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1. Preventing Childhood Obesity in Early Care and Education Programs: How to implement a new set of national standards in nutrition, physical activity, and screen time for early childhood programs National Association for the Education of Young Children (NAEYC) November 4, 2011, Orlando, FL.

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National resource center for health and safety in child care and early education nrc

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Preventing Childhood Obesity in Early Care and Education Programs: How to implement a new set of national standards in nutrition, physical activity, and screen time for early childhood programs

National Association for the Education of Young Children (NAEYC)

November 4, 2011, Orlando, FL


National resource center for health and safety in child care and early education nrc

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National Resource Center for Health and Safety in Child Care and Early Education (NRC)

Presenters

Marilyn J. Krajicek, EdD, RN, FAAN

Director of the National Resource Center for Health and Safety in Child Care and Early Education

Danette Glassy, MD, FAAP

University of Washington, Clinical Professor

Mercer Island Pediatrics

Sandra Cianciolo

Project Coordinator for National Training Institute for Child Care Health Consultants

University of North Carolina at Chapel Hill


National resource center for health and safety in child care and early education nrc1

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National Resource Center for Health and Safety in Child Care and Early Education (NRC)

The Consortium:

American Academy of Pediatrics (AAP)

American Public Health Association (APHA)

National Resource Center (NRC) for Health and Safety in Child Care and Early Education (at University of Colorado)

National Training Institute (NTI) (at University of North Carolina Chapel Hill)

Funded through the Maternal and Child Health Bureau Cooperative Agreement (MCHB)


National resource center for health and safety in child care and early education nrc2

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National Resource Center for Health and Safety in Child Care and Early Education (NRC)

NRC Mission:

To improve the quality of out-of-home child care and early education programs and support the health and safety of the children they serve.


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National Resource Center for Health and Safety in Child Care and Early Education (NRC)

The NRC supports the efforts of:

Child care providers

Early educators

Families/parents

Health professionals

Early childhood comprehensive systems

State child care regulatory agencies

State and local health departments

Policy makers


Caring for our children cfoc 3 rd ed

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Caring for Our Children (CFOC) 3rd Ed.

Caring for Our Children

National Health and Safety Performance Standards for Early Care and Education Programs

  • 3rd edition Revision completed and published in June 2011

  • 4-year revision process

  • 10 Technical Panels - 85 panel members - Content Experts from AAP, APHA, and subject specialists


Caring for our children cfoc 3 rd ed1

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Caring for Our Children (CFOC) 3rd Ed.

Definitive source on best practice in health and safety in early care and education settings

Evidence-based

Expert consensus

Model for health & safety practices


National resource center for health and safety in child care and early education nrc

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Caring for Our Children (CFOC) 3rd Ed.

Contents:

Chapter 1:Staffing

Chapter 2:Program Activities for Healthy Development

Chapter 3:Health Promotion and Protection

Chapter 4:Nutrition and Food Service

Chapter 5:Facilities, Supplies, Equipment & Environmental Health

Chapter 6:Play Areas/ Playgrounds & Transportation

Chapter 7:Infectious Disease

Chapter 8: Children With Special Health Care Needs & Disabilities

Chapter 9:Administration

Chapter 10: Licensing & Community Action


Preventing childhood obesity in early care and education programs
Preventing Childhood Obesity in Early Care And Education Programs

First spin-off from CFOC 3rd edition

Released July 2010

Available in print through American Academy of Pediatrics and online at nrckids.org

Spanish version available online

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National resource center for health and safety in child care and early education nrc

CFOC Nutrition Panel had primary responsibility Programs

Expert Panel members included:

Pediatricians

Maternal and Child Health Professionals

Nutritionists

Other Health Professionals

Nursing, Social Work

Breastfeeding Experts

Physical Activity Experts

Child Development Specialists

Preventing Childhood Obesity in Early Care And Education Programs

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Obesity
Obesity Programs

1 in 3 low income children are obese or overweight by 5 years

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Health consequences
Health Consequences Programs

Seriously reduced quality of life

Increased risk of chronic disease:

Diabetes

Hypertension and Cardiovascular disease

GE reflux disease

Obstructive sleep apnea, which can contribute to learning problems and behavior problems

Asthma

Increased cost of health and medical care

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Obesity and child care
Obesity and Child Care Programs

Children in child care are more likely to be obese – Maher, et al, Pediatrics 2008 Aug

Children in child care are sedentary for most of their time in child care (70-83%), excluding naps- Pate, et al, Pediatrics 2004 Nov

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 care

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Cfoc standards
CFOC Standards Programs

NUTRITION

variety of healthy foods

promote positive mealtime environment

PHYSICAL ACTIVITY

daily indoor & outdoor activities

SCREEN TIME

limited

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How the standards address the problem
How the Standards ProgramsAddress the Problem

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

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Examples of new and significant changes in cfoc 3rd edition related to childhood obesity

Examples of New and Significant Changes In ProgramsCFOC 3rd Edition Related to Childhood Obesity

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Caring for Our Children (CFOC) 3rd Ed.


Encourage breastfeeding
Encourage Breastfeeding Programs

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

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Nutrition
Nutrition Programs

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

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National resource center for health and safety in child care and early education nrc

Accommodate vegetarian diets Programs

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

Nutrition

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National resource center for health and safety in child care and early education nrc

Water available throughout the day Programs

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

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Physical activity
Physical Activity Programs

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

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National resource center for health and safety in child care and early education nrc

Caregivers and teachers encourage and participate in physical activities:

Lead structured activities

Wear clothing that permits safe and easy movement

Prompt children to be active

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Physical Activity


National resource center for health and safety in child care and early education nrc

Limit restrictions to movement of infants physical activities:

Limit time in infant equipment (bouncy seats, swings, etc) and high chairs 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

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Physical Activity


Barriers to increased physical activity
Barriers to increased physical activity physical activities:

Structural

No outdoor playground

No indoor play-space for days with inclement weather

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

Teacher

Gatekeeper of the playground

Weather:

Rain/Snow

Standing water, snow on playground

“Extreme” heat/ smog alert or cold

Wide variability in minimum temperature,

From Copeland, et al, Arch Pediatr Adol Med, May 2011

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Weather
Weather physical activities:

“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 degrees F and heat index at or above 90°F, as identified by the National Weather Service.”

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Screen time standards
Screen Time Standards physical activities:

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Screen time
Screen Time physical activities:

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

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Using the standards
Using the Standards physical activities:

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.

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National resource center for health and safety in child care and early education nrc

Regulators physical activities: 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.

Using the Standards

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Achieving a state of healthy weight

31 physical activities:

Achieving A State of Healthy Weight

NRC assessed child care regulations of all States and D.C. to determine language in conformity with standards in Preventing Childhood Obesity (PCO).


Achieving a state of healthy weight1

32 physical activities:

Achieving A State of Healthy Weight

  • Three topic areas:

    • Infant Feeding

    • Nutrition

    • Physical Activity


Achieving a state of healthy weight2

33 physical activities:

Achieving A State of Healthy Weight

  • Three child care types

    • Child Care Centers

    • Large Family Child Care Homes

    • Small Family Child Care Homes


Achieving a state of healthy weight3

34 physical activities:

Achieving A State of Healthy Weight

Rating Methodology:

Components Selected

275 PCO/CFOC components of standards derived

Healthy Weight Advisory Committee rated components based on impact on obesity if implemented in child care (see Appendix C of report)

Components divided into 3 content areas:

Infant Feeding

Nutrition

Physical Activity/Screen Time

Top 47 components selected for rating


Achieving a state of healthy weight4

35 physical activities:

Achieving A State of Healthy Weight

Rating Methodology (cont.):

States’ Documents Verified & Vetted

Most recent regulations

Obesity-pertinent content

Rating Scales & Rules Established

4-point scale

Tailored to each component

Spreadsheets Designed to Record Ratings

118 States’ documents

3 child care types


Achieving a state of healthy weight5

36 physical activities:

Achieving A State of Healthy Weight

Rating Methodology (cont.):

Raters Trained and Reliability Tested

Five 2-person teams, with 60 ratings each on same states and same components

Overall average Spearman’s rho coefficients = 0.964 (p>.001)

Ratings over period of 3 months

16,638 individual ratings performed

Post-rating review of all ratings for consistency

For states with multiple documents, a final score per component was calculated for each child care type

Result = 6826 final ratings used for analysis

Data Analyses The Evaluation Center of the School of Education and Human Development, University of Colorado Denver and NRC Staff


Achieving a state of healthy weight6

37 physical activities:

Achieving A State of Healthy Weight

Overall Rating Schema:

Degree of conformity on a scale of 1-4 and color coded on charts.

1 = state regulation contradicts the component

2 = state regulation does not refer to the component

3 = state regulation partially meets component

4 = state regulation fully meets component


Achieving a state of healthy weight7

38 physical activities:

Achieving A State of Healthy Weight

National Exemplary State

(tied with Mississippi)

Delaware

Strongest in Infant Feeding for all child care settings

Weakest in Nutrition for Small Family Child Care


National resources

39 physical activities:

National Resources

NAP SACC:

The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program

Research-tested intervention designed to enhance policies, practices, and environments in child care by improving the:

nutritional quality of food served

amount and quality of physical activity

staff-child interactions

facility nutrition and physical activity policies and practices and related environmental characteristics

Primarily addresses the inter-personal and organizational levels of the socioecologic model.

http://www.center-trt.org/index.cfm


National resources1

40 physical activities:

National Resources

Let’s Move! Child Care

http://healthykidshealthyfuture.org


National resources2

National Resources physical activities:

Motion Moments

Approx. 7 minutes/video

Demonstrates ideas for incorporating physical activity into child care programs for infants, toddlers, and preschoolers

Available at http://nrckids.org/Motion_Moments/index.htm

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National resources3
National Resources physical activities:

Healthy Child Care America

www.healthychildcare.org

Resources include:

Caregiver Newsletter

CFOC Standard of the Month http://www.healthychildcare.org/ENewsCaregiver.html#listserv

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Cfoc 3 rd edition
CFOC, 3 physical activities:rd Edition

  • Standard 1.6.0.1: A facility should identify and engage/partner with a CCHC who is a licensed health professional with education and experience in child and community health.

The National Training Institute for Child Care Health Consultants


What does a cchc do
What does a CCHC do? physical activities:

  • CCHCs have expert information, resources, and referrals to offer.

  • Through onsite and telephone consultation, health education, and technical assistance, CCHCs work with child care facilities to help create environments that support the healthy development of young children.

The National Training Institute for Child Care Health Consultants


Cchcs and nutrition physical activity
CCHCs and Nutrition/Physical Activity physical activities:

  • CCHCs can have a role in improving nutrition and physical activity for children in child care because they:

    • Already established relationships

    • Knowledge base

    • Experience with training and TA

The National Training Institute for Child Care Health Consultants


What can a cchc do
What can a CCHC do? physical activities:

  • Partner with a center to self-assess.

    2. Help the center identify a plan of action.

    3. Provide training on nutrition and physical activity for children, staff and parents/guardians.

    4. Develop and distribute materials or incentives.

    5. Provide technical assistance.

The National Training Institute for Child Care Health Consultants


Cchcs promote
CCHCs Promote physical activities:

  • Breastfeeding

  • Physical Activity

  • Good Nutrition

The National Training Institute for Child Care Health Consultants


Strategies and interventions
Strategies and Interventions physical activities:

  • Let’s Move!

  • NAP SACC

  • I Am Moving, I Am Learning

  • Color Me Healthy

  • Be Active Kids

The National Training Institute for Child Care Health Consultants


National resource center for health and safety in child care and early education nrc

SNAPP: Supporting Nutrition and Active Physical Play physical activities:

Friday, November 4th at 2:30pm

Orlando Convention Center

Room W311H

The National Training Institute for Child Care Health Consultants


Policy changes national initiatives

50 physical activities:

Policy Changes & National Initiatives

Licensing Toolkit

Action Sheets for potential strengthening of child care regulations and practices related to preventing childhood obesity

Specific sheets for:

Caregivers

Legislators

Licensing Agencies

All NRC resources available at http://nrckids.org


Policy changes national initiatives1

51 physical activities:

Policy Changes & National Initiatives

Child and Adult Care Food Program (CACFP)

Existing Meal Patterns:Inconsistent with new Dietary Guidelines for Americans and MyPlate

2011 Meal Pattern Recommendations:

  • Consistent with new Dietary Guidelines for Americans and MyPlate

  • Pending adoption/publication

Available at: http://www.fns.usda.gov/cnd/care/ProgramBasics/Meals/Meal_Patterns.htm


Policy changes national initiatives2

52 physical activities:

Policy Changes & National Initiatives

Race to the Top—Early Learning Challenge

State-level competitive grants Under U.S. Department of Education (DOE) and U.S. Department of Health and Human Services (DHHS)

To close the achievement gap for children with high needs and support states that best prepare their young children for success in kindergarten

Five key areas of reform:

Successful State Systems (interagency and sustainable)

High-Quality, Accountable Programs (TQRIS)

Promoting Early Learning and Development Outcomes for Children (utilize common standards and measures)

Great Early Childhood Education Workforce (standardized education and professional development)

Measuring Outcomes and Progress (assess and inform progress)

http://www2.ed.gov/programs/racetothetop/index.html


Policy changes national initiatives3

53 physical activities:

Policy Changes & National Initiatives

CDC & HHS Grant: CPPW

Communities Putting Prevention to Work

Funding: Intense – Proven – Sustainable - Community

approaches to chronic disease prevention by:

Increasing physical activity

Improving nutrition

Decreasing overweight/obesity

Tobacco cessation

Initiatives involve partnership of leaders from public health, schools, cities, counties, local businesses, and citizens.

60 communities in 33 states and 3 tribes are involved in this grant currently, 49 addressing obesity

http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/about/index.htm


National resource center for health and safety in child care and early education nrc

For more information, please contact the physical activities:

National Resource Center for Health and Safety in Child Care and Early Education:

Website- http://nrckids.org

Telephone -1-800-598-5437

E-mail -info@nrckids.org

National Resource Center for Health and Safety in Child Care and Early Education

13120 E. 19th Ave., F541

Aurora, CO 80045

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