Early Child Care Obesity Prevention Recommendations: Complete List

Daycare Is the New Frontier for Obesity Prevention

Early childhood is a critical time for obesity prevention. Children are developing taste preferences, learning to walk and play, and eagerly mimicking both healthy and unhealthy behaviors of their caregivers. Yet for many children, those caregivers may be someone other than their parents: In the U.S., for example, it’s estimated that 75 percent of children spend time in child care, for an average of 35 hours per week. (1)

Sadly, child obesity rates are rising worldwide, even among the youngest of children: Globally, an estimated 43 million preschool children were overweight or obese in 2010, a 60 percent increase since 1990. (2) And children’s early-life experiences, such as lack of breast feeding, too-little sleep, and too-much television can increase the risk of obesity later in life. That’s why early child care providers have such a crucial role to play in turning around the obesity epidemic.

Child care providers are in a unique position to educate parents about healthy eating and activity habits, and also to provide a healthy environment for children to eat, play, and grow. They can serve children age-appropriate healthy foods, and limit junk food, sugary drinks, and juice. They can offer children lots of opportunities for active play, in fun, short bursts throughout the day. And they can keep televisions turned off and away from areas where children sleep. When parents also adopt these practices at home, children are assured the best chance of growing into a healthy weight.

This section of The Obesity Prevention Source summarizes obesity prevention recommendations for early child care providers, based on a review of expert guidance from the Institute of Medicine, the National Resource Center for Health and Safety in Child Care and Early Education, the American Academy of Pediatrics, and others. These nutrition, feeding-style, activity, screen time, and sleep recommendations are appropriate guidelines for parents to follow, as well. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list on each page, as well as the links to useful toolkits and other resources.

Early Child Care Nutrition

Child care providers can encourage healthy eating habits in young children by providing a variety of nutritious foods, limiting junk food and sugary drinks, and encouraging parents to do the same at home.

Here is a summary of early childhood nutrition recommendations for obesity prevention, based on a review of expert guidance from the American Academy of Pediatrics, the National Resource Center for Health and Safety in Child Care and Early Education, the Institute of Medicine, and others. Though these recommendations are designed for early child care providers, parents can also adopt these nutrition guidelines at home. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.

Serve age-appropriate and healthy beverages Offer safe drinking water regularly and in place of fruit drinks, soda, or other sweetened beverages (1,2,3,4) Ensure that children ages 1 to 6 are limited to 4 to 6 ounces of juice per day, including at home (1,2,3,4) Serve 100 percent juice with no added sweeteners in cups, and only at mealtimes (1,2,4) Offer either skim or 1 percent pasteurized milk to all children over 2 years of age, or whole pasteurized milk for children ages 1 to 2 (1,2,4)

Provide a varied and balanced diet that emphasizes minimally processed foods Offer a mix of different colored vegetables each day, especially dark green and red and orange vegetables (1,2,3,4) Serve a variety of whole fruits, rather than juice (1,2,4) Ensure all breads, cereals, and pastas served are whole grain (1,2,3,4) Choose heart-healthy lean protein such as beans, chicken, legumes, and low-fat yogurt or cottage cheese (1,2,3,4) Opt for foods that contain healthy monounsaturated or polyunsaturated fats like olive or safflower oil instead of foods high in trans or saturated fats, such as packaged snack foods, foods fried or prepared with partially hydrogenated oil, butter, and red meat (1,2,4)

Encourage healthy growth in children by keeping high-calorie, low-nutrient foods out of child care Avoid foods high in trans fats and/or saturated fats (1,2,4) Avoid salty, low-nutrient foods like chips or pretzels (1,2,3,4) Avoid high-sugar foods such as flavored milk, fruit nectars, soda, or candy (1,2,3,4)

Encourage family involvement in healthy eating at the child care facility Provide written nutrition guidelines and posted menus for parents (1,4) Ensure food brought from home meets written standards (1,4) Engage in conversations about healthy eating, including taking menu suggestions from parents consistent with healthy guidelines (1,4)

Early Child Care Nutrition—Source List

1. American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition; 2010.

2. National Resource Center for Health and Safety in Child Care and Early Education, University of Colorado Denver. National Resource Center for Health and Safety in Child Care and Early Education: Achieving a State of Healthy Weight: A National Assessment of Obesity Prevention Terminology in Child Care Regulations 2010. Aurora, CO; 2011.

3. Institute of Medicine. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011.

4. Position of the American Dietetic Association: Benchmarks for Nutrition in Child Care. J Am Diet Assoc. 2011;111:607-615.

Infant Feeding and Mealtime Habits

How infants and children are fed can be just as important as what they are fed. Child care providers can give infants age-appropriate foods and beverages, make mealtimes enjoyable (and television-free), and encourage children to regulate their own food intake.

Here is a summary of infant feeding and mealtime recommendations for obesity prevention, based on a review of expert guidance from the American Academy of Pediatrics, the National Resource Center for Health and Safety in Child Care and Early Education, the Institute of Medicine, and others. Though these recommendations are designed for early child care providers, parents can follow these feeding and mealtime guidelines at home, too. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.

Promote ideal and age-appropriate fluid intake among infants Educate parents on breastfeeding resources and services within the community (1,2,3,5) Provide a welcoming, private place for mothers to breastfeed on site (1,2,3,5) Serve human milk or infant formula, not cow’s milk, to children until at least 1 year of age unless documentation from a parent/provider indicates otherwise (1,2,3,5) Do not serve fruit juice to children under 1 year of age (1,2,3) Do not bottle feed an infant formula mixed with any cereal, juice, or other foods without documentation from a medical provider (1,2,3)

Practice responsive feeding Initiate feedings based on an infant’s cue (opening mouth, making suckling sounds) (1,2,3) Pay attention to an infant’s fullness cues to avoid overfeeding (turning away from the nipple, keeping mouth closed) (1,2,3) Position an infant appropriately in a caretaker’s arms or propped up in a caretaker’s lap, and don’t let infants bottle-feed themselves alone (1,2,3) Bottle feed only one infant at a time (1,2)

Introduce complementary foods at the appropriate age Create a plan for introducing solids in consultation with child’s parent (1,2) Introduce solids around 6 months of age, unless the child’s healthcare provider recommends earlier, and make sure to use iron-fortified foods for breastfed infants (1,2,3)

Encourage children to enjoy meals and regulate their own food intake Offer meals and snacks every 2 to 3 hours (1,2,3,4) Serve meals family style so older children can serve themselves (1,2,3,4) Provide small, age-appropriate portions using child-sized utensils and dishes (1,2,3,4) Ensure that children are seated and undistracted during mealtime (e.g., no television during meals) (1,2,4) Allow children to eat to their own fullness without pressure to overeat (1,2,3,4) Avoid the use of food as a reward or punishment (1,2,4)

Model healthy mealtime behaviors to children Sit and eat with children at meal time (1,2,3,4) Say positive things about foods during meals (1,2,3,4)

Infant Feeding and Mealtime Habits—Source List

1. American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition; 2010.

2. National Resource Center for Health and Safety in Child Care and Early Education, University of Colorado Denver. National Resource Center for Health and Safety in Child Care and Early Education: Achieving a State of Healthy Weight: A National Assessment of Obesity Prevention Terminology in Child Care Regulations 2010. Aurora, CO; 2011.

3. Institute of Medicine (IOM). Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011.

4. Position of the American Dietetic Association: Benchmarks for Nutrition in Child Care. J Am Diet Assoc. 2011;111:607-615.

5. World Health Organization. Global Strategy for Infant and Young Child Feeding. 2003.

Healthy Activity, Screen Time, and Sleep in the Early Years

Young children should spend most of the day being active, not sitting or watching television. During nap times, children need peaceful and television-free places to sleep, both in the child care setting and at home.

Here is a summary of early child care activity, screen time, and sleep recommendations for obesity prevention, based on a review of expert guidance from the American Academy of Pediatrics, the National Resource Center for Health and Safety in Child Care and Early Education, the Institute of Medicine, and others. Though these recommendations are written for child care providers, parents can follow these same guidelines at home. For more detailed guidance on these recommendations and ideas for putting them into practice, explore the source list and the links to other resources.

Encourage daily physical activity among children in child care Offer at least two to three outdoor opportunities for daily active play, weather permitting (1,2,3) Remove barriers to outdoor play, for example, by keeping a change of clothes at the center and providing shade (1,2,3) Ensure that restricted playtime (for example, limiting outdoor play) is never used as a punishment for children who misbehave (1,2,3) Provide child care staff with ongoing training on age-appropriate activities (1,2,3) Maintain a written policy on promoting physical activity and share these policies with parents (1,2,3)

Facilitate age-appropriate activity in short, regular bursts throughout the day Give infants supervised time in the prone position (“tummy time”) every day (1,2,3) Limit the time that infants spend in restricted seating (swings, strollers, exersaucers, high chairs) (1,2,3) Give toddlers 60 to 90 minutes per 8-hour day for vigorous physical activities (activities that get them breathing deeper and faster than typical activities), spread out in short, regular bursts throughout the day (1,2,3) Give preschool-age children 90 to 120 minutes per 8-hour day for vigorous physical activities (activities that get them breathing deeper and faster than typical activities), spread out in short, regular bursts throughout the day (1,2,3)

Model active play Lead at least two structured games or activities that require movement each day, such as Simon Says (1,2,3) Encourage children through positive words, such as “Nice catch!” (1,2,3) Energetically participate in indoor and outdoor play throughout the day (1,2,3) Reduce barriers to adult caretakers being active with children (for example, make sure caretakers wear appropriate shoes, and remove outdoor seating for adults) (1,2,3)

Minimize television/screen time and sedentary time Keep screen media turned off at all times around children under the age of 2 (1,2,3) Limit any media viewing (television, cell phone, or digital media) in the child care setting to no more than 30 minutes per week for children age 2 and older, since many children are already exposed to excessive levels of screen time in their homes (1,2,3) Ensure that children of all ages are not sitting longer than 15- to 30-minute intervals, unless during meals or naptime (1,2,3)

Support healthy sleeping habits Remove any screen media from children’s sleeping areas (3) Maintain calming naptime routines such as reading a book (3) Put infants to sleep while they are drowsy but still awake, so that they can learn to fall asleep without assistance (3)

Healthy Activity, Screen Time, and Sleep—Source List

1. American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition; 2010.

2. National Resource Center for Health and Safety in Child Care and Early Education, University of Colorado Denver. National Resource Center for Health and Safety in Child Care and Early Education: Achieving a State of Healthy Weight: A National Assessment of Obesity Prevention Terminology in Child Care Regulations 2010. Aurora, CO; 2011.

3. Institute of Medicine (IOM). Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011.

4. Position of the American Dietetic Association: Benchmarks for Nutrition in Child Care. J Am Diet Assoc. 2011;111:607-615.

Terms of Use

The aim of the Harvard School of Public Health Obesity Prevention Source Web site is to provide timely information about obesity’s global causes, consequences, prevention, and control, for the public, health and public health practitioners, business and community leaders, and policymakers. The contents of this Web site are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Web site. The Web site’s obesity prevention policy recommendations are based primarily on a review of U.S. expert guidance, unless otherwise indicated; in other countries, different policy approaches may be needed to achieve improvements in food and physical activity environments, so that healthy choices are easy choices, for all.