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

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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 childrens 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 Childrens Hospital Medical Center
• Oct 3rd, 2010

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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.

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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
  insiders 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

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Background Obesity PA, Child Care

• Over past 35 yrs, the of preschoolers who are
  obese (gt95thile 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
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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
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Why are PA levels so low? Voices from the field

• Our ongoing research in Cincinnati 2006-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
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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)

• Addl health benefits from the literature
• Improved fitness
• Lower BP
• Higher serum HDL
• Increased bone mineral density
• Improved sleep

benefits also for teachers
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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

• Addl SE benefits from the literature
• Anti-depressive effects

benefits also for teachers
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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

• Addl learning benefits from the literature
• Improved concentration, attention
• Outdoor exposure for ADHD

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Barriers to physical activity-child and
parentFinding 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)

Copeland KA et al, Int J of Behav Nutr and Phys
Act. 2009
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Barriers to physical activity- physical Findings
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, 32F
  most common in Cincinnati

Telephone survey, ELEPhANTS
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Barriers to physical activity- teachers Finding
from focus groups

• Teachers preferences about the weather
• not a cold weather person"
• Dont 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

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Barriers to physical activity- societal, policy
Finding 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 tightminimal investment available
  for physical activity facilities
• False appeal of the fancy climber

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• New Physical Activity Standards

Released September, 2010
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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

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Example of evidence-basedOutdoor 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
• gt2 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
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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.
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Example of moderate evidenceTime allotted for
structured and unstructured time

• Preschool-aged children are vigorously active in
  very short bursts (15-30 sec)
• Cannot sustain prolonged (gt5 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 371045-70.2007.
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NASPE 2002 USDA 2005 Dietary Guidelines AAP 2006 US Dept HHS 2008 PA guidelines CFOC, 3rd ed 2010
Unstructured time
Infants - - Focus on age-approp play, ex-ploration, safe Not enough data to make rec. 2-3 outdoor occasions
Toddlers 60 min - Focus on age-approp play, ex-ploration, safe Not enough data to make rec. 60-90 min
Preschoolers 60 min 60 min, most d/wk Focus on age-approp play, ex-ploration, safe Not enough data to make rec. 90-120 min
Structured time
Infants promote dev - N/A Not enough data to make rec. 2-3 outdoor occasions
Toddlers 30 min - - Not enough data to make rec. 2 struct occ, 5-10 min ea
Preschoolers 60 min - - Not enough data to make rec. 2 struct occ, 5-10 min ea
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Example of evidence lacking Sedentary time

• Children should not be seated for gt15 min at a
  time, except during meals or naps.

NASPE 2002 AAP 2006 NAP SACC 2007/ Baby NAP 2011 CFOC, 3rd ed 2010
Sedentary time
Infants - - 30 min lt15 min
Toddlers lt60 min - 30 min lt15 min
Preschoolers lt60 min - lt30 min lt15 min
Benjamin, S. E et al The nutrition and physical
activity self-assessment for child care (NAP
SACC). Rev ed.2007
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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 15F and heat
  index at or above 90F, as identified by
• the National Weather Service.

Very different from 32F!
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Weather practical strategies

• 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

• Barriers
• Teachers unsure when appropriate to go out
• Parents request not to take children out

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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

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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 childs primary medical provider to
  maximally control asthma and develop a
  self-management plan

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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, lt15 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

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Conclusion Take-home messages for pediatricians

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

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Questions?
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(No Transcript)
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http//www.nemours.org/filebox/service/preventive/
nhps/paguidelines.pdf
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• For examples of policies, see the Nemours Health
  and Prevention Services guide on best practices
  for physical activity at http//www.nemours.org/f
  ilebox/service/preventive/nhps/paguidelines.pdf

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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/Hea
  lth/ Nutrition/Nutrition20Program20Staff/IamMovi
  ngIam.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