1. www.HealthyKidsHealthyFuture.org Technical Assistance Workshop Honolulu, Hawaii March 8, 2013 Dr. Caree Jackson Cotwright, CDC DNPAO Disclaimer: The findings of this presentation are the conclusions of the presenter and do not necessarily represent the official policies of the CDC nor does the mention of any names or organizations imply endorsement by the Federal government.

2. What is Lets Move! Child Care? One component of the First Ladys Lets Move! initiative to solve the obesity problem Supports providers to adopt best practices for physical activity, screen time, foods, beverages, and breastfeeding through free resources and interactive, online tools Recognizes providers who meet best practices

3. www.HealthyKidsHealthyFuture.org Why Participate? You can make a difference You can be a champion for healthy choices Youre a role model You care Youre a partner in parenting Its easier than you might think

4. www.HealthyKidsHealthyFuture.org Icebreaker: Rainbow Run When I call out one of the colors of the rainbow run and touch 3 things that are that color.

5. www.HealthyKidsHealthyFuture.org Session Agenda Basics about Childhood Obesity Overview of Lets Move! Child Care (LMCC) Physical Activity Focus LMCC Resources LMCC Quiz & Action Planning Tips from Providers that Work! Technical Assistance and Workshop Feedback

6. www.HealthyKidsHealthyFuture.org Session Objectives After participating in the workshop participants should be able to answer the following questions: 1 What are the best practices for obesity prevention in ECE? 2 What are the key challenges I should consider before developing an action plan to address obesity in ECE? 3 What steps should I take to meet the 5 LMCC goals? 4 How can I use the tools and resources in the LMCC technical assistance toolkit to improve nutrition, physical activity, screen time and breastfeeding support?

7. Dr. Caree Jackson Cotwright Centers for Disease Control and Prevention Basics about Childhood Obesity

8. www.HealthyKidsHealthyFuture.org Obesity Common Costly Solvable Photo source: www.obesityinamerica.org

9. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%–14%

10. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%–14% 15%–19% 20%

11. (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% 30% Obesity Trends* Among U.S. Adults BRFSS, 2010

12. www.HealthyKidsHealthyFuture.org We Are Evolving

13. Childhood Obesity 24% - 33% of 2 – 5 year olds are overweight or obese. Obesity rates for young children doubled in about a 20 year period of time (1980s – 2000). Obese children are more likely to become obese adults. If children are overweight, obesity in adulthood is likely to be more severe.

17. Education Consequences Children who are overweight or obese can be undernourished at the same time. Nutrition deficiencies `Impair brain development and cognitive functioning, including learning Physical inactivity Activity promotes brain development, improves sleep, builds self confidence, and reduces stress & depression Children who are not active have more behavioral and disciplinary problems, shorter attention spans in class and do worse in school compared to active children

18. You Play an Important Role in Preventing Obesity!

19. Moving Forward to Reverse the Obesity Trends … we know the cure for this. This isn't like putting a man on the moon or inventing the Internet - it doesn't take some stroke of genius or feat of technology.... Rarely in the history of this country have we encountered a problem of such magnitude and consequence that is so eminently solvable. Michelle Obama February 9, 2010

20. Why obesity prevention in child care and early education programs? You can help children build healthy habits for life Food preferences and physical activity habits develop during early childhood and continue into adulthood You are a role model. Kids do as you do, especially when theyre young. You are in a unique position to educate parents about healthy eating and activity

21. What You Can Do to Prevent Obesity

22. www.HealthyKidsHealthyFuture.org Moving Forward, Reverse the Trend … we know the cure for this. This isn't like putting a man on the moon or inventing the Internet - it doesn't take some stroke of genius or feat of technology.... Rarely in the history of this country have we encountered a problem of such magnitude and consequence that is so eminently solvable. Michelle Obama February 9, 2010

23. www.HealthyKidsHealthyFuture.org Making a Difference Video:

24. www.HealthyKidsHealthyFuture.org Break Time! Leave the room like the motions of weather in: Rain Wind Thunder Snow Sunshine

25. Lets Move! Child Care Goals

26. www.HealthyKidsHealthyFuture.org 5 Goals Provide 1-2 hours of physical activity throughout the day, including outside play when possible. For mothers who want to continue breastfeeding, provide their milk to their infants and welcome them to breastfeed during the child care day. Support all new parents' decisions about infant feeding. Provide access to water during meals and throughout the day, and don't serve sugar-sweetened drinks. For children age 2 and older, serve low-fat (1%) or non-fat milk, and no more than one 4- to 6- ounce serving of 100% juice per day. Serve fruits or vegetables at every meal, eat meals family-style whenever possible, and don't serve fried foods. No screen time for children under 2 years. For children age 2 and older, strive to limit screen time to no more than 30 minutes per week during child care, and work with parents and caregivers to ensure children have no more than 1-2 hours of quality screen time per day (as recommended by AAP). 1 Physical Activity 2 Screen Time 3 Nutrition 4 Beverages 5 Infant Feeding

27. www.HealthyKidsHealthyFuture.org Stand Up & Talk Time! (2 minutes) Turn to your neighbor and discuss which goals are easiest or hardest to adopt in your ECE setting.

28. Why Offer Healthy Food?

31. www.HealthyKidsHealthyFuture.org Food (1) Helps children stay at a healthy weight Food preferences develop at an early age, even in infancy Opportunity to teach kids taste buds to appreciate healthy foods

32. www.HealthyKidsHealthyFuture.org Food (2) Many healthy options cost the same as the not-so- healthy choices (like whole wheat bread vs. white bread) Many children eat most of their daily meals and snacks while in care, especially children in full- time care

33. www.HealthyKidsHealthyFuture.org Food (3) Benefits of family-style dining Improve skills for self-feeding and recognition of hunger cues Promotes and supports social emotional, and motor skill development Language skills improve as adults and peers talk with each other Opportunity for positive role modeling Adults at the table help prevent fighting, feeding each other, potential choking, and other negative behaviors

34. www.HealthyKidsHealthyFuture.org Food Moves! Pretend to move like different foods Melt like a popsicle Pop like popcorn Wiggle like spaghetti

35. Why Offer Healthy Drinks?

38. www.HealthyKidsHealthyFuture.org Beverages (1) Water keeps kids hydrated best Water helps to reduce acid in the mouth that can cause cavities Sugary drinks are high in calories and low in nutrients Drinking water instead of sugary drinks reduces the amount of calories children consume

39. www.HealthyKidsHealthyFuture.org Beverages (2) Serving fresh fruit instead of fruit juice is best, because it is high in dietary fiber and is a natural source of energy Skim or 1% milk have the same amount of calcium and other essential nutrients as whole milk, but less fat and calories

42. Reasons for Reducing Screen Time Gets in the way of exploring, playing, and social interaction. As kids get older, screen time can get in the way of being active, reading, doing homework, playing with friends, and spending time with family. Kids who spend more time watching TV are more likely to be overweight or obese.

43. When screen time is allowed: Make it quality programming by choosing shows or computer games that are educational or get kids moving. Track screen time with a simple scheduling sheet so you know how much screen time a child has and when theyve reached their limit for the week. Avoid watching while eating (snacks or meals). REMINDER: Touch screen technology does NOT count as active screen time. Also, watch the quality of childrens movement with active video games

44. Why Support Breast Feeding?

47. www.HealthyKidsHealthyFuture.org Breast Feeding (1) Breast milk helps to: Prevent obesity Defend against infections (keeping infants from getting sick with things like diarrhea and ear infections) Protect against a number of conditions like asthma, diabetes, and sudden infant death syndrome (SIDS)

48. In-Depth Review of Physical Activity Goal

49. My Bonnie Lies Over the Ocean My Bonnie lies over the ocean, my Bonnie lies over the sea, My Bonnie lies over the ocean, O bring back my Bonnie to me. Bring back, bring back, O bring back my Bonnie to me, to me. Bring back, bring back, O bring back my Bonnie to me.

50. Knowledge Check What is the recommended amount of physical activity for toddlers in full day care? 15 - 30 min 30 - 45 min 60 - 90 min 90 - 120 min

51. Knowledge Check What is the recommended amount of physical activity for toddlers in full day care? 15 - 30 min 30 - 45 min 60 - 90 min 90 - 120 min

52. Physical Activity Best Practices Infants: Short supervised periods of tummy time several times each day Toddlers & Preschoolers: Active play time every day, both indoor and outdoor Toddlers: 60 – 90 minutes or more (for half-day programs, 30 minutes or more) Preschoolers: 120 minutes or more (for half-day programs, 60 minutes or more) REMINDER: Make sure that kids with special needs can participate in activities too!

53. Benefits of Physical Activity Helps children stay at a healthy weight In childhood In adulthood – physical activity habits learned in early childhood can last a lifetime Helps children: Develop motor skills and build their strength, flexibility, and endurance Develop and maintain strong bones Improves social skills and brain development Sleep better Feel confident about themselves and their bodies Reduce their risk of feeling stressed or depressed

54. Benefits of Physical Activity Children who are active tend to have fewer behavioral and disciplinary problems, do better in school, and have longer attention spans in class.

55. Ways to Get Kids Moving Two kinds of physical activity 1. STRUCTURED: Organized, quick, and intense activities led by adults 2. UNSTRUCTURED: Free Play to stimulate the imagination and creativity

56. Ways to Get Kids Moving Add physical activity into your daily routine Have children act out a story as you read it to them. Encourage kids to move like different animals during transitions from one activity or room to another. Use props to help kids move and identify shapes, colors and numbers

57. Ways to Get Kids Moving Mix up the usual hokey pokey and head, shoulders, knees and toes with a dance party or obstacle course Encourage working together to come up with games and activities

58. Where to Play Opt for the outdoors as much as possible. Be weather-ready. Check your childproofing. Get down to their level. Lets Play!

59. Keep infants active too Tummy Time: Is allowing babies to interact and play while awake and on their tummies Prepares babies for sliding on their bellies and crawling Begins as a three-five minute period and is gradually increased as the infant shows enjoyment of the activity

60. Keep infants active too During tummy time: Encourage them to see, touch, and feel whats around them Try putting their favorite toys just out of reach REMINDER: Always make sure infants have tummy time when theyre awake and alert and placed on a solid surface on the floor (never on a surface thats soft or up high like a mattress or sofa).

61. Know the Developmental Milestones Kids should do specific things at every age and stage. Know the milestones to help them work on the appropriate physical and motor skills. Check out the following chart of developmental milestones from birth to 36 months old.chart of developmental milestones

62. Know the Developmental Milestones

63. www.HealthyKidsHealthyFuture.org Motion Moments: Toddlers

64. Be a Get Moving Role Model Participate in and enjoy physical activity Wear comfortable clothing If you have limitations, be a cheerleader!

65. Available in English and Spanish

66. Physical Activities Fun activity ideas, tips for incorporating physical activity into your daily routine, activity sheets, and more!

68. www.HealthyKidsHealthyFuture.org Physical Activity Innovation: Yoga Flashcards

69. Activity sheets eXtension Alliance for Better Child Care Hands-on Activities Database Songs to get kids dancing

70. Creative Physical Activity: Bean Bag Blitz! *These bean bags should only be used with children ages 3 and up

71. Lets Move Child Care Resources Fruit & Veggie Bean Bags Sesame Street: We Have the Moves! Sesame Street: Food For Thought: http://www.sesamestreet.org/parents/topicsandactivities/toolkits/food Grow It, Try It, Like It! Garden Curriculum USDA http://teamnutrition.usda.gov/Resources/growit.html 4 oz and 6 oz cup samples Potter the Otter: Book about Water Consumption http://www.potterloveswater.com/ Child Size Pitchers Helpful Resource Idea Printed Tip Sheets

72. Curriculum Menu Planning & Recipes Training videos Activity Sheets Parent Handouts And more! Website Resources

73. www.HealthyKidsHealthyFuture.org Start Early Start Early tab: Provides research base for LMCC Answers questions providers may have Links providers to relevant areas of the website as they get started: Sign up Quiz Tools & Resources

74. Child & Adult Care Food Program Resource http://healthymeals.nal.usda.gov/cacfp-wellness-resources-child-care- providers/electronic-media-use-screen-time

75. Physical Activities Fun activity ideas, tips for incorporating physical activity into your daily routine, activity sheets, and more!

76. Kid-friendly recipes, menu planning guides, healthy eating tips, shopping lists, and more! Healthy Eating

77. Tip Sheets

78. Resources for families Tips for parents

79. Nutrition & Physical Activity Curriculum (with DVD)

80. Action Story New Fruits and Veggies at the Market

81. Healthy eating and activity tips for you! Healthy recipes

82. Posters Breastfeeding Resource Kit

83. Free Online Trainings One for every LMCC goal Special topics Farm to Preschool Using LMCC resources

84. Stretch Time! Moving like an animal: Prowl like a lion Hop like a bunny Strut like a flamingo Swing your trunk like an elephant Tip toe like a mouse

85. Sign Up & Lets Move! Child Care Quiz

86. www.HealthyKidsHealthyFuture.org 1. Sign up online to receive a participation certificate and get emails from LMCC www.HealthyKidsHealthyFuture.org 2. Take the Checklist Quiz to see how you are doing in the goal areas 3. Build your Action Plan 4. Use the free online tools and resources to help implement your action steps 5. Retake the Checklist Quiz once best practices have been met and earn the LMCC Provider Recognition Award 6. Share your success story LMCC Steps

87. www.HealthyKidsHealthyFuture.org The Checklist Quiz can be taken any time on the LMCC Website:www.HealthyKidsHealthyFuture.org Fun way to see where you are and make a manageable action plan to achieve the LMCC goals You choose your priorities -- start with whatever is going to be easiest and then build on your success Take the Checklist Quiz

88. Small Group Discussion Consider key challenges to meeting the LMCC Best Practices in the Child Care Setting Choose one person to report out to the group

89. Action Planning

90. Action Planning is an important step to help you make changes You choose your priorities Start where you and your program are most likely to be successful Be ready to create individual action steps Samples are available Action Plan using the Checklist Quiz

91. www.HealthyKidsHealthyFuture.org Sample Action Plan

92. Tips From Providers that Work!

93. www.HealthyKidsHealthyFuture.org Nutrition Mix it up serve a variety of nutritious choices. Opt for healthier alternatives. Let children participate in preparing food, if possible. - special jobs (like stirring and adding ingredients) makes kids feel like helpful "big boys" and "big girls" and proud of what they created Have kids create their snacks.

94. www.HealthyKidsHealthyFuture.org Nutrition Learn about how food grows. -Plan field trips to the local farmers market or pick your-own-farm, garden with the kids to talk about where food comes from and to pique their interest in trying the new produce they see Dont use food as a reward or punishment. -Avoid forcing children to finish the healthy foods to get to their dessert or sweets. Talk about sometime vs. anytime foods. Reinforce nutrition messages with classroom activities.

95. Ways to Make Family Style Dining Work Let kids practice serving themselves first Use play food, like plastic fruits and veggies. Use the right equipment Use child size pitchers, tongs, and serving bowls and plates. Put dressings and dips in child size squeeze bottles. Be prepared for spills! Show kids you enjoy eating healthy foods. They will follow your example!

96. Ways to Promote Healthy Drinks Take water jugs and cups with you outside. Try adding fruit slices or berries to water for an extra fun taste! Try diluting 100% fruit juice with water to train childrens palette to enjoy less sweetness. Model healthy drinking by avoiding sugary drinks in front of children. Instead of juice, serve fresh fruit, which includes important dietary fiber and is a natural source of energy.

97. Ways to Reduce Screen Time Keep the TV/computer out of sight Put it in rooms not used by children Hide it with a blanket or sheet Get rid of it Replace screen time with fun, interactive activities Turn on the radio or a CD and dance Play outside Bring kids into the kitchen and let them help you set the table, cook, and clean up

98. Ways to Support Breastfeeding Educate teachers and staff about the importance of breastfeeding and how to properly handle breast milk. Respect parents wishes to give breast milk, infant formula, or both. Reassure nursing mothers. Create an ideal environment to pump or nurse.

99. www.HealthyKidsHealthyFuture.org Success Stories

100. www.HealthyKidsHealthyFuture.org Neighborhood House Association Head Start: San Diego, CA 26 Head Start and Early Head Start centers in San Diego Hired a Registered Dietitian and professional chef who spearheaded a menu overhaul Engage in Farm to Preschool

101. www.HealthyKidsHealthyFuture.org Break Time! MARCH to your break and pretend to play your favorite instrument. Have someone guess which instrument you are playing!

102. Back to Action Planning

103. Sharing & Role Play Examine one specific goal and discuss solutions to potential barriers that might arise for parents and/or providers. Choose a partner to role play with and create a solution to the barrier.

104. www.HealthyKidsHealthyFuture.org LMCC Process Snapshot Make Action Plan NO Implement Steps in Plan Free online tools, resources, webinars, help from trainers Take Checklist Quiz Meet all best practices? Sign Up on Website CONGRATULATIONS! LMCC Recognition Award YES

105. www.HealthyKidsHealthyFuture.org

106. Success StoriesSuccess Stories (within Ideas and Resources) Learn from others and overcome challenges Submit Success StoriesSuccess Stories May be highlighted in e-mail blasts, articles or on the LMCC website Inspire others to achieve the LMCC goals Be recognized for outstanding efforts

107. Technical Assistance & Feedback Complete Feedback Form Questions & Answers Next Steps

108. For more information Visit www.HealthyKidsHealthyFuture.orgwww.HealthyKidsHealthyFuture.org Contact the Lets Move! Child Care Help Desk LMCChelp@cdc.gov Share your success stories! www.healthykidshealthyfuture.org/resources/ testimonials.html