ers on the importance of physical activity. This lack of focus on the importance of activity results in a general lack of emphasis, reinforcement, and ongoing support of it in Head Start and related settings.
Physical Activity Curricula: Interviewees felt strongly that: Physical education programs and curricula
used in elementary schools are not age-appropriate for Head Start and other programs; and the early childhood education settings require physical education curriculum and programs that target young children, and that are appropriate given the limited training that staff receive regarding physical activity. In addition, qualified professionals who understand the needs, limitations and abilities of young children often are lacking in the development and delivery of quality physical activity opportunities.
Role Modeling: While related to perceptions of physical activity described above, interviewees viewed
the lack of staff to engage in activities with children as a major barrier. It was also recognized that this could be related to a lack of understanding of what it means for young children to be physically active. In addition, staff do not always dress appropriately for and often are unable to engage and be physically active with children.
Measures of Success: Dearth of information on measures of success for physical activity in Head Start
and related settings was viewed as a barrier. This is directly related to a lack of a well-recognized defini-tion of active play and physical activity for young children, including a lack of evidence related to how much time a young child should be physically active.
Solutions to Physical Activity
In order for Head Start and other programs to be able to promote more physical activity as part of their daily operations, a number of factors should be considered.
• There needs to be a better understanding of “facilitated active play” in order for providers and staff to utilize limited time, whether it is in the classroom or as part of unstructured play time, to encourage children to be physically active.
• Any standards that are put in place regarding physical activity in Head Start and other programs must be evidence-based and include measures of success to enable better accountability and measurement of physi-cal activity practices; one example would be standards or guidelines related to dedicated amount of time for and type of physical activity for young children in Head Start and other settings.
• Programs should ensure that there is adequate space, both indoors and out, with appropriate surfaces, equip-ment, and storage facilities, to allow for optimal physical activity.
• Unstructured play provides a critical opportunity to promote physical activity and should be viewed by pro-viders and staff as an important component of the day – not as a time to disengage from children and social-ize with other adults.
• Nature-based play should be promoted to link children more closely with nature to help in their long-term enjoyment of the outdoors.
• Staff training in a number of areas related to promoting physical activity is key. Areas for training include unstructured play; nature-based play; incorporating movement into the educational setting; understanding gross motor movement; and staff role modeling.
• Appropriate dress, both for providers as well as for children, to encourage physical activity in a variety of envi-ronments and weather conditions will help to foster both more engagement from staff and more opportuni-ties for children to be active.
• Incentives and accountability, similar to those described for nutrition, may be applied to the physical activity component as well; examples include recognizing and highlighting programs that are effective at promoting physical activity throughout the day in a variety of venues.
Professional Development and Staff Training
Professional development and staff training were identified by many interviewees as critical areas that could be enhanced and improved, but there was also recognition that significant barriers – specifically re-sources and time – often prevent improvement in these areas. As indicated above, staff training is needed to improve both nutrition and physical activity in Head Start and other programs, but the biggest barrier to engaging staff through training and professional development is providing the time for staff to attend. This relates directly to resources; taking staff away to provide training and professional development re-quires additional staff resources to ensure children are being cared for. In addition, effective training and professional development require resources to ensure that the training is up-to-date and engaging. Interviewees also highlighted the need for such training to be appropriate for the education and skill level of the staff receiving the training. Training should be hands-on, with easy-to-grasp concepts, practical tips, turn-key initiatives, cultural appropriateness, and -- in the case of Head Start in particular -- must be connected to the Head Start philosophy of school readiness with an emphasis on multi-level interven-tions.
As noted above, staff often lack understanding of the important role they play in setting the example for health-promoting behaviors. When staff consume unhealthy beverages and foods in the presence of chil-dren, purchase high sugar or calorie products from vending machines or bring them in from the outside, they often are not aware of what they are presenting to parents and children. Low morale and the lack of motivation to attend trainings that impact their professional development and personal health were also cited as difficult challenges to overcome. Reasons for lack of interest in attending trainings include feeling uncomfortable when personal habits are poor, as well as feelings of being overworked and under-paid.
Use of peer-facilitated programs and trainings were mentioned as a potential model for consideration outside of traditional in-service. This “Diffusion of Innovations” approach involves the identification of staff innovators who are selected to serve as peer trainers to reach out to other staff and community members to train and mentor. This could result in more ownership of concepts and practices. However, it was also pointed out that given the rate of staff turnover, a variety of training approaches are necessary. Others pointed to the use of tools such as the Nutrition and Physical Activity Self-Assessment for Child
Care (NAP SACC) as being useful in the identification of targeted staff trainings.
Examples of training and professional development for nutrition and healthy eating may include: hands-on training in preparing healthy and easy meals and snacks that engage children in growing, purchasing, and preparing meals on a limited budget; providing kid-tested and tasty recipes and menus; instruction on the importance of not using food as a reward; coaching on culturally sensitive approaches to talking with parents about nutrition and eating habits; instruc-tion in effective approaches to encourage healthy eating during family meal service, including how to encourage children to make healthy selections and portion sizes; and role modeling.
Examples of training and professional development for physical activity may include: instruction on getting the most out of unstructured play; how to
engage otherwise sedentary children in active play; ways to encourage physical activity throughout the day (not just in specific physical activity or unstructured play time); identification of easy-to-use, rea-sonably priced and age-appropriate play equipment and nature-based items; putting physical activity and nutrition into a nature-based framework to help make connections; appropriate dress for different climates; and simple ways for staff to be engaged and to actively play with children.
Parent Engagement
Given the emphasis in Head Start on parent and community engagement, interviewees who worked and were familiar with Head Start programs identified parent engagement as an important component. Parents are more engaged and connected when they spend time at the Head Start location and have the opportunity to receive information and training in a variety of topics -- and often remain engaged even after their children move on to elementary school. All interviewees recognized parents as critical players that could help or hinder nutrition and physical activity habits of young children.
Interviewees recognized that it is not always easy to reach and engage with parents, citing a number of barriers they have encountered in efforts to promote healthy eating and physical activity. A main barrier recognized by a number of interviewees was time; time is limited and unless there are simple and quick messages, tools, and resources provided in a way that is engaging and culturally appropriate, it is diffi-cult to reach parents. Language barriers and literacy levels were also cited as challenges that limit parent engagement. As discussed above, cultural preferences and parental habits also make it difficult to get “buy-in”. For example, parents may feel that rewarding children with food is an important and positive way to recognize good behavior or performance, and may feel that taking such “treats” away and replac-ing with non-food options is mean-spirited and inappropriate.
Examples provided of ways to enhance parent engagement, participation, and interest, and to recognize cultural preferences and habits include:
• Improve interagency efforts to develop and disseminate best practices and strategies (e.g., USDA, Maternal and Child Health Bureau, Centers for Disease Control and Prevention, Department of Education, state depart-ments of health, national associations and guidelines including Caring for Our Children, American Academy of Pediatrics, and the American Public Health Association).
• Encourage programs and trainings that include babysitting options or activities for other children (like siblings) to allow parents greater flexibility in attending trainings.
• Provide hands-on activities; if food is provided, ensure it is healthy.
• Connect parents to other community-based services such as Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Supplemental Nutrition Assistance Program, and Expanded Food and Nutrition Education Programs.
• Use consistent visuals (e.g. posters, pamphlets) and other similar items in the program and throughout the community, to the extent possible; brand and redefine concepts of quality childcare to include physical activ-ity and nutrition.
• Engage parents as peer trainers/leaders.
Efforts to Promote Nutrition and Physical Activity through
Policy, Programs, and Guidance
When asked about opportunities at various levels – federal, state, regional, and local – to promote nutri-tion and physical activity, interviewees provided feedback in a number of areas.
Resources: Adequate funding to enhance and improve efforts to promote healthy food and beverage
options, physical activity and staff training are essential. Some examples of funding needs include hiring state or regional coordinators to implement and monitor efforts at the local program/center level, im-proving the quality of meals and snacks served, purchasing equipment and other physical activity tools and resources (including nature-based items), and providing training and professional development – including hiring substitute teachers.
Partnerships: Community partnerships are an important component in Head Start programs, and are
generally supported in other early childhood education and childcare programs. There may be other op-portunities to partner with organizations and entities to bring more expertise and resources to the table to promote nutrition and physical activity policies, programs and practices. In addition, for some programs that have established effective partnerships, it may be time to expand those partnerships. For example, WIC as well as CACFP partner with Head Start to promote healthy eating. There may be opportunities to work with local farmers in the area to bring farmers’ markets to locations near or on the premises of a Head Start or other setting. Joint-use agreements where schools and other community centers allow other entities to use their play spaces and equipment also can be pursued.
Another opportunity for partnerships includes the Centers for Disease Control and Prevention child obesity prevention efforts that are taking place at the state and local level, as well as the state and commu-nity agencies and programs that were or will be funded through the Communities Putting Prevention to Work initiative.
Sustainability: In order for nutrition and physical activity programs and initiatives to be effective and
sustainable, there needs to be total engagement and buy-in among staff and parents. In the case of Head Start in particular, staff uptake (the ability of staff to “absorb” the program or initiative and continue to
promote and incorporate it) will depend on the philosophical approach that is used. There must be a direct connection to the overarching goals of Head Start in terms of school readiness that integrates children’s cognitive, social, and emotional development with their physical health. Unless these factors are con-sidered and imbedded in nutrition and physical activity efforts, sustainability will be a problem.
Incorporation into Existing Components: Interviewees identified
unstruc-tured play time and family meal service as two areas that should be better utilized to promote healthy eating and activity behaviors. As described above, the amount and type of physical activity that children get during unstructured play can vary greatly, and is dependent on provider engagement and role mod-eling. Similarly, the types of food and quantities consumed during family meal service also are related to staff encouragement and actions during that time. More emphasis should be placed on these opportunities to promote physical activity and healthy eating, given that these opportunities exist in practically all Head Start programs and many other early childhood education settings.
Federal, State, and Other Standards and Licensing: Head Start programs are
required to abide by regulations outlined in federal Program Performance Stan-dards, which include some nutrition and physical activity components. Early childhood education and childcare centers and home-based childcare programs often are required to abide by state licensing standards and regulations, with nutrition and physical activity components varying widely from state to state.
emphasis on nutrition and physical activity in the early childhood education settings, interviewees stressed the importance of regularly reviewing and updating standards and regulations to reflect the latest research, evidence, and best practices relating to promoting nutrition, healthy eating, and physical activity.
The Model State Regulations for Child Care, published in 2009 after being developed by nutrition, physi-cal activity, early care and education, and policy and regulatory experts, were referred to by a number of interviewees, and can serve as examples of best practices for Head Start and other early childhood educa-tion settings. (Model regulaeduca-tions are provided in the Best Practices seceduca-tion below.) In addieduca-tion, physical activity and nutrition regulations enacted in New York City as part of its health code are more stringent than those for New York State, highlighting the importance of local jurisdictions in promoting healthy environments in childcare settings.
The model regulations described above and included under Best Practices are based, in part, on recom-mendations developed by the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) research team from the University of North Carolina at Chapel Hill. The regulations also are based on draft standards put forth by the Nutrition Technical Panel convened by The National Resource Center for Health and Safety in Child Care and Early Education (NRC), in partnership with the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) for the third edition of Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Out-of Home Child Care Programs (CFOC).
The CFOC performance standards are in the process of being updated and willinclude enhanced stan-dards related to nutrition and physical activity and other areas that address healthy eating, play spaces, injury prevention, staff training, and professional development. These standards often are incorporated into state licensing standards and regulations, and provide an opportunity to promote consistency among states with evidence and practice-based standards and recommendations.
Consistent Messages: Given the increased attention at all levels to childhood obesity prevention – from
the First Lady’s Let’s Move! campaign to state and local efforts to promote healthy foods and beverages and physical activity settings where children live, learn and play – it is critical that messages regarding healthy eating and physical activity are consistent across programs and initiatives.
Accountability: In addition to strengthening standards and regulations at the federal and state level,
there also should be a complimentary accountability component to ensure that standards are being imple-mented at the appropriate levels. For example, the documentation of specific physical activity-related elements in a federal or state accountability/evaluation/review system would provide greater assur-ance that policies actually are being implemented. Accountability provisions also can be used by parents to determine the emphasis placed on physical activity and nutrition when evaluating options for early childhood education programs.
Child Focused: Policy makers and other leaders at the federal, state, local, and regional levels, as well as
others involved in Head Start and other early childhood education and childcare settings, should ensure that recommendations, guidance, training, and other initiatives are developed and disseminated with a clear focus on young children, with the ultimate goal being to create environments that promote healthy, happy, and productive children.
Best Practices
Interviewees provided a number of examples and resources regarding best practices. These are summa-rized below.
Food Research and Action Center’s The Child Care Wellness Tool Kit: Child and Adult Care Food Program (CACFP): This toolkit was designed for advocates, state childcare subsidies, CACFP and
licens-ing agencies, state and local health promotion and obesity prevention initiatives, childcare providers, policy makers, and other stakeholders. The toolkit focuses on innovative and effective CACFP best prac-tices and strategies for implementing good nutrition and physical activity policies and standards at the state and local level. The first phase of the toolkit includes:
• Model wellness policies that reflect important best practices, including:
»Nutrition standards for assuring only healthy meals and snacks fully consistent with current nutritional science and the
U.S. Dietary Guidelines are served.
»A recommended minimum amount of daily physical activity, recommended types of activities, and limitations on the
amount of screen time.
»Plans for nutrition and physical activity education for children, teachers, and parents.
• Best practice models that provide the steps to success for developing and implementing effective new nutri-tion and wellness policies on the state or local level (e.g., recommendanutri-tions for stakeholders to include in the process and for factors to consider before creating the wellness policy).
• Tools for assessing the current nutrition and physical activity environment in childcare settings, including a sample self-assessment tool and a comprehensive evaluation tool.
• Nutrition and physical activity resources for childcare providers, including materials to share with parents such as newsletters and fact sheets.
To access the toolkit, go to http://www.frac.org/html/federal_food_programs/programs/cacfp.html.
Preventing Obesity in the Childcare Setting: Evaluating State Regulations:In a study released in 2009, Benjamin and colleagues reviewed state policies for childcare facilities, and ranked states based on their average score of healthy eating and physical activity policies for childcare and family childcare homes. Findings from this examination may be useful as federal, state and local policy makers, sponsors, and program directors look to develop regulations, standards, guidelines, and policies for Head Start and other early childhood education and childcare settings. To learn more about the examination and to view state rankings, go to http://cfm.mc.duke.edu/childcare.
As part of this examination, nutrition, physical activity, early care and education, and policy and regula-tory experts considered a number of standards and recommendations related to the prevention of obesity among young children and compiled a list of the top 10 healthy eating and top 10 physical activity model policies for states.
MODEL STATE CHILDCARE POLICIES
Healthy Eating Physical Activity
• High fat*, high sugar, and high salt foods are served less than one time per week or are not served.
• Sugar-sweetened beverages are not served .
• Children older than two years are served reduced fat milk (skim or 1%).
• Clean, sanitary drinking water is available for chil-dren to serve themselves throughout the day.
• Nutrition education is offered to childcare providers at least one time per year.
• Juice is limited to a total of four to six ounces or less per day for children over one year of age.
• Childcare providers do not use food as a reward or punishment.
• Nutrition education is offered to children at least three times per year.
• At least one childcare provider sits with children at the table and eats the same meals and snacks.
• Providers encourage, but do not force, children to eat.
*saturated fat and trans fat
• Children are provided with 60 minutes of physical activity per day, a combination of both teacher-led and free play.
• Television, video, and computer time are limited to one time per week or less and not more than 30 minutes each time.
• Childcare providers do not withhold active play time as punishment.
• Children with special needs are provided opportu-nities for active play while other children are physi-cally active.
• Children are provided outdoor active play time at least two times per day.
• Physical activity education is offered to childcare providers at least one time per year.
• At least one provider joins children in active play at least one time per day.
• Shaded area is provided during outdoor play.
• Children are not seated for periods longer than 30 minutes except when sleeping or eating.
• Physical activity education is offered to children at least three times per year.
I Am Moving, I Am Learning (IMIL): This program, funded by Head Start, provides an approach for
addressing childhood obesity in Head Start children. IMIL seeks to increase moderate to vigorous physi-cal activity every day, improve the quality of movement activities intentionally planned and facilitated by adults, and promote healthy food choices every day. Details can be found at http://eclkc.ohs.acf.hhs.gov/ hslc/ecdh/Health/Nutrition/Nutrition%20Program%20Staff/IMIL/IamMovingIam.htm.
Caring for Our Children National Health & Safety Performance Standards: Guidelines for Out-of-Home Childcare Programs: This publication, issued jointly by the American Academy of Pediatrics,
American Public Health Association, and National Resource Center for Health and Safety in Child Care, includes a set of health and safety performance guidelines or “standards” with accompanying rationales for childcare providers, parents of children in childcare, health professionals, and state health officials. Topics covered include health promotion, nutrition and food services, safe-play environments, and program activities for healthy development.
The National Association for the Education of Young Children (NAEYC): This organization focuses
on the quality of educational and developmental services for all children from birth through age eight. Specific efforts of NAEYC include setting and publicizing standards that promote excellence in early childhood education and professional preparation, and providing professional development opportuni-ties and resources. Part of NAEYC efforts to improve early childhood education include different systems of accreditation for programs that are committed to meeting national standards of quality. The NAEYC voluntary accreditation system has set professional standards for early childhood education programs,
and helps families identify high-quality programs for their young children. The standards that address nutrition and physical activity mirror those outlined in the Caring for our Children National Health & Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.
State Regulations Database: While not a Best Practice, the National Resource Center for Health and
Safety in Child Care provides a public access database of regulations for all fifty US states, the District of Columbia, Puerto Rico, and the Virgin Islands. Regulations are updated when changes are made, and reflect the most current regulations available from states. To view state regulations and other resources to assist in implementation of the Caring for Our Children: National Health and Safety Performance Stan-dards, go to http://nrckids.org/STATES/states.htm
.
Summary
According to the interviewees, the lack of time, resources, and knowledge to effectively promote healthy environments in the early childhood education and childcare settings are significant and interrelated barriers that must be addressed. Identifying ways to support staff, sponsors, and parents in their efforts to promote nutritious and acceptable foods and beverages, to understand the importance of a healthy diet through effective nutrition education and promotion, and to recognize the role of age-appropriate physical activity in young children are critical to the success of early childhood education and childcare settings. In addition, there is a clear need to better understand perceptions that early childhood educators and providers bring to the table surrounding nutrition and physical activity, and how those perceptions help or hinder the ability to promote healthy behaviors in young children.
The interviewees also concluded that offering consistent messaging, providing accountability, updat-ing standards and regulations at all levels, beupdat-ing child focused, establishupdat-ing partnerships and providupdat-ing evidence-based resources and tools are meaningful and essential components to improving and enhanc-ing early childhood education and childcare settenhanc-ings. The identification and dissemination of best prac-tices and recommendations from credible organizations is critical to building the capacity to impact the future of children, providing them and providers and caregivers with the necessary knowledge, tools, and confidence to adopt healthy habits throughout their lives.
Interviewees
Marilyn Briggs, RD, SNS, MS
Co-Director, Center for Integrative Nutrition Environments in School Communities University of California at Davis
Davis, CA
Cheryl Charles, PhD
President and CEO
Children & Nature Network (C&NN) Santa Fe, NM
Catherine Cowell
Clinical Professor Columbia University New York, NY
(Interviewed with Barbara Hamilton)
Jeffrey Gehris, PhD
Assistant Professor of Kinesiology Temple University
Philadelphia, PA
(Interviewed with Robert Whitaker)
Mark Ginsberg, PhD
Executive Director
National Association for the Education of Young Children Washington, DC
Barbara Hamilton, MA
Assistant Director
National Resource Center for Health and Safety in Child Care and Early Education University of Colorado
Denver, CO
Geri Henchy, MPH, RD
Director of Nutrition Policy and Early Childhood Programs, Food Research and Action Center (FRAC)
Washington, DC
Risa Jaslow, MS, RD
Head Start Team Leader and Nutrition Coordinator New York City Agency for Children’s Services New York, NY
Susan Nitzke, PhD, RD
Professor and Extension Specialist in Nutritional Sciences University of Wisconsin-Madison
Madison, WI
Lynne Oudekerk, MA, RD, CDN
Acting Director
Child and Adult Care Food Program (CACFP) NYS Department of Health
Russ Pate, PhD
Professor in the Department of Exercise Science
Director of the Children’s Physical Activity Research Group Arnold School of Public Health
University of South Carolina Columbia, SC
Madeleine Sigman-Grant, PhD, RD
Professor
University of Nevada Cooperative Extension Reno, NV
Jim Sallis, PhD
Director, Active Living Research, Robert Wood Johnson Foundation San Diego State University
San Diego, CA
Mary Story, PhD, RD
Director of Healthy Eating Research, Robert Wood Johnson Foundation Professor, University of Minnesota
Minneapolis, MN
Dianne Stanton Ward, EdD
Professor of Nutrition
University of North Carolina at Chapel Hill Chapel Hill, NC
Robert Whitaker, MD, PhD
Professor of Public Health and Pediatrics Temple University
Philadelphia, PA
Harriet Worobey, MA
Professor and Head Start Educator
Department of Food Science and Human Nutrition Rutgers University
New Brunswick, NJ
NOTES
1. Whitaker RC, Gooze RA, Hughes CC, Finkelstein DM. Barriers to obesity prevention in Head Start. Health Affairs 2010; 29(3):454-462.
2. Whitaker RC, Gooze RA, Hughes CC, Finkelstein DM. A national survey of obesity prevention practices in Head Start. Archives of Pediatric & Adolescent Medicine 2009; 163(12):1144-1150.
3. Gooze RA, Hughes CC, Finkelstein DM, Whitaker RC. Reaching staff, parents, and community partners to prevent childhood obesity in Head Start, 2008. Preventing Chronic Disease 2010; 7(3).
