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-ChairExecutive 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 Move-

Michelle Obama’s initiative to prevent obesity- www.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

• 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 throughMaternal and Child Health Bureau, Health

Resources and Services Administration, USDHHS Cooperative Agreement (MCHB)

Caring for Our Children (CFOC) Partners

• 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.

• Pediatricians• Maternal and Child Health Professionals• Nutritionists• Other Health Professionals

– Nursing, Social Work

• Breastfeeding Experts• Physical Activity Experts• Child Development Specialists

Expert Panel Members

• NUTRITION – variety of healthy foods– promote positive mealtime environment

• PHYSICAL ACTIVITY – daily indoor & outdoor activities

• SCREEN TIME– limited

Nutrition and Physical Activity Comprehensive Standards

• 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

How Standards Address Problem

• 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

Opportunities for Early Care and Education Programs

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

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

• 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

Nutrition 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

Physical Activity 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

Screen Time Standards

Applying the 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.

Using “Preventing Obesity” CFOC Standards

• 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.

http://nrckids.org/CFOC3/PDFversion/preventing_obesity.pdf

Public Health, Seattle & King County grant:

Communities Putting Prevention to Work

from the CDC

Applying the Standards

Community Pediatric Foundation of

Washington with the Coalition for Safety and Health in Early Learning

(www.cshelwa.org)

• 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

King County Healthy Active Kids

• 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

Two Activities

• 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

Policy and Curriculum Tools

• 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

Train-the-Trainers

• Findings from Focus Groups with Child Care Providers and Parents

• www.altarum.org/publications-resources-health-systems-research/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 OpportunitiesRelated 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.

Challenges and OpportunitiesRelated to Implementation of Child Care Nutrition

and Physical Activity Policies in Delaware May, 2010

• 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

Train-the-Trainers

• 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

State Policy Work

• Farm to table programs

• Bulk buying

• Facilitated system

Increase Access to Healthy Foods

Questions?