Obesity Prevention in Child Care

1. Obesity Prevention in Child Care A Partnership Approach Sandra Rhoades, MPH, RD Director, CACFP Obesity Prevention Unit NYS Dept. of Health Diane Craft, PhD Professor, Physical Activity Department State University of New York at Cortland

2. Objectives Obesity Prevention in Child Care • Describe Early Childhood Obesity Prevention workgroup • Present the proposed standards • Nutrition • Screen time • Breastfeeding • Physical activity • Discuss challenges and next steps

3. Background • NYS Dept. of Health • Division of Nutrition • Bureau of CACFP • Division of Disease Prevention • Bureau of Chronic Disease Prevention • CDC Division of Nutrition, Physical Activity, and Obesity • Develop an Action Guide • Provide guidance to States • To implement model policies and environmental strategies • Nutrition • Physical activity • Screen time reduction

4. Statistics Child Care Data (2010) Obesity Data (2010) • 4,000 child care centers • 14,000 family day care homes • 650,000 child care spaces • 14,000 participate in CACFP • 350,000 children served • 31.5% of 2-4 year olds • 32% of Upstate public school students • 40% of NYC public school students

5. Obesity Prevention in Child Care Partnership – Steering Committee • Dept. of Health • CACFP • Obesity Prevention Program • Office of Children and Family Services • Child care licensing and subsidy • NYS Head Start Collaboration • Physical Activity Specialist • NYS Early Care Advisory Council members • Early Care and Learning Council

6. Partnership Focus

7. Common Standards • Increase physical activity • Reduction in screen time • Decrease in sedentary behavior • Supporting breastfeeding mothers • Expansion of required training to include topics related to obesity prevention, including CACFP’s Healthy Meal Pattern • Support for CACFP Healthy Meal Pattern

8. Nutrition and Screen Time

9. CACFP Obesity Prevention • Healthy Child Meal Pattern • 1% or Less for children over 2 years • No flavored milk for children under 5 years • Juice served no more than once per day (breakfast or snack) • Water served at snack if no other beverage • Sweet grains limited to twice per week (breakfast or snack) • EWPH Child Care Settings • Child care centers • Day care homes • Breastfeeding Friendly Centers and Homes

10. NYS Day Care Licensing - Nutrition • Existing Standards • Adequate food must be available in appropriate portions for size and age of children • Center programs must have 4 weeks of menus reviewed by nutrition professional (or CACFP) • Medical, religious and personal food preferences must be accommodated • Children must be helped to feed themselves • Safe drinking water must be available at all times • Every effort must be made to accommodate a breastfed child

11. NYS Day Care Licensing - Nutrition • Proposed Program Standards • No new nutrition or breastfeeding standards • Proposed Required Training Topics • Healthy menu planning • Obesity prevention • Benefits of and how to encourage breastfeeding for mothers returning to work

12. NYS Day Care Licensing – Screen Time • Proposed Program Standards • Screen Time • Center: Infants (under 18 mo) must not be exposed to any screen time • Family: TV must be off when not in use for program activities • Must be part of planned, developmentally appropriate program for educational, social, physical or other learning objective • Screen time during meals is prohibited • Screen time should not be used solely to occupy time

13. Quality Stars NY – Nutrition Standards Before Partnership With Partnership • Points awarded if: • Program compares revenues and expenses to budget, OR • Fiscal records and budget are reviewed to ensure no deficit OR • If eligible, program participates in CACFP • Meals and snacks served or consumed meet the CACFP meal pattern for ages in care • Program implements an obesity prevention program • Staff attends training on obesity prevention • Program supports breastfeeding

14. Quality Stars - Screen Time Standards Before Partnership With Partnership • Only to the extent that credentialing programs address it • Program must have a policy: • Regarding use of TV/Video • Birth-2 years: None • 2-5 years:30 min/wk • Educational only • Commercial-free

15. NYS Early Care and Education Core Body of Knowledge Framework • Proposed changes: • Considers developmental appropriateness of screen time • Provides meals that align with NY CACFP meal patterns • Limits fruit juice to 4 oz. per day • Encourages exclusive breastfeeding until 6 months and accommodates breastfeeding mothers

16. Beyond the Partnership • NYS Governor’s Race to the Top Early Care and Learning • Recognized CACFP’s impact on early child care and education • NYS Department of Health Commissioner • Agency-wide Childhood Obesity Council • Advocating for CACFP as the nutrition standard in licensing

17. Physical Activity

18. NYS Day Care Licensing – Physical Activity • Proposed Program Standards • Daily schedule must include “tummy time” • Offer indoor activities, out door activities and variety of large muscle activities throughout the day • There must be physical activity every day • Proposed Required Training Topics • Promoting play and physical activtiy

19. Quality Stars – Center & Home-based Physical Activity Standards Infants/Toddlers to 18 month Children over 18 month • Daily opportunities to move freely under adult supervision to • Explore indoor and outdoor environment • Including tummy time when awake • 15 min. PA/hr in care • Developmentally appropriate PA • Include structured and unstructured PA • Moderate to vigorous PA • Both indoors and outdoors

20. NYS Early Care and Education Core Body of Knowledge Framework Existing Policies Proposed Policies • Children must effectively develop small muscle skills and large muscle coordination through play • Provide opportunities for gross motor and outdoor play for the development of large motor skills • Recognize and respect importance of play in children’s development and growth • Provides children with at least 120 min. of gross motor activity (for children attending a full day program) each day through both structured and unstructured play

21. Consider changing term to • Recommend development of ‘fundamental movement skills’ instead of ‘gross motor activity’

22. Fundamental Movement Skills

23. This is NOT Rocket Science

24. Let’s try a few fun ways to practice Fundamental Movement Skills

25. Partnership Challenges/Lessons • There are no quantitative measures in regulations • Monitoring meals of non-participating programs • Monitoring amount of physical activity • Access to physical activity training • Breastfeeding Friendly recognition for non-participating programs • Support from Early Childhood Advisory Council • Influential people are important for policy changes

26. Next Steps • Supporting implementation of regulatory changes and Quality Stars Rating System • Increasing CACFP participation • Revisiting EWPHCCS and DCH models • Increasing Breastfeeding Friendly Child Care programs • Creating a physical activity training plan • Reviewing progress towards standards

27. Thank You!