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Section on Early Education and Child Care Hot Topics in Early Childhood Influencing Early Education and Child Care: Research, Early Literacy, Obesity Prevention Practical strategies for increasing children’s physical activity in child care. Kristen Copeland, MD, FAAP

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Section on Early Education and Child Care Hot Topics in Early Childhood Influencing Early Education and Child Care: Research, Early Literacy, Obesity PreventionPractical strategies for increasing children’s physical activity in child care

Kristen Copeland, MD, FAAP

Nutrition Technical Panel Member, Caring for Our Children, 3rd Ed.

Assistant Professor of Pediatrics

Division of General and Community Pediatrics

Cincinnati Children’s Hospital Medical Center

Oct 3rd, 2010

disclosures
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.
outline
Outline
  • Why do we need to increase physical activity in child care?
    • Background on PA: link to obesity, current levels in child care
  • What is going on? Why are levels so variable?: An insider’s view
    • Focus groups w/ child care providers re: perceived benefits and barriers
    • Telephone survey of PA environment
    • Ongoing fieldwork in childcare centers
  • How do we increase physical activity levels in child care?
    • The new physical activity standards in Caring for Our Children
      • Based on evidence and/or expert opinion
      • Address common barriers
      • Offer practical strategies
  • Take home messages
background obesity pa child care
Background: Obesity & PA, Child Care
  • Over past 35 yrs, the % of preschoolers who are obese (>95th%ile for BMI) has tripled, school-age ~quintupled1
  • Obesity linked to inadequate physical activity2-5
  • 13 M children, 75% US 3-6yo in some form of child care
  • Many spend long hours in child care: Only opportunity for exercise may be in child care
    • Young children are completely dependent on their caregivers for opportunities to be active

1. Ogden CL, JAMA 2006. 2. Patrick K, et al Arch Pediatr Adolesc Med. 2004 ; 3. Robinson TN. Jama. 1999 4. Gortmaker SL et al Arch Pediatr Adolesc Med. Sep 1999; 5.Epstein LH, et al. Health Psychol. Mar 1995

background physical activity levels in child care
Background: Physical activity levels in child care
  • Children are sedentary for most (70-83%) of their time in child care, excluding nap1-2
    • only small amount (2-3%) of time in vigorous activity
    • only 12-46 min of moderate or vigorous activity over course of 6 hr day in child care1-2
  • The amount of physical activity children get in child care varies widely, and depends mostly on the center attended (27-47% of variance), not child factors (3-10% of variance combined)1-3

1. Pate RR et al Pediatrics. Nov 2004 2. Pate RR et al. J Sch Health. Aug 2008, 3.Finn K, et al J Pediatr. Jan 2002

why are pa levels so low voices from the field
Why are PA levels so low? Voices from the field

Our ongoing research in Cincinnati2006-present

  • 9 focus groups* with 49 child care providers from 34 centers. 2006-8
    • re: perceived benefits and barriers to PA in child care
  • Telephone survey of PA environment in childcare (ELEPhANTS) 2008-9
    • Playground, indoor gross-motor room, weather policies for outdoor play
  • Ongoing fieldwork in childcare centers 2009-present

*Copeland KA et al, Int J of Behav Nutr and Phys Act. 2009

focus groups teachers perceptions of the health benefits of pa and outdoor time for young children
Obesity prevention

Build healthy habits

Develop fundamental motor skills

Children nap better**

Outdoor time:

More room to run

Vitamin D**

Escape germs from indoors (children less likely to get sick)**

Add’l health benefits from the literature

Improved fitness

Lower BP

Higher serum HDL

Increased bone mineral density

Improved sleep

Focus Groups: Teachers’ perceptions of the health benefits of PA and outdoor time for young children

**benefits also for teachers

teachers perceptions of the socio emotional benefits of physical activity and outdoor time
Improved self-efficacy, self-confidence after mastering gross motor skills

Improved peer relationships

Energy/stress relief, calm the classroom**

Outdoor time:

Improved mood**

‘endorphins’

More creative, expressive

Add’l SE benefits from the literature

Anti-depressive effects

Teachers’ perceptions of the socio-emotional benefits of physical activity and outdoor time

**benefits also for teachers

teachers perceptions of the learning benefits of physical activity and outdoor time
Improved concentration, attention

Hands-on “Active Learning”

concepts of time, distance, language

Outdoor time:

Sensory experiences

Science

Understanding concepts of society, citizenship

Add’l learning benefits from the literature

Improved concentration, attention

Outdoor exposure for ADHD

Teachers’ perceptions of the learning benefits of physical activity and outdoor time
barriers to physical activity child and parent f inding from focus groups
Child:

injuries

getting dirty

Parent:

direct parent requests not to take child outside

Child will get sick

Concerns about asthma

indirect

dressing child in improper clothing (eg, nice/expensive clothes, flip flops, or no coat in winter)

Barriers to physical activity-child and parentFinding from focus groups*

*Copeland KA et al, Int J of Behav Nutr and Phys Act. 2009

barriers to physical activity physical f indings from telephone survey
Structural*

No outdoor playground

No indoor play-space for days with inclement weather

Playground too small, not enough equipment- Wide variability across different centers

Weather:

Rain/Snow

Standing water, snow on playground

“Extreme” heat/ smog alert or cold

Wide variability in minimum temperature, 32°F most common in Cincinnati*

Barriers to physical activity- physical Findings from Telephone Survey*

*Telephone survey, ELEPhANTS

barriers to physical activity teachers f inding from focus groups
Teachers’ preferences about the weather

“not a cold weather person"

Don’t like going outside, getting dirty, sweaty, insects,

Too much work involved

Putting on coats, sunscreen, setting up portable play equipment

Teacher has low self-efficacy

Not trained in “playground teaching”

Teacher overweight, low self-esteem

Teacher as the gatekeeper to the playground

Barriers to physical activity- teachers Finding from focus groups
barriers to physical activity societal policy f inding from focus groups
Focus on “academics” (at expense of outdoor/gross motor time)

“Climbers are boring”--Playgrounds are safe but have little variety, minimally challenging, not fun for the children

“Budgets are tight”—minimal investment available for physical activity facilities

False appeal of the fancy climber

Barriers to physical activity- societal, policy Finding from focus groups
slide14
New Physical Activity Standards

Released September, 2010

new pa guidelines in cfoc background
New PA guidelines in CFOC: Background

Previous editions of CFOC had no guideline to promote physical activity, focus on safety

  • Based on evidence
  • Address common barriers
  • Offer practical strategies
    • Informed by our focus groups and telephone survey
  • Where evidence lacking, rely on expert opinion
    • PA, nutrition, public health, pediatric, and ECE experts
example of evidence based outdoor occasions and structured and time
Example of evidence-based:Outdoor occasions and structured and time
  • Evidence supporting:
    • Children are more active
      • when outdoors 1-2
      • when prompted by adults 1,3-5
  • All children 0-6yrs should have daily:
    • 2-3 outdoor occasions, weather permitting;
    • >2 structured or adult-led movement activities

1Brown WH Child Development 2009; 2Burdette Arch Ped Adol Med 2005, 2004. 3 McKenzie 1997. 4 McKenzie, 1992, 5 Sallis 1993

examples of structured activities movement and learning
Examples of structured activities-movement and learning
  • Simon Says, Mother May I
  • “Get the Wiggles Out”
  • Dance party*
  • Acting out animals
  • Track team*, relay races
  • Community walk through the neighborhood
  • Several good websites listed in CFOC

*Brown WH J of Early Intervention Mar 2009.

example of moderate evidence time allotted for structured and unstructured time
Example of moderate evidence:Time allotted for structured and unstructured time
  • Preschool-aged children are vigorously active in very short bursts (15-30 sec)*
    • Cannot sustain prolonged (>5 min) periods of vigorous activity
  • In adults, short bouts of vigorous activity (10 min) have health benefits (2008 PA Guidelines for Americans)

*Oliver, M. et al. Sports Med 37:1045-70.2007.

example of evidence lacking sedentary time
Example of evidence lacking: Sedentary time
  • Children should not be seated for >15 min at a time, except during meals or naps.

* Benjamin, S. E et al The nutrition and physical activity self-assessment for child care (NAP SACC). Rev ed.2007

outdoor play weather
Outdoor play: weather
  • “STANDARD: Children should play outdoors daily when weather and environmental conditions do not pose a significant health or safety risk:
    • Wind chill factor at or below minus 15°F and heat index at or above 90°F, as identified by

the National Weather Service.”

Very different from 32°F!

weather practical strategies
Barriers:

Teachers unsure when appropriate to go out

Parents’ request not to take children out

Strategies:

Have a written policy in the parent handbook that specifies the temps and precipitation conditions children permitted outdoors, & expected clothing

Benefits of PA

For “buy-in”

Weather: practical strategies
catching a cold from the cold practical strategies
Barrier:

Belief that children will get sick if exposed to cold air

Strategies:

Educate parents & child care providers about causes of winter illness (i.e., viruses)

Review importance of frequent hand-washing

Proper sanitation techniques, esp. during mealtimes

Catching a cold from the cold: practical strategies
asthma practical strategies
Barrier:

Children with Asthma

Cold or Hot temperatures can trigger symptoms

Indoor allergens (dust and dust mites) are common triggers, become elevated during the winter.

Strategies:

Attention to air circulation during winter

Try to go outside: children can wear a scarf

Work with child’s primary medical provider to maximally control asthma and develop a self-management plan

Asthma: practical strategies
conclusion take home messages for pediatricians
Conclusion: Take-home messages for pediatricians
  • Policy maker/Advocate: Focus on holistic ways to increase physical activity in child-care
    • Early learning standards vs. PA, <15 min seated
  • Researcher: Need for more and better evidence to inform guidelines, most based on (divergent) expert opinion
  • Child care consultants: Teachers are the gatekeepers to the playground, ultimately decide what active opportunities children have
    • Importance of proper training, and support
conclusion take home messages for pediatricians1
Conclusion: Take-home messages for pediatricians

In the office:Discuss with parents:

  • Importance, benefits of daily physical activity
    • Don’t just focus on the negative (TV, bike helmets)
  • Importance of good role-modeling
    • Don’t let the weather be an excuse--Go outside!
  • Will not get sick if exposed to cold
  • Work with their children’s child-care setting to improve the physical environment and increase active opps.
slide29

http://www.nemours.org/filebox/service/preventive/nhps/paguidelines.pdfhttp://www.nemours.org/filebox/service/preventive/nhps/paguidelines.pdf

slide30
For examples of policies, see the Nemours Health and Prevention Services guide on best practices for physical activity at: http://www.nemours.org/filebox/service/preventive/nhps/paguidelines.pdf
practical strategies resources
Practical strategies resources
  • Nutrition and Physical Activity Self Assessment for Child Care - NAP SACC Program - http://www.napsacc.org
  • “Color Me Healthy Preschoolers Moving and Eating”- http://www.colormehealthy.com
  • “Move and Learn” physical activity curriculum from Kansas State University
  • “I am Moving I am Learning” Intervention in Head Start - http://eclkc.ohs.acf.hhs.gov/hslc/ecdh/Health/ Nutrition/Nutrition%20Program%20Staff/IamMovingIam.htm
  • Moving and Learning: The Physical Activity Specialists for Birth through Age 8 - http://www.movingandlearning.com
  • “How to Lower Your Risk for Type 2 Diabetes “National Diabetes Education Program http://ndep.nih.gov/media/kids-tips-lower-risk.pdf