Technical Assistance Workshop
Honolulu, Hawaii
March 8, 2013
Dr. Caree Jackson Cotwright, CDC DNPAO
Disclaimer: The findings of this presentation are the conclusions of the presenter and do not necessarily represent the official policies of
the CDC nor does the mention of any names or organizations imply endorsement by the Federal government.
www.HealthyKidsHealthyFuture.org
What is Let’s Move! Child Care?



One component of the First Lady’s
Let’s Move! initiative to solve the
obesity problem
Supports providers to adopt best
practices for physical activity,
screen time, foods, beverages,
and breastfeeding through free
resources and interactive, online
tools
Recognizes providers who meet
best practices
Why Participate?
www.HealthyKidsHealthyFuture.org
You can make a difference
 You can be a champion for healthy
choices
 You’re a role model
 You care
 You’re a partner in parenting
 It’s easier than you might think

Icebreaker: Rainbow Run
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
When I call out one of the colors of the rainbow run
and touch 3 things that are that color.
Session Agenda
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
Basics about Childhood Obesity

Overview of Let’s Move! Child Care (LMCC)

Physical Activity Focus

LMCC Resources

LMCC Quiz & Action Planning

Tips from Providers that Work!

Technical Assistance and Workshop Feedback
Session Objectives
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After participating in the workshop participants should be able to answer the following
questions:
1
2
3
4
What are the best practices for obesity prevention in ECE?
What are the key challenges I should consider before
developing an action plan to address obesity in ECE?
What steps should I take to meet the 5 LMCC goals?
How can I use the tools and resources in the LMCC technical
assistance toolkit to improve nutrition, physical activity, screen
time and breastfeeding support?
Basics about Childhood Obesity
Dr. Caree Jackson Cotwright
Centers for Disease Control and Prevention
Obesity
www.HealthyKidsHealthyFuture.org
Common
Costly
Solvable
Photo source: www.obesityinamerica.org
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
www.HealthyKidsHealthyFuture.org
We Are Evolving
Childhood Obesity




24% - 33% of 2 – 5 year olds are overweight or
obese.
Obesity rates for young children doubled in about
a 20 year period of time (1980’s – 2000).
Obese children are more likely to become obese
adults.
If children are overweight, obesity in adulthood is
likely to be more severe.
Education Consequences
Children who are overweight or obese can be
undernourished at the same time.

Nutrition deficiencies

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`Impair brain development and cognitive functioning,
including learning
Physical inactivity
Activity promotes brain development, improves sleep, builds
self confidence, and reduces stress & depression
 Children who are not active have more behavioral and
disciplinary problems, shorter attention spans in class and do
worse in school compared to active children

You Play an Important Role in Preventing Obesity!
Moving Forward to Reverse the
Obesity Trends
“ … we know the cure for this. This isn't like
putting a man on the moon or inventing the
Internet - it doesn't take some stroke of genius or
feat of technology. ... Rarely in the history of this
country have we encountered a problem of such
magnitude and consequence that is so eminently
solvable.”
Michelle Obama
February 9, 2010
Why obesity prevention in child care and
early education programs?


You can help children build healthy habits for
life

Food preferences and physical activity habits develop
during early childhood and continue into adulthood

You are a role model. Kids do as you do, especially when
they’re young.
You are in a unique position to educate
parents about healthy eating and activity
What You Can Do to Prevent Obesity
Moving Forward, Reverse the Trend
www.HealthyKidsHealthyFuture.org
“ … we know the cure for this. This isn't like putting
a man on the moon or inventing the Internet - it
doesn't take some stroke of genius or feat of
technology. ... Rarely in the history of this country
have we encountered a problem of such magnitude
and consequence that is so eminently solvable.”
Michelle Obama
February 9, 2010
Making a Difference Video:
www.HealthyKidsHealthyFuture.org
Break Time!
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
Leave the room like the motions of weather in:
 Rain
 Wind
 Thunder
 Snow
 Sunshine
Let’s Move! Child Care Goals
5 Goals
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1
Physical Activity
2
Screen Time
3
4
5
Nutrition
Provide 1-2 hours of physical activity throughout the day, including
outside play when possible.
No screen time for children under 2 years. For children age 2 and
older, strive to limit screen time to no more than 30 minutes per
week during child care, and work with parents and caregivers to
ensure children have no more than 1-2 hours of quality screen time
per day (as recommended by AAP).
Serve fruits or vegetables at every meal, eat meals family-style
whenever possible, and don't serve fried foods.
Beverages
Provide access to water during meals and throughout the day, and
don't serve sugar-sweetened drinks. For children age 2 and older,
serve low-fat (1%) or non-fat milk, and no more than one 4- to 6ounce serving of 100% juice per day.
Infant Feeding
For mothers who want to continue breastfeeding, provide their milk
to their infants and welcome them to breastfeed during the child
care day. Support all new parents' decisions about infant feeding.
Stand Up & Talk Time! (2 minutes)
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Turn to your neighbor and discuss which goals are
easiest or hardest to adopt in your ECE setting.
Why Offer Healthy Food?
Food (1)
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

Helps children stay at a
healthy weight
Food preferences develop at
an early age, even in infancy
Opportunity to teach kids’
taste buds to appreciate
healthy foods
Food (2)
www.HealthyKidsHealthyFuture.org


Many healthy options cost
the same as the not-sohealthy choices (like whole
wheat bread vs. white
bread)
Many children eat most of
their daily meals and
snacks while in care,
especially children in fulltime care
Food (3)
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Benefits of family-style dining
 Improve skills for self-feeding and
recognition of hunger cues
 Promotes and supports social emotional,
and motor skill development
 Language skills improve as adults and
peers talk with each other
 Opportunity for positive role modeling
 Adults at the table help prevent fighting,
feeding each other, potential choking,
and other negative behaviors
Food Moves!
www.HealthyKidsHealthyFuture.org

Pretend to move like different foods
 Melt
 Pop
like a popsicle
like popcorn
 Wiggle
like spaghetti
Why Offer Healthy Drinks?
Beverages (1)
www.HealthyKidsHealthyFuture.org


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Water keeps kids hydrated
best
Water helps to reduce acid in
the mouth that can cause
cavities
Sugary drinks are high in
calories and low in nutrients
Drinking water instead of
sugary drinks reduces the
amount of calories children
consume
Beverages (2)
www.HealthyKidsHealthyFuture.org


Serving fresh fruit instead of
fruit juice is best, because it is
high in dietary fiber and is a
natural source of energy
Skim or 1% milk have the same
amount of calcium and other
essential nutrients as whole milk,
but less fat and calories
Reasons for Reducing Screen Time
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
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Gets in the way of exploring,
playing, and social interaction.
As kids get older, screen time can
get in the way of being active,
reading, doing homework, playing
with friends, and spending time
with family.
Kids who spend more time
watching TV are more likely to be
overweight or obese.
When screen time is allowed:


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Make it “quality programming” by choosing shows
or computer games that are educational or get kids
moving.
Track screen time with a simple scheduling sheet so
you know how much screen time a child has and
when they’ve reached their limit for the week.
Avoid watching while eating (snacks or meals).
REMINDER: Touch screen technology does NOT count as ‘active’
screen time. Also, watch the quality of children’s movement with
active video games
Why Support Breast Feeding?
Breast Feeding (1)
www.HealthyKidsHealthyFuture.org

Breast milk helps to:
 Prevent
obesity
 Defend against infections
(keeping infants from getting
sick with things like diarrhea
and ear infections)
 Protect against a number of
conditions — like asthma,
diabetes, and sudden infant
death syndrome (SIDS)
In-Depth Review of Physical Activity
Goal
My Bonnie Lies Over the Ocean
My Bonnie lies over the ocean,
my Bonnie lies over the sea,
My Bonnie lies over the ocean,
O bring back my Bonnie to me.
Bring back, bring back, O bring back my Bonnie to
me, to me.
Bring back, bring back, O bring back my Bonnie to
me.
Knowledge Check

What is the
recommended amount
of physical activity for
toddlers in full day
care?
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15 - 30 min
30 - 45 min
60 - 90 min
90 - 120 min
Knowledge Check

What is the
recommended amount
of physical activity for
toddlers in full day
care?




15 - 30 min
30 - 45 min
60 - 90 min
90 - 120 min
Physical Activity Best Practices


Infants: Short supervised periods of tummy time several times
each day
Toddlers & Preschoolers: Active play time every day, both indoor
and outdoor

Toddlers: 60 – 90 minutes or more
(for half-day programs, 30 minutes or more)

Preschoolers: 120 minutes or more
(for half-day programs, 60 minutes or more)
REMINDER: Make sure that kids with special needs can
participate in activities too!
Benefits of Physical Activity

Helps children stay at a healthy weight



In childhood
In adulthood – physical activity habits learned in
early childhood can last a lifetime
Helps children:





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Develop motor skills and build their strength,
flexibility, and endurance
Develop and maintain strong bones
Improves social skills and brain development
Sleep better
Feel confident about themselves and their bodies
Reduce their risk of feeling stressed or depressed
Benefits of Physical Activity
Children who are active tend to
have fewer behavioral and
disciplinary problems, do better
in school, and have longer
attention spans in class.
Ways to Get Kids Moving
Two kinds of physical activity
1.
2.
STRUCTURED: Organized, quick, and intense
activities led by adults
UNSTRUCTURED: Free Play to stimulate the
imagination and creativity
Ways to Get Kids Moving

Add physical activity into your daily
routine
 Have children act out a story as you
read it to them.
 Encourage kids to move like
different animals during transitions
from one activity or room to another.
 Use props to help kids move and
identify shapes, colors and numbers
Ways to Get Kids Moving


Mix up the usual ‘hokey
pokey’ and ‘head,
shoulders, knees and toes’
with a dance party or
obstacle course
Encourage working
together to come up with
games and activities
Where to Play

Opt for the outdoors
as much as possible.

Be weather-ready.

Check your
childproofing.

Get down to their
level.

Let’s Play!
Keep infants active too
Tummy Time:
 Is allowing babies to interact and play while
awake and on their tummies


Prepares babies for sliding on their bellies
and crawling
Begins as a three-five minute period and is
gradually increased as the infant shows
enjoyment of the activity
Keep infants active too
During tummy time:


Encourage them to see, touch, and feel what’s
around them
Try putting their favorite toys just out of reach
REMINDER: Always make sure infants have tummy time when
they’re awake and alert and placed on a solid surface on the
floor (never on a surface that’s soft or up high like a mattress or
sofa).
Know the Developmental Milestones



Kids should do specific things at every age
and stage.
Know the milestones to help them work on
the appropriate physical and motor skills.
Check out the following chart of
developmental milestones from birth to 36
months old.
Know the Developmental Milestones
Motion Moments: Toddlers
www.HealthyKidsHealthyFuture.org
Be a Get Moving Role Model
Participate in and enjoy
physical activity
Wear comfortable
clothing
If you have limitations,
be a cheerleader!
Available in English and Spanish
Physical Activities
Fun activity
ideas, tips for
incorporating
physical
activity into
your daily
routine, activity
sheets, and
more!
www.HealthyKidsHealthyFuture.org
Physical Activity Innovation: Yoga Flashcards
Activity sheets
eXtension Alliance
for Better Child
Care Hands-on
Activities Database
Songs to get
kids dancing
Creative Physical Activity: Bean Bag Blitz!
*These bean bags should only be used with
children ages 3 and up
Let’s Move Child Care
Resources
•
•
•
Fruit & Veggie Bean Bags
Sesame Street: We Have the Moves!
Sesame Street: Food For Thought:
http://www.sesamestreet.org/parents/topicsandactivities/toolkits/food
•
Grow It, Try It, Like It! Garden Curriculum USDA
http://teamnutrition.usda.gov/Resources/growit.html
•
•
4 oz and 6 oz cup samples
Potter the Otter: Book about Water Consumption
http://www.potterloveswater.com/
•
•
Child Size Pitchers
Helpful Resource Idea Printed Tip Sheets
Website Resources

Curriculum

Menu Planning & Recipes

Training videos
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Activity Sheets

Parent Handouts
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And more!
Start Early
www.HealthyKidsHealthyFuture.org

Start Early tab:

Provides research base
for LMCC

Answers questions
providers may have

Links providers to
relevant areas of the
website as they get
started:

Sign up

Quiz

Tools & Resources
Child & Adult Care Food Program
Resource
http://healthymeals.nal.usda.gov/cacfp-wellness-resources-child-careproviders/electronic-media-use-screen-time
Physical Activities
Fun activity
ideas, tips for
incorporating
physical
activity into
your daily
routine, activity
sheets, and
more!
Healthy Eating
Kid-friendly
recipes, menu
planning guides,
healthy eating
tips, shopping
lists, and more!
Tip Sheets
Tips for parents
Resources for families
Nutrition & Physical Activity
Curriculum (with DVD)
Action Story
New Fruits and Veggies at the Market
Healthy recipes
Healthy eating
and activity tips
for you!
Posters
Breastfeeding Resource Kit
Free Online Trainings
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
One for every
LMCC goal
Special topics
 Farm
to
Preschool
 Using LMCC
resources
Stretch Time!

Moving like an animal:
 Prowl
like a lion
 Hop like a bunny
 Strut like a flamingo
 Swing your trunk like an
elephant
 Tip toe like a mouse
Sign Up & Let’s Move! Child Care Quiz
LMCC Steps
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1.
Sign up online to receive a participation
certificate and get emails from LMCC
www.HealthyKidsHealthyFuture.org
2.
Take the Checklist Quiz to see how you are
doing in the goal areas
3.
4.
Build your Action Plan
5.
Retake the Checklist Quiz once best
practices have been met and earn the
LMCC Provider Recognition Award
6.
Share your success story
Use the free online tools and resources to
help implement your action steps
Take the Checklist Quiz
www.HealthyKidsHealthyFuture.org



The Checklist Quiz can be taken any time on the
LMCC Website: www.HealthyKidsHealthyFuture.org
Fun way to see where you are and make a
manageable action plan to achieve the LMCC goals
You choose your priorities -- start with whatever is
going to be easiest and then build on your success
Small Group Discussion
Consider key challenges to meeting
the LMCC Best Practices in the
Child Care Setting
Choose one person to report out to
the group
Action Planning
Action Plan using the Checklist Quiz



Action Planning is an important step to help you
make changes
You choose your priorities
Start where you and your program are most
likely to be successful

Be ready to create individual action steps

Samples are available
Sample Action Plan
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Tips From Providers that Work!
Nutrition
www.HealthyKidsHealthyFuture.org



Mix it up — serve a variety of nutritious choices.
Opt for healthier alternatives.
Let children participate in preparing food, if
possible.
-special jobs (like stirring and adding ingredients) makes kids
feel like helpful "big boys" and "big girls" and proud of what
they created

Have kids create their snacks.
Nutrition
www.HealthyKidsHealthyFuture.org

Learn about how food grows.
-Plan field trips to the local farmers’ market or pick your-own-farm, garden
with the kids to talk about where food comes from and to pique their
interest in trying the new produce they see

Don’t use food as a reward or punishment.
-Avoid forcing children to finish the “healthy foods” to get to their dessert or
sweets.


Talk about “sometime” vs. “anytime” foods.
Reinforce nutrition messages with classroom
activities.
Ways to Make Family Style Dining Work

Let kids practice serving themselves first


Use the right equipment




Use play food, like plastic fruits and
veggies.
Use child size pitchers, tongs, and serving
bowls and plates.
Put dressings and dips in child size
squeeze bottles.
Be prepared for spills!
Show kids you enjoy eating healthy
foods. They will follow your example!
Ways to Promote Healthy Drinks





Take water jugs and cups with you outside.
Try adding fruit slices or berries to water for an extra
fun taste!
Try diluting 100% fruit juice with water to train
children’s palette to enjoy less sweetness.
Model healthy drinking by avoiding sugary drinks in
front of children.
Instead of juice, serve fresh fruit, which includes
important dietary fiber and is a natural source of
energy.
Ways to Reduce Screen Time

Keep the TV/computer out of sight
Put it in rooms not used by children
 Hide it with a blanket or sheet
 Get rid of it


Replace screen time with fun, interactive activities
Turn on the radio or a CD and dance
 Play outside
 Bring kids into the kitchen and let them help you set the
table, cook, and clean up

Ways to Support Breastfeeding




Educate teachers and staff about the importance of
breastfeeding and how to properly handle breast
milk.
Respect parents’ wishes to give breast milk, infant
formula, or both.
Reassure nursing mothers.
Create an ideal environment to pump or nurse.
Success Stories
www.HealthyKidsHealthyFuture.org
Neighborhood House Association
Head Start: San Diego, CA
www.HealthyKidsHealthyFuture.org



26 Head Start and Early
Head Start centers in San
Diego
Hired a Registered
Dietitian and professional
chef who spearheaded a
menu overhaul
Engage in Farm to
Preschool
Break Time!
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
MARCH to your break and pretend to play your
favorite instrument. Have someone guess which
instrument you are playing!
Back to Action Planning
Sharing & Role Play
Examine one specific goal and
discuss solutions to potential barriers
that might arise for parents and/or
providers.
Choose a partner to role play with
and create a solution to the barrier.
LMCC Process Snapshot
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Sign Up
on
Website
Take
Checklist
Quiz
Meet all
best
practices?
YES
NO
CONGRATULATIONS!
LMCC Recognition
Award
Make Action
Plan
Implement Steps
in Plan
Free online tools,
resources,
webinars, help
from trainers
www.HealthyKidsHealthyFuture.org
Success Stories (within “Ideas and Resources”)
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
Learn from others and
overcome challenges

Submit Success Stories

May be highlighted in
e-mail blasts, articles or
on the LMCC website

Inspire others to achieve
the LMCC goals

Be recognized for
outstanding efforts
Technical Assistance & Feedback
Complete Feedback Form
Questions & Answers
Next Steps
For more information
Visit www.HealthyKidsHealthyFuture.org
Contact the Let’s Move! Child Care Help Desk
LMCChelp@cdc.gov
Share your success stories!
www.healthykidshealthyfuture.org/resources/
testimonials.html