- Encourage and model healthy habits in children.
- Teach, model, and observe family style dining, which should include portion control and desirable meal components. Incorporate strategies when snack is a choice in preschool or school-age programs.
- Train classroom staff in food preparation and service in infant classrooms.
- Train staff in bottle preparation and bottle-feeding practices.
Child development professionals are models for children and youth. They play a major role in helping children develop lifelong healthy habits. As a trainer or coach, you can help staff foster healthy habits in themselves and in the children they care for. Understanding what to eat, how much to eat, and how to stay fit are important skills for everyone to learn.
This learning happens early in life when infants enter our programs. It is critical that you ensure staff members know how to feed infants appropriately. This includes:
- Storage and serving guidelines for human milk
- Procedures for warming milk and preparing bottles
- Nurturing and responsive feeding routines that include holding infants for feeding, never propping a bottle, etc.
Handling of Breastmilk and Formula
It is essential that staff are trained on the safe handling and storage of breast milk and formula. Staff must utilize a tracking system to ensure that breast milk or formula is not given after the expiration date or given to the wrong child.
You can support families who choose to breastfeed by making the process of labeling and storing human milk as easy for them as possible; e.g., providing pre-printed labels where they only need to write the date expressed. You can read more about how to properly handle and store human milk by visiting: http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm. Work with your program manager to develop a system that supports families and fulfills all the guidelines for safe handling and storage of human milk and formula.
When following proper bottle preparation techniques, the chance of feeding breastmilk to the wrong infant is small. In the case of an infant being fed another child's breastmilk by mistake, there is the possibility that the infant has been exposed to hepatitis B, hepatitis C, or HIV. If this mistake should ever happen in your program, you should immediately do the following:
- With the reporting staff member, inform the mother who expressed the breastmilk about the error and discuss with her how the milk was handled before it was delivered to your program. You will also need to ask if she has ever had hepatitis B, hepatitis C, or an HIV blood test. It will be important to ask if she is willing to discuss this information with the family of the child who was mistakenly fed her milk.
- Next, you will need to discuss the mistake with the family of the infant who was fed the wrong bottle. Let them know that the risk of transmission of infectious disease is low, but that it would be best to notify their child's primary care provider of the mistake. Provide as much information as you can about the time and date the milk was expressed and how the milk was handled before coming to your program. Depending on the health history of the mother whose milk was given, the child who received the wrong bottle may need to have baseline blood tests for hepatitis B, hepatitis C, or HIV.
- You will need to assess how the wrong milk was given and create a plan to prevent future mistakes from happening. This plan should be shared with families.
Staff must be properly trained in the handling and distribution of breastmilk and formula.
It may be helpful for you to refer to the Infant and Toddler track Healthy Environments course, Lesson 5 (or Lesson 5 in the Healthy Environments course in the Family Child Care track) for more information on feeding the youngest children in your program.
As children get older, it is important to teach staff how and when your program introduces solid foods. Support staff as they maintain communication with families. As children enter the toddler and preschool years, you can communicate with staff about family style dining, portion control, and healthy eating habits.
The U.S. Department of Agriculture (USDA) has developed a tool, known as MyPlate, to help us all make healthier food choices. You can find more information at www.choosemyplate.gov. Make sure staff members are familiar with MyPlate. Provide posters and teaching materials from the USDA to staff members.
Review what staff members have learned about family style dining, bottle preparation, portion control, and food safety. Also make sure that school-age staff members understand the signs of eating disorders and how to respond.
Make sure staff members understand their roles and responsibilities related to physical fitness. Talk to staff members about what they have learned about modeling healthy habits and make sure they understand the importance of outdoor play. Reinforce the fact that children need at least 60 minutes of physical activity per day and discuss how much physical activity children should be offered during your program day. Talk to staff about their own physical activity. Encourage them to move around the active play spaces and to engage in physical activity with the children. Physical activity is covered more in-depth in the Physical Development course.
How Can You Model Healthy Habits in Your Workplace?
Food is a major characteristic of many cultures. Sharing a meal is often seen as a way to build relationships and a sense of community. It is easy, though, for groups to fall into unhealthy habits. One special event turns into a month of special events. Think about the following scenarios. Do any of them happen in your program? What could be done to make these events healthier? Are healthier alternatives or adaptations available?
Birthday treats on each staff member's birthday
Potluck lunches on staff development days
Candy jar in the staff area
Events like "muffins with moms" or "donuts with dads"
How Can You Help Staff Promote Healthy Eating?
You can support family style dining in child development programs and healthy choices of cafeteria-style snacks in school-age programs. Follow your program guidelines with regard to the regularity of meals and snacks offered to children. Generally meals or snacks for preschool and school-age children should be offered 2-3 hours apart. Get involved during mealtimes by joining children and staff at the table. Sit and have a conversation. Model healthy habits: serve yourself healthy portions of fruits, vegetables, and healthy grains. Keep in mind that children should have access to second servings of nutritious foods. Talk about the choices you make and how those foods make you feel. If you are no longer hungry, stop eating. It's OK not to clean your plate! Together, you and the staff members can help children learn lifelong healthy habits.
You can also help preschool and school-age staff members reflect on the messages they send during cooking activities. Make sure you help staff get the ingredients they need for healthy cooking options. Review activity plans and ask staff members to branch out from the usual cookies, muffins, and cupcakes. Cooking is a valuable skill; children can learn to make whole grain breads or granola, vegetable dishes, and healthy fruit-based desserts.
You can also model healthy fitness habits in your program. Hold walking meetings: discuss lesson plans or other topics while walking around the building with a staff member. You can also set goals for staff fitness. Consider starting a walking, running, or biking club for staff members and/or school-age children. If your school-age program offers Zumba classes or other organized fitness activities for children, encourage staff to join in--and join in yourself! It's also important to help staff remember that fitness is not seasonal--it's essential all year long. In locations with severe weather in the winter (or extremely hot summers) help staff think of indoor options to keep themselves and children fit. Dance classes, yoga, volleyball, basketball, or weightlifting clubs can be good alternatives to outdoor sports.
To encourage and model healthy feeding, eating, and physical activity habits, encourage staff and providers in the following best practices:
- Feed infants on cue.
- Build secure relationships with infants to help staff and providers recognize their feeding patterns.
- Listen for crying that may indicate missed feeding cues.
- Do not feed an infant who does not show signs of hunger.
- Know that cues vary among infants; staff and providers should become familiar with each infant’s mannerisms and cues.
- Talk with families to understand what feeding schedule best fits their child.
- Staff and providers should individually bottle feed each child.
- Pacifiers are not used to remedy infant hunger. Instead, staff and providers should work quickly to offer a bottle or food and use soothing words to describe the child’s feelings as they work to remedy their hunger.
- Document daily what and when young children eat, especially infants and toddlers, and share this information with families at pick up time.
For a comprehensive resource on feeding infants, see the U.S. Department of Agriculture (USDA) resource, Feeding Infants in the Child and Adult Care Food Program at https://www.fns.usda.gov/tn/feeding-infants-child-and-adult-care-food-program.
Regarding older children:
- Practice family style dining.
- Provide a variety of healthy foods, including second helpings of nutritious food.
- Provide appropriately sized foods that are ready to eat when served.
- Encourage children to try new foods.
- Respect when children shows signs of fullness.
- Model healthy habits. Do you drink soda, eat fast food, chips, or sweets in front of the children? Because they look up to you, the children in your care will want to consume food and drinks similar to what you consume.
- Make sure water is always available
- If you must offer something different than what is listed on your program’s posted menu (e.g., due to food supply issues), notify families of these substitutions (e.g., on posted menus and/or through electronic communication).
- Note food substitutions on posted menus before serving
- If families provide their own meals and snacks, ensure these are nutritious, and supplement when necessary.
- Sit down to eat and drink for snacks and meals. Teach children that they must sit while eating and drinking. Model this habit by doing so yourself.
- Be physically active during indoor and outdoor gross-motor time. Do staff and providers supervise infants and toddlers while up, moving, and playing or while sitting? Children will imitate the behaviors they model.
As you help teachers improve their practice, think about ways you can talk to staff members about their work.
Case Example: School-Age Fitness
Let's follow a case example about a school-age program's fitness initiative. As you watch the video, notice how adults are (or are not) engaged in modeling healthy habits. What would you do?
You might have noticed in the video that the adults were not very active. Several adults were standing around the sides of the rooms. Some were doing paperwork, and some were just watching the children. The trainer, coach, or administrator in this program decided to model healthy habits for the staff. Watch the next video to see the difference it made once the trainer, coach, or administrator got involved.
As this video shows, you can model healthy habits for children and staff. If you want to see change in your program, look for ways you can make the change happen. Sometimes staff just need a little push and a role model saying, "It's OK." Give it a try and see what a difference you can make in your program.
Additional Examples of Nutrition and Fitness
Because this lesson covers nutrition and fitness, the following videos will provide examples of the ways different programs have helped promote health in both categories. First you will watch a video that highlights a range of feeding and nutrition practices in infant, toddler, preschool and school-age programs. Then you will watch a video that shows a range of fitness activities for toddlers and preschoolers.
In the first example, you saw a staff member engaged in a nurturing interaction. You might have also spotted a bottle on the floor near the staff member. It is essential to make sure all staff members in infant rooms understand the importance of careful bottle preparation and feeding standards. It would be good practice to remind the staff member that bottles should not be set on the floor.
In the second example, we heard a staff member describing their bottle preparation and storage procedures. All staff members who work in infant classrooms should be able to describe these procedures: where bottles are stored, how they are labeled, how long they can be stored, what is done with unused milk or formula. Your work is not finished after you describe the steps accurately, though. You must observe and monitor to make sure steps are followed. It is critically important that staff members follow these steps to prevent the feeding of human milk to the wrong infant. In the event that an infant receives another mother's expressed milk, you will likely be called to help handle the situation. Be prepared to help explain what happens in such a situation, calm anxious or upset families, and put procedures in place to prevent such problems in the future.
Finally, we saw a school-age program cooking activity. Cooking activities are great ways to influence healthy habits. We have to make sure, though, that children get consistent messages about the foods they choose. You must be prepared to help staff members think of ways to offer “fun” cooking activities that rely on healthful foods that limit calories from added sugars, saturated fats and sodium. What options could you suggest to staff members who plan to cook cupcakes, cookies, or muffins? Can children learn just as much (or more) from cooking bread or granola bars? Can they learn to make guacamole or other interesting fresh foods? Ask questions like these to help staff reflect on more healthful options that still taste good. Also make sure your program makes food purchasing decisions that support these healthier options.
Finally, these videos showed us a range of fitness activities for young children. Just like in the case example of school-age programs, physical activity is as important for children as it is for adults. Read the table below to see how you might respond.
After staff members complete the Healthy Environments course, you will be able to better assess their practices around nutrition, family style dining, and fitness. It’s important to remember your cyclical process in being able to observe staff, provide constructive feedback, and offer resources as needed throughout that staff’s career. Needs will change, but your role in this mission is critical. Remember that the information you share with staff, family child care providers, parents, and guardians is valuable to children’s trajectory. When parents make an effort to improve or maintain their good health, those benefits are strongly related to their children's good health. (Murphey, Cook, Beckwith, & Belford, 2018).
Providing nutritious meals and snacks is an important function of your program. It is also important for staff members to model a healthy approach to fitness, but sometimes this is not so easy. Read the scenarios in the Talking about Healthy Habits activity and decide how you would respond. Then compare your answers to the suggested responses.
It is important to observe staff members as they carry out programs and provide feedback on what you see. Use the Fitness and Nutrition Best Practices Checklist as a focused observation tool to support staff that have completed the Healthy Environments course but may need additional support or follow up on promoting physical activity and healthy nutrition habits. This checklist provides an easy way to follow up on goals set around this topic and specific feedback for staff members about what you observed.
|Cafeteria-style dining||A style of food service in which children choose their food (or are given predetermined food) on a serving line|
|Family style dining||A style of food service in which adults and children sit together at a table, eat the same menu, and talk together|
|System||An organized method of accomplishing something. A system for tracking information, according to the Program Administration Scale, includes tangible and concrete evidence, involvement from multiple individuals, and defined accountability|
|Vigorous physical activity||Vigorous physical activity raises the heart rate. Examples include running, jumping, skipping, fast dancing, or riding a bike|
|Weather permitting||Children should not play outdoors when the wind chill is below minus 15 degrees or the heat index is above 90 degrees. However, individual program policies may prohibit outdoor play even when the weather is not this extreme (i.e., weather is unusual for the region and children do not have heavy coats). Children should also stay indoors during rain, thunder, snow, high winds, or other potentially dangerous weather situations|
Action for Healthy Kids. (2019). Game on activity library. https://www.actionforhealthykids.org/game-on-activity-library/
Action for Healthy Kids. (2019). Healthy eating toolkit. https://www.actionforhealthykids.org/nutrition-toolkit/
Action for Healthy Kids. (2019). Tip sheets: Before and after school activities. https://www.actionforhealthykids.org/references/
American Academy of Pediatrics. (2006). A Parent’s Guide to Childhood Obesity: A Roadmap to Health. S. Hassink [Ed.]
American Academy of Pediatrics. (2012). Healthy Children: Ages & Stages: Preschool: Nutrition & Fitness. Retrieved from http://www.healthychildren.org/English/ages-stages/preschool/nutrition-fitness/Pages/default.aspx
Child Care Aware. (2020). Health Resources and Links. Retrieved from https://www.childcareaware.org/our-issues/health-nutrition/health-resources-and-links/
Food and Nutrition Service. U.S. Department of Agriculture. (2019). Feeding infants in the child and adult care food program. Retrieved from https://www.fns.usda.gov/tn/feeding-infants-child-and-adult-care-food-program
Food and Nutrition Service. U.S. Department of Agriculture. (2019). CACFP trainer's tools: Feeding infants. Retrieved from https://www.fns.usda.gov/tn/feeding-infants-cacfp-trainers-tools
Institute of Child Nutrition. (2018). (2012). Education and Training Resources for Participants in the Child and Adult Care Food Program (CACFP). Retrieved from https://theicn.org/cacfp
Lerner, C. & Parlakian, R. (n.d.) Healthy from the Start. Zero to Three: Washington, D.C. Retrieved from https://www.zerotothree.org/resources/352-healthy-from-the-start
MacLaughlin, S. (2017). The Truth about Juice. Zero to Three. Retrieved from https://www.zerotothree.org/resources/1902-the-truth-about-juice
Murphey, D., Cook, E., Beckwith, S., & Belford, J. (2018). The health of parents and their children: A Two-Generation Inquiry. Washington, D.C.: Child Trends. Retrieved from https://www.childtrends.org/wp-content/uploads/2018/10/AECFTwoGenerationHealth_ChildTrends_October2018.pdf Summary retrieved from https://www.childtrends.org/a-parents-health-is-one-of-the-strongest-predictors-of-a-childs-health
National Diabetes Education Program. (2007). Tips for Teens: Lower your risk for type 2 diabetes.
National Food Service Management Institute. (2012). More Than Mud Pies: A nutrition curriculum guide for preschool children (6th ed). University of Mississippi.
National Resource Center for Health and Safety in Child Care and Early Education. (2018). Achieving a state of healthy weight: 2017 update. Aurora, CO: University of Colorado Denver. Retrieved from http://nrckids.org/files/ASHW.2017_7.23.18.pdf
National Resource Center for Health and Safety in Child Care and Early Education.(2018). Achieving a state of healthy weight 2017 Supplement: State Profiles. Aurora,CO: University of Colorado Denver. Retrieved from http://nrckids.org/files/ASHW.2017.Supplement_7.23.18.pdf
National Resource Center for Health and Safety in Child Care and Early Education. (2018). Healthy Weight. Retrieved from http://nrckids.org/HealthyWeight
National Resource Center for Health and Safety in Child Care and Early Education. (2017). Preventing Childhood Obesity in Early Care and Education Programs. Retrieved from http://nrckids.org/CFOC/Childhood_Obesity
National Resource Center for Health and Safety in Child Care and Early Education. (n.d.). Motion Moments.
North Carolina Cooperative Extension. (n.d.) Color Me Healthy: Preschoolers moving and eating healthy. Retrieved from http://www.colormehealthy.com
Office of Head Start. (2015). I am Moving, I am Learning: Intervention in Head Start.
Patrick, K., Spear, B., Holt, K. & Sofka, D. (Eds.). (2001). Bright Futures in Practice: Physical Activity. Arlington, VA: National Center for Education in Maternal and Child Health.
Pérez-Escamilla R, Segura-Pérez S, Lott M (2017) on behalf of the RWJF HER Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers from Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Guidelines for Health Professionals. Durham, NC: Healthy Eating Research. Retrieved from http://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_brief_021416.pdf
Physical Activity Guidelines Advisory Committee. (2008). Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services. Retrieved from https://health.gov/our-work/physical-activity/about-physical-activity-guidelines
Pica, Rae. (n.d.) Moving and Learning: The Physical Activity Specialists for Birth through Age 8.
Roths, B., Frees, B.S., Bailey, G., & Fitzgerald, K. (2002). Let’s Move, Learn, and Have Fun. Journal of Nutrition Education and Behavior, 34:6, 343-344.
Sanders, S. (2002). Active for Life: Developmentally appropriate movement programs for young children. Champaign, IL: Human Kinetics Publishers.
The National Association for Sport and Physical Education. (2009). Active Start: A statement of physical activity guidelines for children from birth to age 5. (2nd ed.). Retrieved from https://www.shapeamerica.org/standards/guidelines/activestart.aspx
The National Association for Sport and Physical Education. (2004). Physical Activity for Children: A statement of guidelines for children 5-12 (2nd ed.). Retrieved from https://www.shapeamerica.org/standards/guidelines/pa-children-5-12.aspx
University of North Carolina at Chapel Hill. (2018). NAP SACC. Nutrition and Physical Activity Self-Assessment for Child Care program. Retrieved from https://gonapsacc.org/self-assessment-materials
U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). 2015–2020 Dietary Guidelines for Americans. 8th Edition. Retrieved from http://health.gov/dietaryguidelines/2015/guidelines/
U.S. Department of Agriculture Child and Adult Food Care Program. (n.d.). Child Day Care Centers. Retrieved from https://www.fns.usda.gov/cacfp/child-day-care-centers
U.S. Department of Agriculture. (n.d.). Choose My Plate. Retrieved from http://www.choosemyplate.gov
U.S. Department of Agriculture. (n.d.). Choose My Plate: Health and Nutrition Information for Preschoolers. Retrieved from https://www.choosemyplate.gov/browse-by-audience/view-all-audiences/children/health-and-nutrition-information
U.S. Department of Agriculture. (2013). The Two Bite Club. Retrieved from https://www.fns.usda.gov/tn/two-bite-club