CACFP National Professional Association
Conference
St. Louis, MO
April 2, 2014
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
Session Objectives
www.HealthyKidsHealthyFuture.org
After participating in this session participants should be able to
answer the following questions:
1
2
3
What are best practices for obesity prevention in
child care?
What steps should child care providers take to meet
the 5 LMCC goals?
What kinds of free tools and resources are available
through LMCC to help providers improve nutrition,
physical activity, screen time, and breastfeeding
support in child care?
Obesity
www.HealthyKidsHealthyFuture.org
Common
Costly
Solvable
Photo source: www.obesityinamerica.org
What about young children?
www.HealthyKidsHealthyFuture.org

Too many U.S. preschoolers (2 – 5 years) are
obese

23% are overweight or obese (~4% decline)

Why still important?
 Overweight
5 years olds 4x as likely to become obese
(January 2014; NEJM)
Changes in Our Society & Environment
 More foods with high
calories
 Growth of the food industry
and advertising

More TV watching

Less physical activity
More labor assisting
devices
 More meals away from
home

 Extraordinary portion sizes

Lack of sidewalks
 Consumption of soda &
sweetened beverages

Automobile travel

Perception of safety
Calories in
Calories out
6
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
Healthy
Kids,
Ready to
Learn
Physical Activity
Healthy Eating
Why obesity prevention in child care and
early education programs?

Habits form early.

Prevention must start early.

11 million children spend 30 hours/week in care.

You are in a unique position to educate providers.
Let’s Move! Child Care Overview



One component of the First Lady’s
Let’s Move! initiative to solve the
obesity problem
Supports providers to adopt best
practices in 5 goal areas through
free resources and interactive,
online tools
Recognizes providers who meet
best practices
5 Let’s Move! Child Care Goals
1
Physical Activity
2
Screen Time
3
4
5
Food
Beverages
Infant Feeding
Physical Activity Best Practices


Infants: Short supervised periods of tummy time
several times each day (3-5 min, longer as
tolerated)
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)
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
Benefits of Physical Activity

Helps children:
 Develop
motor skills and build their
strength, flexibility, and endurance
 Develop and maintain strong bones
 Improve social skills and brain
development
 Sleep better
 Feel confident about themselves
and their bodies
 Reduce their risk of feeling stressed
or depressed
Kinds and Intensity of Physical Activity
KINDS
1. STRUCTURED: Organized, quick, and intense
activities led by adults
2. UNSTRUCTURED: Free Play to stimulate the
imagination and creativity
INTENSITY
Moderate to vigorous physical activity MVPA
(aka ‘breathless’ play)
Screen Time Best Practices



Infants: No screen time
Toddlers: No more than 3 – 4 times per year, or
never
Preschoolers: Only for educational or physical
activity purposes
No more than 30 minutes per week or never, while in your
care
 Work with families to ensure no more than 1 - 2 hours per
day

Screen Time Best Practices

Parents:
 Provide screen time reduction and/or media
literacy education to parents at least twice a
year,
 Special programs, newsletters, information sheets,
etc.
Rationale


Gets in the way of exploring,
playing, and social interaction.
As kids get older, gets in the
way of:






being active
reading
doing homework
playing with friends
spending time with family
Kids who spend more time
watching TV are more likely to
be overweight or obese.
When screen time is allowed:



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
Food Best Practices

Toddlers and preschoolers
 Serve a fruit and/or a vegetable at every meal
 Juice doesn’t count as fruit*
 French fries, tater tots, and hash browns don’t
count as vegetables!*
*Conflicts with CACFP meal requirements
 Limit
fried and pre-fried foods: no more than
1/month
 French fries, tater tots, hash browns, potato chips,
frozen and breaded meats or fish
Food Best Practices

Preschoolers:
 Serve all meals family style when possible so
that children are encouraged to serve themselves
with limited help.
Food
www.HealthyKidsHealthyFuture.org



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
www.HealthyKidsHealthyFuture.org

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
Food
www.HealthyKidsHealthyFuture.org

Benefits of family-style dining
 Opportunity for positive role
modeling
 Adults at the table help prevent
fighting, feeding each other,
potential choking, and other
negative behaviors
Beverages Best Practices




Water: Visible and available inside and outside for selfserve
Fruit juice: Only100%; limited to no more than 4 – 6 oz.
per day per child* and encourage parents to support this
limit *Conflicts with CACFP meal requirements
Sugary Drinks: Never
(includes fruit drinks, sports drinks, sweet tea, and soda)
Milk: Serve only 1% or non-fat (skim) milk to children 2
years and older (unless otherwise directed by the child’s
health provider)
Beverages
www.HealthyKidsHealthyFuture.org




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
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
Infant Feeding Best Practice
Have a private room for
moms to breastfeed or
pump


other than a bathroom
appropriate seating and
privacy
Have the space available for mothers who want
privacy; but allow breastfeeding openly too.
Take A Look
Drop of formula
vs. Drop of breast milk
White blood
cells protect
against
infection
Fat globules
help eyes
and brain
grow faster
Create a space for breastfeeding or
expressing milk

Pick a private space other than a bathroom

A privacy barrier could be:
 Door
 Curtain
 Room
divider
Breast Feeding



Provide training on handling
of breast milk for providers
Expressed milk is food from
home NOT bodily fluid
requiring special precautions
Create breastfeeding
friendly signs and handouts
to encourage mothers who
choose to breastfeed to
continue
Sign Up & Let’s Move! Child Care Quiz
Visit www.HealthyKidsHealthyFuture.org
www.HealthyKidsHealthyFuture.org
Simple Steps
Sign up
Take
Checklist
Quiz
Become a
Recognized Let’s
www.HealthyKidsHealthyFuture.org
Move! Child Care
Provider & celebrate
your success!
Yes
Meet all
best
practices?
No
Make
changes
in plan
Build
action plan
Use free online resources & tips
Centers and providers can post their participation certificate to let
families know the goals
they’re working towards!
Take the Checklist Quiz
Providers can see where
they are and make a
manageable action plan to
achieve the LMCC goals
Look for the ‘Take Action’ box
on the homepage.
Checklist Quiz
Providers answer questions to see which best practices
they are meeting and which goals they need to work on
Available in Spanish too!
Action Plan using the Checklist Quiz



Action Planning is an important step in making
changes
Providers choose their priorities
Start where they are; where the program is most likely
to be successful

Be ready to create individual action steps

Samples are available
Sample Action Plan
www.HealthyKidsHealthyFuture.org
www.HealthyKidsHealthyFuture.org
Recognized LMCC Providers:
Get a
Recognition Award
Are Featured on the
LMCC Map
What Kind of Resources Can Providers
Find?

Curricula

Training videos

Menu Planning &
Recipes

Activity Sheets

Parent Handouts



Tips to eat healthier
and be active
CACFP specific
resources
And more!
Free Online Trainings for Providers
More trainings coming soon!
Slide sets for Trainers

Overview of LMCC
and 5 in-depth slide
sets for each of the 5
LMCC goal areas
 Best
practices &
rationale
 Tips
& Resources
 Activity
 Videos
ideas
& ideas for
handouts
Ideas and Resources
www.HealthyKidsHealthyFuture.org


Ideas and resources
are key to improving
healthy environments
for young children
Available resources
include:





Webinars
Tips and
encouragement
Activities
Provider successes
External child
care resources
websites
Healthy Eating
www.HealthyKidsHealthyFuture.org

Healthy Eating and
Physical Activity tabs
offer:


Tips, resources, online
tools and activities
Educational
information:




Videos
Articles
Parent resources
Suggestions for
programs to meet
components of LMCC
goals:


Policies
Practices
Sample Resources
www.HealthyKidsHealthyFuture.org
Articles from KidsHealth.org
Toolkits and Guides
Tip Sheets
Books to encourage healthy habits
Read this tale about water to kids!
Videos
Supporting Breastfeeding Moms
Adding Physical Activity
to Your Daily Routine
Starting Family Style Dining
Resources for Families
Letter about Screen Time
Handout on Picky Eating
Blogs and E-mails
Visit: www.letsmove.gov
Put your thinking caps on!
www.HealthyKidsHealthyFuture.org
Form groups of 3 or 4
and discuss:
3 ways State agencies
can promote LMCC
and support centers
and providers to meet
the best practices.
Join us! April 22-24, 2014
New Orleans, LA
www.HealthyKidsHealthyFuture.org
For more information
Visit www.HealthyKidsHealthyFuture.org
Contact the Let’s Move! Child Care Help Desk
LMCChelp@cdc.gov
Share your success stories!
in Minnesota
MARY MIKKELSON
Minnesota Department of Education
Why are you here today?

Why are we here?
We see a need for continued improvement for the health
of our children
 We are short on time and need assistance with health
promotion activities


Where do we want to be?
Children who are healthy and ready to learn
 Childcare programs that model good nutrition, physical
activity and other health habits

How will we get there today?

Key Aspects of Minnesota LMCC Initiative
Background
 Development and Promotion
 Results and Lessons Learned
 Next Steps


Generalizing aspects to your program

What action steps will you take as a result of today’s
presentation?
Learning Objectives
1) Identify the process of development and
implementation used for statewide LMCC initiative
2) Describe how the LMCC Initiative was strengthened
through statewide partnerships
3) Generalize aspects of the initiative to other
programs
4) Determine the next steps to “move” LMCC farther
in your program
Background

Minnesota Team Nutrition Program

2-year grant from USDA awarded to state agencies that
administer the Child Nutrition Programs (CNP)

Focus on wellness initiatives in the School Nutrition (SNP) and
Child and Adult Care Food Programs (CACFP)

SNP activities focused on strengthening local wellness policies

CACFP activities focused on strengthening wellness activities
through Let’s Move Childcare
Background
Background

Team Nutrition and Let’s Move Childcare-an ideal
partnership

Goals of both programs well-aligned

From Team Nutrition Perspective-promote wellness while also
continuing to prepare providers for CACFP reauthorization

From LMCC Perspective-Team Nutrition provided the staff time
and resources to conduct initiative
Background


Team Nutrition, LMCC and MN Family Daycare Homes-an
even more ideal partnership
Family Daycare Home Statistics

8,900+ total family daycare providers on the CACFP in MN




Third in the nation behind California and New York
Reaching between 8-14 children (and families) per home
Administered through 8 sponsor organizations across the state
Sponsors are the “face” of the Food Program 
Background

Team Nutrition, LMCC, MN FDCH Sponsors and the MN
Statewide Health Improvement Program-the ultimate
partnership

Opportunity to build upon prior work

Minnesota Statewide Health Improvement Program (SHIP)


Let’s Move Childcare Trainings
Child care setting-now mandatory strategy
Background

Opportunity to build upon prior work

One Sponsor’s Viewpoint: Providers
Choice Inc.
 LMCC
allowed us to build on prior
training topics of increasing whole
grains, fruits and vegetables in
children’s meals.
 Results
provided ideas for additional
training
Development

Decided to focus LMCC initiative on family daycare
homes

Unique Opportunities Working with Homes



Less formal structure than centers-ability to adopt/support new
initiatives
Modeling what can occur in child’s own home
Unique Challenges Working with Homes


Communication-no direct access
Logistics of distribution of materials, etc.
Development

Importance of Partnerships



Relied on the 8 family daycare home sponsors in Minnesota
Involved from the beginning of development
Sole means of communication for initiative

State agency --- sponsor organizations --- sponsor program monitors --providers
Development

Determined goals of initiative based on prior work
and goals of all partners
Promote wellness activities of Let’s Move Childcare
 Continue to expose providers to impending CACFP meal
pattern changes
 Track provider’s current state
 Allow for provider goal setting

Development

Decided to host the LMCC quiz at alternate website
to allow for:
State Agency access to results
 Additional goal setting related to impending CACFP meal
pattern changes


Limitation: Promotion of LMCC national website, but
unsure how many of our providers also signed up
through LMCC national
Development

Used same assessment questions as LMCC website:

15 questions, 5 goal areas:






Physical Activity
Nutrition
Screen Time
Healthy Beverages
Infant Feeding
4 choices for answers:

Fully Meeting, Making Progress, Ready to Get Started or Unable to
Work On
Development

Included goal setting question from LMCC survey

Also required providers to set 1 CACFP meal pattern goal

Related to IOM recommendations for CACFP and Healthy Hunger Free
Kids Act Requirements for SNP

IOM Recommendations:
Development

CACFP meal pattern goal choices, providers will serve:
 Fresh fruit 3x per week for breakfast
 Fresh fruit 2x per week for snack
 1 fruit and 2 vegetables at each lunch
 1 fruit and 1 vegetable or 2 vegetables at each supper
 A dark green vegetable at least 2x per week for
lunch/supper
 An orange vegetable at least 2x per week for
lunch/supper
Development

CACFP meal pattern goal choices, providers will:
Legumes at least 1x per week for lunch/supper
 Corn, potatoes, green peas and green lima beans no more
than 2x per week for lunch/supper
 Limit fruit juice to no more than 1 serving per week at
breakfast
 Make half of the grains served per week in all meals
whole grain rich


Providers were to select 1 goal and agree to
maintain it for at least 1 month (honor system)
Promotion

Created packet for 70+
sponsor monitors who visit
homes 3 times per year


Eatin’ to the Beat
Instructions on:
How to promote initiative
 Flyer to be handed out to
providers
 Nutrition Instructional materials
for whole grains and vegetable
subgroups

Promotion

Incentives

Team Nutrition provided stipends to
sponsors to purchase educational
incentives for participants

Incentives were additional motivation
for providers to participate

Sponsors held a drawing for
participating providers
Nutrition Island Game
Promotion

Sponsors Perspective on Promotion

PCI Promoted in a number of ways:

Face to Face on monitoring visits

E-mail blasts

Newsletter articles

Food Program Training Workshops
1,293 PCI providers took the LMCC survey and set goals.
Results

1,674 total providers participated in the survey and
CACFP goal setting initiative

Approximately 18% of total MN FDCH providers participating
in the CACFP

Allowed answer of “Not applicable” if not serving the age
group specified
Results-Toddlers and Preschoolers
100% fruit juice is limited to 4-6 fl oz per day
1600
1400
1200
1000
800
600
400
200
0
Fully Meeting
Making Progress
Ready to Start
Unable to Work On
Not Applicable
Results-Toddlers and Preschoolers
Fried potatoes limited to 1x/month
1600
1400
1200
1000
800
600
400
200
0
Fully Meeting
Making Progress
Ready to Start
Unable to Work On
Not Applicable
Results-Toddlers and Preschoolers
Fried/breaded meats limited to 1x/month
1600
1400
1200
1000
800
600
400
200
0
Fully Meeting
Making Progress
Ready to Start
Unable to Work On
Not Applicable
Results-Toddlers and Preschoolers
Active Play Per Day
Toddlers: 60-90 minutes Preschoolers: 120 minutes
1600
1400
1200
1000
Preschoolers
800
Toddlers
600
400
200
0
Fully Meeting
Making Progress
Ready to Start
Unable to Work On
Not Applicable
Results-Toddlers and Preschoolers
Screen Time
Toddlers: 3-4x/year
Preschoolers: 30min/wk
1600
1400
1200
1000
Toddlers/Infants
800
Preschoolers
Parent Education
600
400
200
0
Fully Meeting
Making Progress
Ready to Start
Unable to Work On
Not Applicable
Results-CACFP Goal Setting
600
500
400
300
200
100
0
Make 1/2
Fresh Fruit
Dk Green Veg Juice 1x/wk at
Fresh Fruit Legumes 1x/wk Orange Veg
grains WGR 2x/wk for snack
2x/wk
brkfst
3x/wk at brkfst
2x/wk
Starchy veg 1 Fruit + 2 Veg
2x/wk or less
at lunch
Results-Sponsor Stories


Provider Spotlight – Featured one of the
providers who received the Nutrition
Island Game on our Website
Certificates of Commitment mailed to all
Providers who completed the LMCC
Survey
Results-Promoting Success
Next Steps

State CACFP Wellness Advisory Group

Team Nutrition Grant
Web-based training on Dietary Guidelines
 Partnership with Cornell University for “Smarter
Lunchrooms” Behavioral Economics training


Current SHIP strategies
Created assessment using LMCC and NAPSACC
 Provides direction for additional technical assistance and
training

Generalizing to Your Program

Form strong partnerships

Gather input from the planning stages

Develop a strong project plan from start to finish

Listen to your sponsors

Communicate clearly

Market and promote

Provide incentives

Celebrate participation and success
Generalizing to Your Program

Don’t forget why we’re in this--to impact kid’s lives!
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