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This is part of our Latina Mom and Baby Health: A Research Review »
Children spend many hours in early childcare settings
Most young children spend a significant amount of time in day care, preschool, pre-kindergarten (pre-K), and Head Start programs.164
An estimated 60 percent of children younger than 6 are placed in some form of non-parental care during the work week, averaging.164 nearly 30 hours per week.
This presents an opportunity for childcare centers and providers to encourage healthy behaviors in young children and to better educate parents on how to continue healthy behaviors at home.164
Early childcare settings can promote healthy behaviors
Evidence from the literature supports the notion that childcare is an important resource for promoting healthy behavior among children ages 2-5.
Nutrition interventions and following nutrition guidelines in this setting can improve children’s diets by decreasing fat intake and increasing fruit and vegetable consumption.165–169
Physical activity interventions in preschool and childcare can increase children’s activity levels and have a positive impact on fitness and motor skills.169–172
There have also been reports that targeting nutrition and physical activity in this setting can benefit measures of a child’s adiposity (i.e., weight, body fat, or BMI); however, fewer studies have investigated this correlation.165,173,174
Programs to promote health in childcare settings
A 2014 study evaluated the effects of an early childhood obesity prevention program implemented at 4 childcare centers compared with four non-intervention control centers.175 Children at intervention centers received healthier menu options and family-based education promoting increased physical activity, decreased screen time, more fresh produce consumption, and fewer simple carbohydrate-based snacks.
Results demonstrated that there was a significant inverse correlation between children’s BMI scores and the number of home activities completed by six months after the intervention. Additionally, children in the childcare-based intervention group consumed less junk food and drank less juice, while eating more fresh fruits and vegetables and drinking more 1 percent milk versus children at control sites.175
In recent years, the U.S. Department of Health and Human Services issued the Surgeon General’s Vision for a Healthy and Fit Nation.176
This report promoted the importance of childcare centers and early childhood education programs in implementing strategies to meet expert recommendations on physical activity, screen time, proper nutrition, and healthy sleep. It also emphasized the role of childcare providers in helping to educate parents on how to promote these healthy habits at home.
Childcare providers are called to: identify effective approaches for promoting healthy behaviors, establish best practices, stay current through regular training, and educate parents in training activities.176
State regulations regarding effective policies may vary according to state and type of childcare center.176
For instance, federally-funded Head Start regulations may differ from those encountered in a state-funded pre-K program or a private, family-based childcare setting.176 The Surgeon General’s report called for standardized national goals surrounding the issue of early childcare regulations, particularly as it relates to those for achieving a healthy weight.176 Sample recommended policies from this report include: requiring a mixture of structured and unstructured daily physical activity, following national recommendations to establish nutrition requirements, implementing a structured training approach for childcare providers to expand their knowledge on how to promote healthy eating, physical activity, and parent education in their practice, and providing parents with materials that will help in reinforcing these healthy practices at home.176
In January 2015, the United States Department of Agriculture (USDA) proposed a new rule that would revise the nutrition standards for the Child and Adult Care Food Program (CACFP) in the United States.177 Should the proposed changes be implemented, meals with a greater variety of fruits and vegetables, more whole grains, and less sugar and fat will be provided to children in day care.
The proposed CACFP meal patterns would help to promote healthy, balanced meal habits in this setting in an incremental manner that should not increase costs for childcare providers. This marks the first significant CACFP meal pattern revision since the program’s inception in 1968.177 Pending approval, this policy may have more universal implications on establishing healthy eating patterns and corresponding health outcomes for participating children.
Best practices for early childhood obesity prevention
The IOM has issued two reports outlining best practices in early childhood obesity prevention.178,179
In addition, comprehensive national standards for the childcare setting have been outlined by the AAP, APHA, and National Resource Center for Health and Safety in Childcare and Early Education.180
These standards address important areas of opportunity for encouraging healthy eating and sufficient physical activity among children in the childcare setting:
Healthy eating: According to national standards,178–180 measures to ensure healthy eating in childcare may include serving healthy, age-appropriate beverages, such as water as a substitute for fruit drinks and soda, and offering low-fat milk options. Also, providing a balanced diet with a variety of fruits and vegetables, whole grains, lean protein, and minimally processed foods.
Facilities should avoid high-calorie, low-nutrient foods, including salty snacks or foods high in saturated fats. In addition, care should be taken to follow age-appropriate feeding habits, such as no mixing of cereal or juice in infant formula bottles and no fruit juice for children under 1 year of age. Avoiding overfeeding by staying aware of cues that an infant is full and waiting until an appropriate age to begin introducing complementary foods is also advised.
As children age, childcare providers should allow them to regulate their own food intake by offering meals or snacks every few hours and providing small portions. Children should be seated and undistracted during mealtime, and childcare providers should sit and eat with children to encourage positive, healthy mealtime behaviors. In addition, food should not be used as a reward or a punishment in the childcare setting.178–180
Physical activity: In addition to healthy nutrition and mealtime habits, standards have also been outlined for appropriate levels of physical activity, screen time, and sleep. This is especially important for Latino children in low-income areas, as they may have limited access to safe outdoor spaces to engage in active play outside of childcare.196
Overall, daily physical activities should be offered during childcare, including time to play in a safe, outdoor space.178–180 It is helpful to have a written policy outlining plans to promote physical activity and train childcare staff on age-appropriate activities. Infants should have appropriate tummy time on a daily basis, toddlers should have 60-90 minutes of vigorous physical activities interspersed over short, regular bursts, and children of preschool age require 90-120 minutes of such activity per day.
Childcare providers should lead and participate in structured games or activities to model active play in an encouraging, positive fashion. Television, video game, or other screen time and sedentary time should be limited. This includes not allowing any screen time for children younger than 2, and limiting that for ages 2 and older to less than 30 minutes per week. Screen media should also be removed during naptimes to encourage healthy sleeping habits. Establishing a calming naptime routine is also recommended.178–180
Training parents: In addition to promoting these healthy habits during childcare hours, providers should also be trained to educate parents.178–180
Childcare providers should encourage families to get involved in healthy eating approaches by providing parents with nutrition guidelines and copies of menus, while initiating conversations about the importance of healthy eating habits. Providing mothers with breastfeeding resources and an on-site location for breastfeeding is also encouraged.
In addition, providers are encouraged to work with parents to develop a plan for appropriately timing the introduction of complementary foods for infants. The facility’s policies for promoting physical activity, limiting screen time, and cultivating healthy sleeping habits should also be shared with parents. This may encourage parents to continue reinforcing healthy habits with their children at home.178–180
A study of Latino childcare providers in a family, home-based setting reported that the low-income, majority Latino children in their care typically have home environments that are not conducive to healthy eating and physical activity patterns.190 They stressed that engaging and educating parents in these areas was an important responsibility. Several other focus group-based studies have supported the claim that childcare providers are crucial for engaging and educating parents in healthy eating and physical activity behaviors.193,197,198
It is important to note that other members of the community such as peers, family members, or community and religious leaders may also play an important role in promoting healthy parenting choices.
The importance of Pre-K programs
Pre-K programs, including the federally funded Head Start program for low-income children, are an example of interventions designed to encourage a healthy foundation for preschool-aged children (ages 3-5).
These programs often follow more strict regulations aimed to prepare kids for kindergarten and ensure that they are succeeding by third grade.181
For instance, federally mandated regulations for Head Start programs place strict requirements on nutrition, adequate time and space for active play, and parental involvement and education.181
As Head Start programs are generally restricted to families in poverty, where obesity rates tend to be higher than national estimates,182–185 this may be an important arena for early childhood obesity prevention in Latino youths.
One study of 423 primarily Mexican-American preschool children (90% Latino) in Head Start centers in San Antonio, demonstrated that an obesity prevention program was able to significantly increase outdoor physical activity and intake of healthy food among children who participated in treatment groups.186 In addition, measures of relative weight (adjusted for child age and sex) were positively improved for children participating in a combined center- and home-based intervention compared with those in the control group.186
Furthermore, a small study at a single Head Start program in 2010 demonstrated that children experienced healthy changes in BMI over the course of the academic year.187
An additional study published in 2015 monitored changes in BMI across 12 Head Start programs in Michigan, compared with two age-matched sample populations from a primary care setting (one Medicaid sample and one non-Medicaid).188
Results demonstrated that children who were obese or overweight upon entering Head Start experienced a significant reduction in BMI-for-age percentiles over the course of the first academic year. Importantly, this reduction was greater than that observed in the two control populations. The improvements in BMI were maintained during the second academic year, although no additional significant changes in BMI occurred.
After completion of the two-year study period, children who had entered Head Start obese or overweight were significantly less obese/overweight than children from comparison groups. Investigators concluded that, among the other reported social and educational benefits of Head Start,189 program participation offered “robust, early, and sustained improvements” on children’s BMI. Children in the Head Start program had significantly healthier BMIs upon entry into kindergarten than those either enrolled or not enrolled in Medicaid.
Latino families often express a preference for childcare in a family-like setting and tend to use preschools and day care centers less often than other ethnic groups.160
One recent study in Massachusetts conducted Spanish-speaking focus groups with licensed Latino family childcare home (FCCH) providers.190
These providers indicated that they play an important role in promoting healthy eating and physical activity habits among preschool-aged children in low-income, Latino communities. Latino providers in this study also expressed the feeling that they had a responsibility for engaging and educating parents in these healthy practices.
Results of the study were concomitant with findings from a group of Latino Head Start providers.191 However, they contradict another report that Latino childcare providers may promote negative eating behaviors, such as pressuring children to eat or providing rewards for eating certain foods.192 Barriers identified by Latino FCCH providers included prohibitive prices of healthy foods, weather restrictions to outdoor play, and the physical environment of the FCCH.190
It is important to note that interventions tailored for home-based FCCH services may face both logistical and financial constraints; for instance, these facilities are often limited in terms of access to appropriate indoor and outdoor spaces for physical activity.193–195
More from our Latina Mom and Baby Health: A Research Review »
- Introduction & Methods
- Key Research Finding: Maternal obesity
- Key Research Finding: Breastfeeding
- Key Research Finding: Breastfeeding promotion
- Key Research Finding: Marketing of infant formula
- Key Research Finding: Latino infant habits
- Key Research Finding: Early childcare settings (this section)
- Policy Implications
- Future Research Needs
References for this section »
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