H E A D STARTB O D Y START

POLICY SERIESPolicy Action Recommendationsfor Physical Activity and Nutritionin Early Childhood Settings

American Alliance forHealth, Physical Education,Recreation and Dance

by Head Start Body Start a project of the American Alliance for Health, Physical Education, Recreation and Dance©2012 All rights reserved.

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Building Health in Early Childhood Requires Policy Attention

Healthy, active children have the building blocks for school success, and Early Childhood Education and Care (ECEC) providers want their children to have foods, learning activities, play, and spaces for strong bodies and minds. However, time, know-how, resources, and limited policy support currently constrain providers’ ability to promote wellness.

This brief will help ECEC policymakers, administrators, providers, parents, and other stakeholders un-derstand the barriers to sound nutrition and active physical play in Head Start and other ECEC settings. These stakeholders can take five steps to improve ECEC environments for young children’s health and physical development. The findings and recommendations are based on existing research, evidence-based guidelines, and input from experts in the field (see also Head Start Body Start’s What Do the Experts Say? Interviews with Experts in Nutrition and Physical Activity, 2012).

Physical Activity, Healthy Foods Fuel Child Development

Physical health in early childhood can influence both school readiness and the development of healthy behaviors.1,2 For this reason, it is concerning that one in five preschoolers are overweight, which puts their longer-term health – and learning potential – at risk (see also Head Start Body Start’s Just the Facts: Evi-dence Base and Policy Overview, Physical Activity and Nutrition in Early Childhood Settings, 2012).

To develop strong minds and bodies, young children need both well-balanced diets and moderate-to-vig-orous physical activity (MVPA).3 National guidelines recommend young children engage in at least one hour each day of playful MVPA.3,4 An active early childhood fueled by healthy foods also helps establish lifelong preferences that support wellness.

ECEC settings play a vital role in assuring that children enter school with the health and development to succeed. First, many young children spend many of their waking hours outside the home. As a result, MVPA and foods in ECEC settings can be a major factor in young children’s learning, growth, and devel-opment. Second, ECEC settings influence the formation of young children’s preferences for physical activ-ity and nutrition over time. For example, children who develop age-appropriate physical movement skills at an early age are more likely to participate in athletic activities later due to the feeling of competence.5,6,7

HSBS POLICY SERIESPolicy Recommendationsfor Physical Activity and Nutritionin Early Childhood Settings

Summary

All young children should have the opportunity to learn and grow each day by eating well, actively playing, and developing motor skills. However, many Head Start and early childhood education and care settings do not consistently support wellness. Numerous barriers impede the ability of childcare providers to offer healthy environments. Federal, state, and local actions can help providers overcome these obstacles.

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ECEC leaders, researchers, and child advocates increasingly are focused on meeting the nutritional and MVPA needs of young children. National Initiatives Addressing Childhood Obesity (below) highlights a few of these efforts.

ECEC Providers Face Multiple Barriers

ECEC providers care about children’s health and wellbeing but face several interrelated obstacles to getting children active and eating well.12,13,14,15,16,17,18,19,20,21,22 Figure 1 summarizes constraints internal to many ECEC settings. Figure 2 focuses on external challenges.

Just the Facts• 42 percent of young children (birth to six years) spend 35 hours or more per week in childcare

settings.8

• 1 million young children (three to five years) participate in the Head Start program.9

• Preschool-aged children consume 50 to 100 percent of their daily calories in care settings outside the home.10

• 21 percent of children ages two to five are overweight, increasing their risk for disease, disability, and psychosocial problems.11

National Initiatives Addressing Childhood Obesity • First Lady Michelle Obama’s Let’s Move! Initiative

• The US National Physical Activity Plan

• Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children

• Head Start Body Start National Center for Physical Development and Outdoor Play

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Figure 1: Internal ECEC Barriers to Promoting MVPA and Healthy Eating

Barriers Faced by ECEC

Administrators and TeachersOverview

Knowledge and Skills Gaps in education and training include:

• What constitutes MVPA and healthy diets

• Why these matter

• How to get children active and eating healthy foods

Cultural Preferences and Beliefs Cultural preferences and beliefs presenting challenges include:

• Partiality to foods that have low nutritional value

• Beliefs that are inconsistent with research about:

- Feeding young children

- “Good” foods and physical activity in general

Inadequate Time ECEC staff lack the time outside of the classroom or office to:

• Participate in professional development

• Build community partnerships

• Plan and implement improvements

Resource Constraints Resources often are insufficient or lacking in terms of:

• Food preparation equipment

• Meal reimbursement for nutritious foods

• Access to age-appropriate equipment as well as indoor and outdoor spaces that are safe

Limited Family Support Family support issues presenting challenges include:

• Families’ cultural beliefs, knowledge, values, and practices that are at odds with MVPA and healthy foods

• Foods from home may have low nutritional value due to lack of access, lack of knowledge, or differing cultural beliefs

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Figure 2: Gaps in External Support That Inhibit Improvements in ECEC Environments

Gaps in

External SupportOverview

Policy Attention • Limited attention to both wellness in ECEC settings and young children’s need for MVPA and nutrition

• Insufficient reinforcement of the connection between Head Start’s school readiness goals and the physical health component of the new Early Learning Framework

Policy Support and Fi-

nancial Investments

• Federal, state, and local ECEC policies about MVPA and nutrition often are outdated

• Existing quality standards for healthful environments are weak, lacking connection to

- Incentives or rewards for improvements

- Accountability policies and procedures that assure

• implementation of standards at appropriate levels

Research Gaps Dearth of studies regarding:

• Impact of ECEC regulations on MVPA and nutrition

• ECEC providers’ professional development needs

• The needed quality of indoor and outdoor spaces for MVPA

• Strategies for adapting model programs and guidelines into Head Start and other ECEC settings

Limited Community Support Local governments, civic groups, and businesses often do not assist ECEC

providers in obtaining:

• Joint-use agreements for access to community facilities, parks, and gardens

• Grants for equipment and curriculum upgrades

• Healthy foods stocked in neighborhood stores

Proven and promising strategies are available to address these barriers. Existing resources include expert guidelines, toolkits for ECEC providers, and model regulations.3 The challenge is helping ECEC poli-cymakers, providers, and families recognize the importance of and take steps to improve places where young children are learning, playing, and growing.

Five Actions to Promote Child Health in ECEC Settings

Giving all young children in ECEC settings the benefits of healthful environments will require local, state, and federal action, as well as private sector support. Five investment opportunities collectively address the barriers identified above. Each investment is necessary to move solutions into practice.

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FIRST, to attain sustainable improvements, early childhood advocates and policymakers must secure buy-in from ECEC administrators, teachers, and families. A starting point is to raise awareness among these key audiences about the importance of MVPA and nutrition in early childhood. (Other key audi-ences include employers that sponsor childcare, local businesses and civic groups, and human services agencies that support families.) Champions should use consistent, tested messaging about the benefits of MVPA and healthy eating for young children. The US Department of Agriculture’s dietary guidelines (www.ChooseMyPlate.gov) provide one source of nutrition messaging for preschoolers. Head Start Body Start and its resources, including the 2012 HSBS Policy Guide documents as well as HSBS literature reviews on the benefits of play and sociocultural influences on play are valuable resources for best practices and current research in the area of physical play. The collaborative, multi-agency National Physical Activity Plan and the Institute of Medicine’s Early Childhood Obesity Prevention Policies also are useful sources of physical activity messaging.

Moving from awareness to buy-in will require involving ECEC stakeholders in making changes. Plans must specifically address the needs of infants, toddlers, and preschoolers. Further, investments should take into account ECEC providers’ realities, especially those listed in Figure 1, above.

SECOND, policymakers should integrate evidence-based guidelines about MVPA and

nutrition into ECEC standards, licensing, and funding policies. Both Head Start policies and the federal Child and Adult Care Feeding Program need updating. State and local ECEC regulators can adapt model regulations to local conditions and goals. To assure feasibility, policy changes should be phased in, with regular review and updating.

THIRD, national, state, and local stakeholders should offer ECEC provid-ers a range of new resources to build healthful environments. Ongoing training, technical assistance, community partnerships, and seed funding

are necessary to help ECEC providers find time to plan and implement changes. Financial support can be time-limited and require recipients to achieve benchmarks. To motivate or reward improvements, new

Five Policy Actions

To get children active and eating well in ECEC settings, policymakers and early childhood advocates must:

A. Secure support from ECEC providers, families, and local stakeholders;

B. Update ECEC policies and regulations using evidence-based guidelines;

C. Provide ECECs with financial and technical resources to make improvements;

D. Enhance systems of accountability at all levels; and

E. Expand research about how best to meet the dietary and MVPA needs of young children in different ECEC settings.

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incentives could include certification, regional recognition, or increased meal reimbursements for exceed-ing Child and Adult Care Feeding Program standards.

FOURTH, ECEC regulators and employers that sponsor childcare should enhance ECEC systems of ac-countability. Wellness-related performance standards must be transparent, and measures should corre-spond with evidence-based guidelines and program goals. Accountability should be woven into all levels of ECEC oversight. State or regional coordinators can monitor changes at the local level, help resolve problems, broker partnerships, and arrange regional professional training.

FIFTH, private philanthropies and governments should expand research to:

• Develop programs and curriculum for MVPA and healthy eating that are tailored to young children and ECEC settings;

• Identify and test promising practices; and

• Evaluate different regulatory approaches to promoting healthful ECEC environments and to measuring per-formance.

Conclusions

Young children can thrive and be ready for school when they have opportunities for healthy growth and development in ECEC settings. The first steps to realizing this vision are, one, engaging ECEC provid-ers and families and, two, updating federal, state, and local policies. Related actions include increas-ing support to enable ECEC providers to make improvements, enhancing accountability for wellness throughout the system, and furthering research about meeting young children’s needs for MVPA and healthy foods.

For More Information

This policy brief is based on a Head Start Body Start study that reviewed the literature, existing policies, and evidence-based guidelines regarding nutrition and MVPA in ECEC settings. Researchers also inter-viewed 17 experts for the analysis. This policy brief has three companion reports:

• Head Start Body Start: Summary: Highlights of HSBS Policy Recommendations for Early Childhood Physical Activity, 2012

• Head Start Body Start: What Do the Experts Say? Interviews with Experts in Nutrition and Physical Activity, 2012

• Head Start Body Start: Just the Facts: Evidence Base and Policy Overview, Physical Activity and Nutrition in

Early Childhood Settings, 2012

Head Start Body Start National Center for Physical Development and Outdoor Play

This policy brief was developed by the Head Start Body Start National Center for Physical Development and Outdoor Play, a project of the American Alliance for Health, Physical Education, Recreation and Dance. With grant funding from the Administration for Children and Families, U.S. Department of Health and Human Services (HHS), Head Start Body Start aims to increase physical activity, outdoor play, and healthy eating among Head Start and Early Head Start children, families, and staff. To learn more about Head Start Body Start, please visit: http://www.headstartbodystart.org.

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of HHS, the contractor, or any other organization.

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NOTES

1. High PC, Committee on Early Childhood, Adoption, and Dependent Care, and Council on School Health. School Readiness. Pediatrics 2008; 121(4):e1008.

2. Campbell KJ, Hesketh KD. Strategies which Aim to Positively Impact on Weight, Physical Activity, Diet and Sedentary Behaviors in Children from Zero to Five Years. A Systematic Review of the Literature. Obesity Re-views 2007; 8:327-338.

3. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Preventing Childhood Obesity in Early Care and Education: Se-lected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition, 2010.

4. Fox TA, Brown K. Head Start Body Start Policy Series: Just the Facts: Evidence Base and Policy Overview, Physical Activity and Nutrition in Early Childhood Settings. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance, 2012.

5. Carroll B, Loumidis J. Children’s Perceived Competence and Enjoyment in Physical Education and Physical Activity Outside School. European Physical Education Review 2001; 7(1):24-43.

6. Okely AD, Booth ML, Patterson JW. Relationship of Physical Activity to Fundamental Movement Skills among Adolescents. Medicine & Science in Sports & Exercise 2001; 33(11):1899-1904.

7. Weiss MR, Duncan SC. The Relationship Between Physical Competence and Peer Acceptance in the Context of Children’s Sports Participation. Journal of Sport & Exercise Psychology 1992; 14(2):177-191.

8. Cappizano J, Adams G. The Hours that Children Spend in Childcare: Variations across the States. No-B.8. Washington, DC: Urban Institute, 2000.

9. US Department of Health and Human Services, Administration for Children and Families. Head Start Program Fact Sheet 2010. Washington, DC: Office of Head Start, 2010. Available at: http://www.acf.hhs.gov/programs/ohs/about/fy2010.html#. Accessed on February 14, 2011.

10. American Dietetic Association. Position of the American Dietetic Association: Benchmarks for Nutrition Pro-grams in Child Care Settings. Journal of the American Dietetic Association 2005; 105:979-986.

11. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008. Journal of the American Medical Association 2010; 303:242-249.

12. Benjamin SE, Cradock A, Walker EM, Slining M, Gillman MW. Obesity Prevention in Child Care: a Review of US State Regulations. BMC Public Health 2008; 8:188; doi: 10.1186/1471-2458-8-188.

13. Benjamin SE. Preventing Obesity in the Child Care Setting: Evaluating State Regulations. Available at: http://cfm.mc.duke.edu/wysiwyg/downloads/State_Report-SC.pdf. Accessed on: January 23, 2010.

14. Benjamin SE, Cradock A, Neelon B, Walker E, Slining MM, Gillman MW. Menus in Child Care: a Comparison of State Regulations with National Standards. Journal of the American Dietetic Association 2009; 109:109-115. Doi:10.1016.j.jada.2008.10.015.

15. McWilliams C, Ball SC, Benjamin SE, Hales D, Vaughn A, Ward DS. Best-Practice Guidelines for Physical Activity at Child Care. Pediatrics 2009; 124:1650-1659.

16. Bower JK, Hales DP, Tate DF, Rubin DA, Benjamin SE, Ward DS. The Childcare Environment and Children’s Physical Activity. American Journal of Preventive Medicine 2008; 34:23-29.

17. Story M, Kaphingst KM, French S. The Role of Child Care Settings in Obesity Prevention. Future Child 2006; 16:143-168.

18. Kaphingst KM, Story M. Child Care as an Untapped Setting for Obesity Prevention: State Child Care Licensing Regulations Related to Nutrition, Physical Activity, and Media Use for Preschool-Aged Children in the United States. Preventing Chronic Disease 2009; 6:1-13.

19. Gabor V, Mantinan K, Rudolph K, Morgan R, Longjohn M. Challenges and Opportunities Related to Implemen-tation of Child Care Nutrition and Physical Activity Policies in Delaware: Findings From Focus Groups with Child Care Providers and Parents. Washington, DC: Altarum Institute, 2011.

20. Gabor V, Rudolph K, Mantinan K, Longjohn M, Morgan R, Dull P. Environmental Scan of Physical Activity Prac-tices and Resources in Washington, DC, Child Care Centers. Washington, DC: Altarum Institute, 2011

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21. Fox TA, Brown K. Head Start Body Start Policy Series – Summary: Highlights of HSBS Policy Recommenda-tions for Early Childhood Physical Activity, Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance, 2012.

22. Fox TA, Brown K. Head Start Body Start Policy Series: What Do the Experts Say? Interviews with Experts in Nutrition and Physical Activity. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance, 2012.