Gold Sneaker Initiative

1. Gold Sneaker Initiative Child care facility staff Training Packet ~ Take it back and enact! Use this presentation to present the information to staff within your facility to enact the Gold Sneaker initiative. This packet is also available as a power point presentation online at http://health.state.tn.us/goldsneaker.htm

2. Instructions • Read and follow the presentation for presenting to staff. • During the training session, you may want to provide handouts for your staff that were included in the implementation packet such as the physical activity handouts, the breastfeeding scenarios and sample infant feeding plan, and required forms. You may choose which ones to include.

3. Vision • To enhance policy related to physical activity and nutrition within licensed child care facilities across the state of Tennessee with the hopes of building lifelong skills for living a healthy life. Child care facilities will enact specific policies and will be recognized as a Gold Sneaker facility. • Funded by National Governors Association, with funds from Robert Wood Johnson Foundation.

4. Why? • Tennessee ranks 47th in the nation for overall health status according to the United Health Foundation. • Statistics from Tennessee’s Coordinated School Health Program demonstrate that up to 46% of our school age children are overweight, or at risk of becoming overweight. • The Department of Health data set, measuring yet a different sample of school children, has found similar astonishing results showing 42% of Tennessee’s children being overweight, or at risk of becoming overweight. • With Tennessee leading the nation for mortality and morbidity related to heart disease, stroke and diabetes, coupled with high rates of obesity – the future looks grim. • According to research, health habits are instilled at a young age, with most habits being formed during adolescence. Following adolescence, as we see with adults, habits become much harder to change. If we can instill good habits at an early age, we can address behavioral factors that contribute to overweight and obesity from the beginning; early adoption of healthy behavior is important to prevent or delay health problems. In Tennessee, we have taken advantage of the opportunity to impact the states children through the Coordinated School Health Program reaching all children enrolled in the public school system. At this time, we wish to target the infant, toddler and preschool age children within the state. Such a focus allows for a continuous approach in reaching Tennessee children from the beginning of childhood to the end.

5. Gold Sneaker Policy 1.1 • Children ages 12 months or older attending a full day program shall be scheduled to participate in at least 60 minutes of physical activity per day. Children attending less than a full day program shall be scheduled in a proportional amount of such activities. For children ages three and older, at least 30 of the 60 minutes shall be guided physical activity. The remainder of the physical activity may be other active play, learning and movement activities.

6. Gold Sneaker Policy 1.1 • Structured and guided physical activity shall be facilitated by teachers/caregivers and shall promote motor skill development, basic movement, creative movement, and general coordination. Such structured and guided physical activity shall consist of curricula developed by, and resources recommended by the Department of Health, Department of Human Services and the Child Care Resource & Referral Network. This must be documented on forms provided with the Gold Sneaker initiative.

7. Gold Sneaker Policy 1.1 • Child care centers shall document physical activities on forms for that specified purpose and make such documentation available to the Department of Health for maintenance of the Gold Sneaker designation. • Adequate periods of outdoor or indoor play shall be provided daily for all children, requiring that children be appropriately dressed for outdoor play associated with the weather conditions.

8. What is Physical Activity? • PA is any bodily movement produced by skeletal muscles that results in an expenditure of energy (expressed as kilocalories) and includes a broad range of occupational, leisure-time, and routine daily activities. • Children must have the foundational motor skills, in order to prepare their bodies for physical activity as adults. • These activities can require either light, moderate, or vigorous effort and they can lead to improved health if they are practiced regularly (USDHHS)USDHHS = United States Department of Health and Human Services

9. Guided Physical Activity • Assisting children in reaching goals through physical activity • Guidance • Organized • the individual or the team work towards a common goal • What are some examples? Lead a discussion of examples. • - Anything that someone leads or provides instruction • See handout previously provided in implementation packet – discuss, and provide a copy to staff if desired

10. Activities for 12 – 16 months

11. Balls Down the Tube • This activity targets increased motor skill development • The act of placing balls in the tube • Retrieving the balls from the basket and starting over

12. Running Galloping Jumping Hoping Skipping 1 ½ years 2 – 2 ½ years 2 ½ -3 years 3 -4 years 4-5 years Desired Outcomes Early Childhood These are milestones that children should be able to achieve for coordination, balance, and major motor skill development by these ages. Like the saying you have to learn to walk before you run.

13. Activities for Ages 2-5

14. Coaching Guided Physical Activity For these activities we encourage teachers and child care instructors to think of themselves as Coaches. A coach always believes in encouragement the spirit of “Yes you can, go for it, keep it up”. An effective coach lets people know that they believe they can succeed in an activity, offer needed attention, and stay focused on the potential, don’t be discouraged by the situation. See handout previously provided in implementation packet – discuss, and provide a copy to staff if desired “Top ten ways adults can help preschoolers enjoy being physically active” – this handout is included in the implementation packet, following information on policy 1.1

15. Is this Activity Safe? Check list for developing active play: • Are there enough instructors per child (1 instructor/5-6 children) • Is this activity safe • Does this activity require equipment • What will the child learn from the activity • Is this appropriate learning for this age child • Is there a warm up activity • Debrief with instructors after activities • see handout in implementation packet! • Have participants break into groups of 3-5 • They need to come up with an activity • Demonstrate that activity to the class • The entire class assess whether the activity is safe

16. Resources • Websites – try a Google search! • Books • Instructional Videos • Handouts Handouts • Play Messages - toddler • Play Messages – 3 to 5 year old • Low Tech Equipment for Kids

17. Document! Implement It! • Let staff know this will be/must be included in classroom lesson plans. • Must document physical activity on form provided. • Discuss form teachers have to complete daily. Ask if any questions.

18. Gold Sneaker Training Policy 1.2, 1.3, 1.4 and 1.8

19. Policy 1.2 The policy: • Television, video and other visual recordings shall not be used with children two years of age or younger. For children ages two and older, viewing of television, videos and other visual recordings shall be limited to no more than 60 minutes per day of educational programs or programs that actively engage child movement. • Children attending less than a full day program shall be limited to a proportionate amount of such viewing. This shall be stated in the individual child care facility’s policies.

20. Policy 1.2 • What can you do to ensure minimal use of such devices? • Roundtable discussion • Use completed worksheet from training to provide staff with ideas

21. Policy 1.3 The policy: • Children shall not be allowed to remain sedentary or to sit passively for more than 60 minutes continuously, except for scheduled rest or naptime. This shall be stated in the individual child care facility’s policies.

22. Policy 1.3 • What can you do to ensure minimal sitting time? • Roundtable discussion • Use completed worksheet from training to provide staff with ideas • Ideas: • Active storybooks • Active word recognition stories • Make anything a game – when counting, count your hops

23. Policy 1.4 The policy: Child care facilities must ensure physical activity, if used to control behavior, is used as a positive reinforcement and is never used negatively. This shall be stated in the individual child care facility’s policies. Important Points: • Every child has the right to daily physical activity. • Child care facilities must ensure physical activity is incorporated as a natural part of a child’s routine. There should be a variety of opportunities and many different options throughout the day for the child to work on and develop their gross motor and fine motor skills through play.

24. Policy 1.8 The policy: Food is intended to nourish the body; therefore no food, candy or drink shall be used to control a child’s behavior. All eating opportunities should consist of a respect for the child and promoting a positive attitude toward food. This shall be stated in the individual child care facility’s policies. Important Points: Controlling behavior with food can lead to automatic triggers for eating in the future and can lead to abnormal eating patterns and overeating. On the other hand, negative associations with food could also lead to eating disorders.

25. “How To Support A Breastfeeding Mother” Childcare Facility Gold Sneaker Initiative

26. Gold Sneaker Facility Policy 1.5 The policy: • Ensure appropriate infant and child feeding patterns, including breastfeeding. Staff will be sensitive to breastfeeding mothers and infants, and their eating patterns. Each breastfeeding infant will have a feeding plan on file, which is completed by the parent/parents and facility as a team to address their unique feeding patterns.

27. AAP Policy Statement • Breastfeeding is best • Exclusively for the first 4-6 months • Continue for at least 1 year • And as long thereafter “as is mutually desired” AAP = American Academy of Pediatrics

28. Benefits to Baby Reduced risks for: • otitis media • upper and lower respiratory infections • urinary tract infections • gastroenteritis; NEC in preemies • allergies • Obesity • Diabetes

29. Benefits for baby • Ulcerative colitis/Crohn’s disease • Childhood leukemias • SIDS • Enhanced brain and IQ development • Optimal mother-infant bonding • increased serotonin receptors in the brain • less dental malocclusion

30. Benefits for Mom • decreases post-partum bleeding • decreased anemia • weight reduction • reduced risk of breast cancer, especially premenopausal • ovarian cancer • endometrial cancer

31. Breastfeeding Benefits ~ child care facilities • Baby is sick less often. • Diapers have less odor. • Baby is happier. • Breastfed baby spits up less. • Less Colic. • Generally happy babies. • Less diaper rash.

32. AAP Recommendations • AAP = American Academy of Pediatrics • That breastfeeding continue for at least 12 months, and thereafter as mutually desired. • That arrangements be made to provide expressed breast milk if mother and child must be separated during the first year. • That breastfeeding be promoted as a normal part of daily life, and that the AAP encourages family and community support for breastfeeding. • That the media be encouraged to portray breastfeeding as a positive norm. • That employers be encouraged to provide appropriate facilities and adequate time in the workplace for breast-pumping.

33. Support of the Breastfeeding Mom • Praise • Support breastfeeding as the NORM!! • Complete the Infant Feeding Plan

34. Temperature 79 F / 25 C 66-72 F / 10 - 22 C 60 F / 15 C 32-39 F / 0-4 C freezer within fridge freezer unit deep freeze (0 F / -19 C) Time 4 - 6 hours 10 hrs 24 hrs 8 days 2 weeks 3 - 4 months at least 6 months Storing that Liquid Gold Most people think of breastmilk as being very fragile … that it requires a lot of special handling …. Not true! There are properties in breastmilk that actually destroy bacteria.

35. Handling of Breastmilk • Breastmilk is a food not a body fluid. The Center for Disease Control and OSHA both consider breastmilk breastmilk to be “Food”, not a “body fluid”, so universal precautions are not necessary. Also, may store in same fridge as other “foods”. • Refrigerated or frozen separates. Breastmilk will separate … the cream rises to the top and there is a bluish watery layer at the bottom .. THIS IS NORMAL! • Heat breastmilk in a warm water bath. Do Not Microwave ! Don’t cook on stove … cooking will destroy essential protective properties in breastmilk. • Swirl gently to mix layers back together. • Shaking cold breastmilk makes butter! • If the breastmilk has been previously frozen and you thaw in a warm water bath, mix • Thawed breastmilk can be kept in fridge for 24 hrs. Do not refreeze.

36. Breastfeeding Infant Feeding Plan EXAMPLE!! Review Directions: To be completed by the parent(s) and the infant care giver. Plan should be updated every other month to reflect child’s current feeding pattern. Child Care facility name: Good Times Daycare Name of child: Baby Laura Date of Birth: (8 weeks old) Parent’s names: Suzie and John Date of initial plan: Any month, any day Date(s) of plan updates: in 2 more months or as the mother desires Describe baby’s usual feeding schedule. Laura nurses every couple of hours throughout the day. At this time, she takes nothing else. How is breastmilk to be stored and served? Keep Laura’s bottles of expressed milk in refrigerator. Heat breastmilk in warm water. Swirl to mix. Hold and cradle Laura during feedings. Discard any leftovers.

37. Outline the mother’s wishes she has regarding when to begin infant foods and what foods to give baby. No solids until 4 – 6 months. First food cereal, then progress with vegetables and fruits. Add strained meats around 8-9 months. Feed solids by spoon. Water in cup at mealtimes. No juice. What should the provider do if baby is hungry and mom is late, or her supply of expressed breastmilk is gone? Mom will leave a can of ready to feed Enfamil formula at the center to be used in the event Laura is hungry and all expressed breastmilk is gone. Mom reminders: Let your provider know if you want to breastfeed at the child care facility. Decide how many feedings you think your baby might need at child care and give your provider enough milk each day.

38. Practice Scenarios! Using the practice scenarios in the implementation packet, pair off groups to complete the scenarios. Inside the implementation packet, there are “Breastfeeding Infant Plan Practice Scenarios”. Have participants look at these and pair off in small groups. Assign each group a scenario to review – it is ok, and almost better, if different groups get the same scenarios – it helps show different ways the plan could be addressed. Have the groups complete the forms based on the scenarios. After a few minutes, reconvene the entire group and have each group report on how they completed the plan. Allow for discussion time.

39. HOLD 1.6-1.7

40. What Now for Staff… • Start documenting physical activity • Complete infant feeding plan, if applicable. • Let staff know process for turning in forms that they will be completing including the physical activity documentation and the completed infant feeding plans. Also, explain the facility’s plan for completing portion size checks. • Review policies – provide quick list handout, if desired.