Time for A Polling Question: 4/15/2015. Webinar Objectives. What is your role?

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1 Caring for Infants and Toddlers: Nutrition and Physical Activity Best Practices Wednesday, April 22, :00 to 2:30 PM ECELS-Healthy Child Care Pennsylvania Webinar Dr. Susan S. Aronson, MD, FAAP ECELS Founder and Pediatric Advisor Moderator Download Powerpoint healthychildcarepa.org Presenters Professional Development > Webinars > Dr. Beth DelConte, MD, FAAP Dr. Sara Benjamin Neelon, PhD, MPH, RD Webinar Objectives Time for A Polling Question: What is your role? As a result of participation in this activity, participants will be able to: 1. Explain the standards from Caring for Infants and Toddlers in Early Care and Education (CFI/T), a subset of the Caring for Our Children Standards. 2. Describe best practices for infant and toddler nutrition and physical activity. 3. Compare recommendations for infant and toddler nutrition and physical activity with current practices used in participants program(s). 4. Describe current research that applies to prevention of obesity and promotion of lifelong wellness for infants and toddlers. 1

2 Caring for Our Children, 3 rd edition (CFOC3) National standards (686) that represent the best evidence, expertise and experience on quality health and safety practices and policies Caring for Infants and Toddlers in Early Care and Education (CFI/T) Subset of materials available in Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition (CFOC3) 232 nationally recognized health and safety standards applicable to the infant and toddler population Caring for Infants and Toddlers in Early Care and Education Compliance/Comparison Checklist Products Tab/Caring for Infants and Toddlers (I/T) Stepping Stones, 3 rd Edition (SS3) 138 essential standards intended to reduce the rate of morbidity and mortality in child care and early education settings *Denotes a standard from SS3* Caring for Infants and Toddlers in Early Care and Education (CFI/T) All standards relevant to Nutrition and Physical Activity Standard Rationale Comment References Caring for Infants and Toddlers in Early Care and Education (CFI/T) Section IV. Program Activities for Healthy Development Section V. Healthy Weight Promotion Section VI. Safe and Healthy Practices and Procedures 2

3 Section IV. Program Activities for Healthy Development A. Developmentally Appropriate Practices: STD Limiting Infant/Toddler time in Crib, High Chair, Care Seat, Etc. A child should not sit in a high chair or other equipment that constrains his/her movement for longer than 15 minutes, other than at meals or snack time Children should never be left out of the view and attention of adult caregivers/teachers while in these types of equipment/furniture A least restrictive environment should be encouraged at all times Children should not be left to sleep in equipment, such as car seats, swings, or infant seats that does not meet ASTM International (ASTM) product safety standards for sleep equipment STD Limiting Infant/Toddler time in Crib, High Chair, Care Seat, Etc. Rationale: Children are continually developing their physical skills. They need opportunities to use and build on their physical abilities. This is especially true for infants and toddlers who are eagerly using their bodies to explore their environment. Extended periods of time in confined space limits their physical growth and also affects their social interactions When children are awake, restricting them to a seat may limit social interactions. These social interactions are essential for children to gain language skills, develop selfesteem, and build relationships. Section IV. Program Activities for Healthy Development STD Restrictive Infant Equipment Requirements: Restrictive infant equipment such as swings, stationary activity centers (e.g., exersaucers), infant seats (e.g., bouncers), molded seats, etc., if used, should only be used for short periods of time (a maximum of fifteen minutes twice a day). Infants should not be placed in equipment until they are developmentally ready. Infants should be supervised when using equipment. Safety straps should be used if provided by the manufacturer of the equipment. Equipment should not be placed on elevated surfaces, uneven surfaces, near the top of stairs, or within reach of safety hazards. Infants should not be allowed to sleep in equipment that was not manufactured as infant rest/sleep equipment. The use of jumpers (attached to a door frame or ceiling) and infant walkers is prohibited. Section V. Healthy Weight Promotion A. Physical Activity (3 standards) STD * Active Opportunities for Physical Activity STD * Playing Outdoors STD Policies and Practices that Promote Physical Activity Physical Activity The facility should promote children s active play every day. All children, birth to six years, should participate daily in: Two to three occasions of active play outdoors, weather permitting (see Standard : Playing Outdoors for appropriate weather conditions) Two or more structured or caregiver/teacher/adult led activities or games that promote movement over the course of the day indoor or outdoor Continuous opportunities to develop and practice ageappropriate gross motor and movement skills. Indoor Active Play 3

4 Physical Activity (Cont.) Outdoor play: Infants should be taken outside two to three times per day, as tolerated. There is no recommended duration of infants outdoor play. Toddlers should be allowed 60 to 90 total minutes of outdoor play. These outdoor times can be curtailed somewhat during adverse weather conditions in which children may still play safely outdoors for shorter periods, but should increase the time of indoor activity, so the total amount of exercise should remain the same. Time for a Polling Question Tummy Time Physical Activity (Cont.) Infants should have supervised tummy time every day when they are awake Beginning on the first day of care, staff interact with infants for short periods of time (three to five minutes) Increase the amount of time as the infant shows s/he enjoys the activity Physical Activity (Cont.) Outdoor Tummy Time Ways to promote tummy time with infants: Place yourself or a toy just out of the infant s reach during playtime to get him to reach for you or the toy; Place toys in a circle around the infant. Reaching to different points in the circle will allow him/her to develop the appropriate muscles to roll over, scoot on his/her belly, and crawl; Lie on your back and place the infant on your chest. The infant will lift his/her head and use his/her arms to try to see your face 4

5 Physical Activity (Cont.) Time spent outdoors has been found to be a strong, consistent predictor of children s physical activity Accumulate opportunities for activity over the course of several shorter segments of at least 10 minutes each Structured activities have been shown to produce higher levels of physical activity in young children Incorporate two or more short structured activities (5 10 minutes) or games daily that promote physical activity Physical Activity (Cont.) Structured Activities and Resources: Simon Says, Mother May I, Red Rover, Get the Wiggles Out, or walk through the neighborhood Nutrition and Physical Activity Self Assessment for Child Care NAP SACC Program Color Me Healthy Preschoolers Moving and Eating Let s Move, Learn, and Have Fun: physical activity curriculum from Kansas State University I am Moving, I am Learning T/TA Resources Health Healthy Active Living Physical Activity (Cont.) Moving and Learning: The Physical Activity Specialists for Birth through Age 8 How to Lower Your Risk for Type 2 Diabetes: National Diabetes Education Program tips lower risk.pdf Motion Moments What About the Infants? Feedback from the field: Creating physical activity opportunities for infants was challenging ECELS staff working on the Early Childhood Comprehensive Systems (ECCS) grant developed Infant and Toddler Physical Activity Resource List Section V. Healthy Weight Promotion (Cont.) B Nutrition (25 standards) STD Assessment and Planning of Nutrition for Individual Children STD * Use of USDA CACFP Guidelines STD * Availability of Drinking Water STD * Feeding Plans and Dietary Modifications Section V. Healthy Weight Promotion (Cont.) * Introduction of Age Appropriate Solid Foods to Infants A plan to introduce age appropriate solid foods (complementary foods) to infants should be made in consultation with the child s parent/guardian and primary care provider. Age appropriate solid foods may be introduced no sooner than when the child has reached the age of four months, but preferably six months and as indicated by the individual child s nutritional and developmental needs. For breastfed infants, gradual introduction of iron fortified foods may occur no sooner than around four months, but preferably six months and to complement the human milk. Modification of basic food patterns should be provided in writing by the child s primary care provider. Evidence for introducing complementary foods in a specific order or rate is not available. The current best practice is that the first solid foods should be single ingredient foods and should be introduced one at a time at two to seven day intervals 5

6 Section V. Healthy Weight Promotion (Cont.) STD Meal and Snack Patterns for Toddlers and Preschoolers STD Serving Size for Toddlers and Preschoolers STD Encouraging Self Feeding by Older Infants and Toddlers Section V. Healthy Weight Promotion (Cont.) STD * Infant Feeding Policy Appendix JJ: Our Child Care Center Supports Breastfeeding ECELS Self learning Module: Breastfeeding Friendly Child Care Center healthychildcarepa.org Go to Prof. Dev Self Learning Modules Time for a Polling Question V. Healthy Weight Promotion Continued * Infant Feeding Policy Breastfeeding Section VI. Safe and Healthy Practices and Procedures A. Safe Food Practices STD * Preparing, Feeding and Storing Human Milk Human milk should be defrosted in the refrigerator if frozen, and then heated briefly in bottle warmers or under warm running water so that the temperature does not exceed 98.6 F. If there is insufficient time to defrost the milk in the refrigerator before warming it, then it may be defrosted in a container of running cool tap water, very gently swirling the bottle periodically to evenly distribute the temperature in the milk. Some infants will not take their mother s milk unless it is warmed to body temperature, around 98.6 F. The caregiver/teacher should check for the infant s full name and the date on the bottle so that the oldest milk is used first. After warming, bottles should be mixed gently (not shaken) and the temperature of the milk tested before feeding. STD * Preparing, Feeding and Storing Human Milk (Cont.) Check for the infant s full name and date on the bottle so that the oldest milk is used first After warming, bottles should be mixed gently (not shaken) and the temperature of the milk tested before feeding. Human milk can be stored using the following guidelines from the Academy of Breastfeeding Medicine (chart for all circumstances is in this standard) 6

7 Section VI. Safe and Healthy Practices and Procedures STD * Preparing, Feeding and Storing Infant Formula Bottles of formula prepared from powder or concentrate or ready to feed formula should be labeled with the child s full name, time and date of preparation Any prepared formula must be discarded within 1hour after serving to an infant Prepared powdered formula that has not been given to an infant should be covered, labeled with date and time of preparation and child s full name, and may be stored in the refrigerator for up to 24 hours STD * Preparing, Feeding and Storing Infant Formula (Cont.) An open container of ready to feed, concentrated formula, or formula prepared from concentrated formula, should be covered, refrigerated, labeled with date of opening and child s full name, and discarded at 48 hours if not used (7,9). The caregiver/teacher should always follow manufacturer s instructions for mixing and storing of any formula preparation. Section VI. Safe and Healthy Practices and Procedures STD * Warming Bottles and Infant Foods STD * Hot Liquids and Foods STD * Foods that Are Choking Hazards Nutrition in Child Care Promoting Healthy Eating and Physical Activity in Infants and Toddlers in Child Care: The Baby NAP SACC Intervention Sara Benjamin Neelon, PhD, MPH, RD Department of Community and Family Medicine Duke University Medical Center April 22, 2015 Children in child care consume inadequate Fruits, vegetables, and whole grains Most common type of milk is whole milk, despite recommendation for fat free (skim milk) for children over 2 years Sugary beverages not common but juice is served much more than recommended 7

8 Gross Motor Activity in Child Care Obesity and Child Care Children watch too much TV in family child care homes, TV in centers not common Outside time encourages gross motor activity, even in less than ideal weather Most research finds children active minutes over full day of care rather than recommended 2 hours Numerous studies found that children in child care heavier than those cared for at home by parent Child care during infancy most associated with obesity Creating child care environments that support healthy eating and promote gross motor activity can help prevent obesity in young children Nutrition and Physical Activity Self Assessment for Child Care (Baby NAP SACC) Baby NAP SACC is a program designed to promote healthy eating and encourage active play for infants and toddlers in center based child care in North Carolina Baby NAP SACC Research Study Goals Primary Goal: Assess extent to which children in intervention group show smaller gains in weight status compared to controls Secondary Goal: Assess extent to which children in Baby NAP SACC group, compared to controls: a. Improve dietary intake b. Increase physical activity c. Decrease sedentary time Baby NAP SACC Intervention Large study of 640 children/families from 80 centers 6 month center and home based intervention Targets behaviors associated with obesity Designed to improve environments where infants & toddlers spend time Child obesity main outcome Characteristics of Child Care Centers Center Characteristics Number Number of children 89 Number of subsidized children 33 Number of staff/teachers 20 Years in operation 18 Percent National Association for the Education of Young Children (NAEYC) accreditation 8% Child and Adult Care Food Program (CACFP) participation 66% R01DK /1/13 12/31/18 8

9 Characteristics of Directors, Teachers, and Children Directors (30) Teachers (90) Children (176) Percent Race White 43% 42% 47% Black 54% 45% 27% Other race 3% 13% 26% Ethnicity Latina/o 4% 15% 6% Education Some college 16% 83% College degree 48% 12% Some graduate school 12% 2% Graduate degree 24% 3% Baby NAP SACC Recommendations What: Provide healthy foods and beverages How: Create an environment that supports healthy eating Help children listen to their own bodies to know if they are hungry or full Baby NAP SACC Recommendations Time for a Polling Question Limit Restricted and Seated Time What: Provide opportunities for gross motor activity How: Create an environment that supports gross motor activity 9

10 Provide tummy time each day for young infants who are not yet able to roll over Young babies need tummy time every day! Intervention materials are designed to create healthier environments Remind teachers to encourage active play Engage children with interactive props Create a culture where healthy eating is norm Baby NAP SACC Intervention Materials 10

11 Kids grow healthy with a variety of meals and snacks! What is biggest challenge serving healthier meals and snacks? None 16% Not enough money to purchase them 58% Not enough time to prepare them 12% Children wouldn t like them 10% Not enough expertise to prepare them 4% Active play is fun each day! What is biggest challenge providing more gross motor activity? None 24% Lack of space 24% Not enough time in schedule 16% Not enough money for equipment 16% Children would not be interested 8% Not enough expertise to lead children 6% Parents would not be supportive 6% Any time, any place, any weather! Infants Toddlers How often do you take children outside to play? Less than once a week 8% 0% Afew days a week 24% 0% Every day 68% 100% 11

12 One in 5 kids will start kindergarten overweight or obese. Promoting healthy eating and active play in child care is essential and can be fun! Acknowledgements Funded by a grant from the National Institutes of Health (R01DK093838) Collaborators: Truls Ostbye, MD, PhD Duke University Medical Center Dianne Ward, EdD University of North Carolina at Chapel Hill Derek Hales, PhD University of North Carolina at Chapel Hill For more information about Baby NAP SACC Q & A Comments? sara.neelon@duke.edu Wrap Up For University of Pittsburgh CME or PA Key credit, fax your completed evaluation form to ECELS at by 5/6/2015. (Form is at healthychildcarepa.org in Professional Development tab, select Webinars) For PA Key Credit, after submitting your evaluation, ECELS sends an with instructions about steps to complete in PD Registry any unanswered questions or comments you d like to share with ECELS or the presenters to: ecels@paaap.org 12