Section on Early Education and Child Care Program
Hot Topics in Early Childhood Influencing Early Education
and Child Care: Research, Early Literacy, Obesity Prevention
Session # H2068
Danette Swanson Glassy, MD, FAAP
Caring For Our Children, 3rd Edition, Co-Chair
Executive Committee, Section on Early Education and Child Care
Clinical Professor, University of Washington, School of Medicine
Mercer Island Pediatrics
Mercer Island, Washington
Disclosures
• In the past 12 months, I have not had a significant
financial interest or other relationship with the
manufacturer(s) of the product(s) or provider(s)
of the service(s) that will be discussed in my
presentation.
This presentation will (not) include discussion of
pharmaceuticals or devices that have not been
approved by the FDA or if you will be discussing
“off-label” uses of pharmaceuticals or devices.
Agenda
• HRSA Early Childhood 2010: Innovations
for the Next Generation
• Preventing Childhood Obesity in Early Care
and Education Programs: Caring For Our
Children Nutrition, Physical Activity, and
Screen Time Standards
• Applying the Standards
Early Childhood 2010: Innovations for
the Next Generation
• www.earlychildhood2010.org
• Jointly convened by the Department of
Education and the Department of Health
and Human Services
• State and Local Partners
• Workshops
• Collaboration Meetings by State
Early Childhood 2010: Innovations
for the Next Generation
• Topics:
– Obesity Prevention including Let’s MoveMichelle Obama’s initiative to prevent obesitywww.letsmove.gov
– Home Visiting
– Quality Child Care
– Healthy Workforce/Professional Development
– Early Identification of development issues
Caring for Our Children (CFOC)
• Definitive source on best practice in health
and safety in early care and education
settings
• Evidence-based
• Expert consensus
• Nationally recognized
• Model for health & safety practices
Caring for Our Children (CFOC)
Partners
• American Academy of Pediatrics (AAP)
• American Public Health Association (APHA)
• National Resource Center for Health and Safety
in Child Care and Early Education
(at University of Colorado Denver) (NRC)
Funded through
Maternal and Child Health Bureau, Health
Resources and Services Administration, USDHHS
Cooperative Agreement (MCHB)
• CFOC 2nd Edition (current edition)
published in 2002
• 3rd Edition revision process underway –
Full set to be released first quarter 2011
• Accelerated Nutrition, Physical Activity and
Screen Time Standards– July 2010
nrckids.org/CFOC3/PDFversion/preventing_obesity.pdf
www.aap.org/bookstorepubs.html
• Nutrition Panel - Primary responsibility for
review, update and new information
regarding nutrition and physical activity
standards.
• Related Panels also reviewed &
contributed from their disciplines – Child
Development, Injury Prevention, General
Health, etc.
Expert Panel Members
•
•
•
•
Pediatricians
Maternal and Child Health Professionals
Nutritionists
Other Health Professionals
– Nursing, Social Work
• Breastfeeding Experts
• Physical Activity Experts
• Child Development Specialists
Nutrition and Physical Activity
Comprehensive Standards
• NUTRITION
– variety of healthy foods
– promote positive mealtime environment
• PHYSICAL ACTIVITY
– daily indoor & outdoor activities
• SCREEN TIME
– limited
How Standards Address Problem
• promote eating a variety of healthy foods
• advocate breastfeeding of infants
• emphasize and promote daily physical activity
• limit access to screen time
• partner with families to promote healthy eating
practices and lifestyles
• encourage collaboration among families,
caregivers, and community health partners
Opportunities for Early Care and
Education Programs
• early identification of problem
• professional health team working with families to
prevent obesity
• education environment – teaching and learning
• prevention and early intervention strategies
• promote goal of achieving standard of nutrition,
physical activity, and limited screen time
Nutrition Standards
Nutrition Standards
Encourage breastfeeding :
• Encourage mothers to breastfeed
at the child care program
– provide comfortable, private areas
• Train caregivers/teachers to support and advocate
for breastfeeding.
• Implement policies and procedures on handling and
feeding human milk safely – reduces mother’s
anxiety and promotes safety for infants
Nutrition Standards
• Feed infants on cue by consistent
caregiver
• Accommodate use of soy formula and
soy milk when necessary
• Use 2% milk for children 12 months to 2 years, for
whom overweight or obesity is a concern with
written documentation from health professional
Nutrition Standards
• Accommodate vegetarian diets
• Serve small size portions
• Availability of age-appropriate nutritious snacks
• Caregivers are models of healthy eating habits
• Provider sits with children during meal time and
encourages socialization
• Food is never used as a reward/punishment
Nutrition Standards
• Water available throughout the day
• No fruit juice for children under 12 months
• 100% juice limited to 4-6 ounces for children 1– 6
years of age
• Whole fruits encouraged
• Nutrition education offered to children & parents
Physical Activity Standards
Physical Activity Standards
• Promote development of infant
movement skills – plenty of tummy time
• Promote active daily play for 1-6 year
olds with:
– 2-3 outdoor occasions
– 2 or more structured activities over course of day
(indoor and/or outdoor)
– Time for unstructured active play
Physical Activity Standards
Caregivers and teachers encourage and
participate in physical activities:
• Lead structure activities
• Wear clothing that permits safe and easy movement
• Prompts children to be active
Physical Activity Standards
Limit restrictive movement
• Limit time in high chair to no more than
15 minutes (except for meals & snacks)
• Cribs are only for sleeping or resting
• Restricting active play as a punishment is not
allowed
Screen Time Standards
Screen Time Standards
• No TV, video, DVD and computer use under 2 years
of age
• 2 years and older:
– Only 30 minutes per week of media time and only
for educational/physical activity purposes
– Computer use – 15 minute increments; school
age children may have longer for homework.
• Caregivers as role models – no TV watching during
day
Applying the Standards
Using “Preventing Obesity”
CFOC Standards
• National and State Campaigns can use to build
integrated nutrition and physical activity
components in their systems.
• Caregivers/teachers can use to develop and
implement practices and policies and use in staff
training.
• Families can support and join with
caregivers/teachers in the implementation of
healthy practices. They can also reinforce at
home.
• Regulators can use to develop and/or improve
state regulations that support the prevention of
obesity and promote healthy habits.
• Health care professionals can assist families
and providers with sound evidence-based
rationale for implementing and following healthy
lifestyles.
• Academic faculty can use standards as a
resource to prepare students for entering the early
childhood workplace.
Applying the Standards
Community Pediatric
Foundation of
Washington with the
Coalition for Safety and
Health in Early
Learning
(www.cshelwa.org)
Public Health, Seattle &
King County grant:
Communities Putting
Prevention to Work
from the CDC
http://nrckids.org/CFOC3/PDFversion/preventing_obesity.pdf
King County Healthy Active Kids
• Focus on sustainable policy changes in
early learning settings and after school
programs that improve nutrition, physical
activity and screen time
• Partners include Child Care Resources,
Schools Out Washington, King County
Parks and Recreation, City of Seattle,
University of Washington Center for Public
Health Nutrition, Seattle Children’s Hospital
Two Activities
• Develop and implement model child care
health policies within King County which
reflect best practice for nutrition and healthy
active living in early learning and after school
programs. Use these standards to improve
state licensing regulations
• Increase access to healthy food for child care
providers
Policy and Curriculum Tools
• Preventing Obesity in Early Care and Education
Settings: New Caring for Our Children Standards
as the basis for the model policies
• Current curriculum also used to meet the standards
• Creation of a Crosswalk comparing the new CFOC
standards with state regulations, Head Start
regulations, and Child and Adult Food Program
regulations
Train-the-Trainers
• Key to success is training-the-trainers:
– Child Care Health Consultants
– Head Start Health
Specialists/Technical
Advisors/Nutrition Specialists
– After School Program Trainers from
Schools Out, YMCA, Montessori
Associations
– State Licensors
• Delaware report from Altarum
Challenges and Opportunities
Related to Implementation of Child Care Nutrition
and Physical Activity Policies in Delaware May, 2010
• Findings from Focus Groups with Child Care Providers and
Parents
• www.altarum.org/publications-resources-health-systemsresearch/CHOMP-Delware-Focus-Group-Report
• Clearly and consistently communicate the rationale for
nutrition and physical activity standards in child care.
• Offer supports to help providers address the challenges of
meal planning, food preparation, and food purchasing.
• Develop new resources and expand on existing ones to
help providers educate and engage preschool children in
healthy eating habits and increased physical activity.
Challenges and Opportunities
Related to Implementation of Child Care Nutrition
and Physical Activity Policies in Delaware May, 2010
• Help providers implement strategies to successfully engage
staff and parents.
• Expand and improve training and technical assistance for
child care directors and staff.
• Develop and implement mechanisms for improved
peer-to-peer information sharing.
• Align state child care Quality Rating and Improvement
Systems (QRIS) with enhanced nutrition and physical
activity standards.
Train-the-Trainers
• Partnerships are essential
• Facilitate provider trainings/provide continuing
education credit
– Child Care Resources
– Schools Out Washington to help
facilitate the trainings and provide
continuing education credit
• Provide ongoing technical assistance
– Child Care Health Consultants
– Head Start Technical Advisors
State Policy Work
• Credible Tool
– Preventing Obesity in Early Care and Education
Settings: New Caring for Our Children Standards
– Crosswalk comparing the CFOC standards with current
State Licensing Regulations, Head Start Regulations,
Child and Adult Food Program Regulations
• Top down strategy
– Governor’s advisors
– Legislators
– Agency Heads: Department of Health, Department of
Early Learning, Head Start Collaboration Office
– Participate in the process for modifying Licensing
Regulations
State Policy Work
Partnerships:
– AAP State Chapter (see
www.aap.org/member/chapters/chapserv.htm)
– American Academy of Pediatrics
Chapter Child Care Contacts:
www.healthychildcare.org/cccc.html
– Other Child Advocacy Organizations
– Other Non Profit Organizations
Increase Access to Healthy Foods
• Farm to table programs
• Bulk buying
• Facilitated system
Questions?