1. obesity prevention recommendations for families

2. Healthy Eating and Active Lifestyles Begin at Home It hardly needs saying that families are one of the most important and lasting influences on the choices—health and otherwise—that children and youth make. So when it comes to preventing excess weight gain and obesity, parents and guardians have fantastic potential to steer children in directions that lay the foundation for lifelong good health.

3. obesity prevention recommendations for family Breastfeed infants from birth to 6 months, without other solid foods or liquids, and continue breastfeeding after starting solid food, until 12 months or longer (1,2,3,4)1234 Promote healthy eating by stocking a variety of nutritious foods at home—fruits and vegetables, whole grains, healthy sources of protein, low-fat dairy (1,4)14 Keep high-calorie, low-nutrient foods and drinks out of the home—especially sugar- sweetened beverages (1,4,5)145 Model healthy eating for children by choosing a healthy diet (4,6) 46 Read tips for choosing a healthy diet: Healthy Weight ChecklistHealthy Weight Checklist Encourage children to try a variety of new healthy foods, such as vegetables; remember that it can take multiple tries for kids to accept a new food (1,4)14 Eat dinner as a family at home, and get children involved in shopping for and preparing meals (3,5,7)357 Eat breakfast and encourage children to eat breakfast daily (8)8 Limit eating in restaurants and fast-food restaurants, and limit takeout food (8)8 Teach children to pay attention to feelings of fullness: Offer smaller portions, allow them to choose their own portions, and don’t force them to “clean their plates” (1,3,4,5,9)13459

4. Promoting Healthy Eating at Home—Source List 1. American Academy of Pediatrics. Prevention and Treatment of Childhood Overweight and Obesity: What families can do. 2011. Accessed January 30, 2012.Prevention and Treatment of Childhood Overweight and Obesity: What families can do 2. American Academy of Pediatrics – Policy Statement. Breastfeeding and the use of human milk. Pediatrics. 2005;115:496-506.Pediatrics 3. U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation 2010 Rockville: U.S. Department of Health and Human Services, Office of the Surgeon General; 2010.The Surgeon General’s Vision for a Healthy and Fit Nation 2010 4. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: The National Academies Press; 2005.Preventing Childhood Obesity: Health in the Balance 5. Office of the Surgeon General. Childhood Obesity Prevention: Parents and Caregivers Checklist. U.S. Department of Health and Human Services, 2011. 6. American Heart Association. Overweight in Children. 2011. Accessed January 30, 2012.Overweight in Children 7. White House Task Force on Childhood Obesity. Solving the Problem of Childhood Obesity within a Generation : White House Task Force on Childhood Obesity Report to the President: White House Task Force on Childhood Obesity; 2010.Solving the Problem of Childhood Obesity within a Generation

5. obesity prevention recommendations for families. Be active as a family, choosing activities that family members of all ages and abilities can enjoy (1,2,3,4)1234 Model active lifestyles for children by becoming more physically active and by limiting sedentary activities, such as television watching (1,2,3,5,6)12356 Promote safe physical activity, such as having children wear bicycle helmets (1,2,6)126 Give children gifts that encourage physical activity (2,4,6)246 Walk or bike to school with children (3,4)34 Encourage children to play outside (1,2)12 Help children play on a sports team or try a new physical activity (1,4,6)146 Limit children’s TV viewing and recreational screen time (computers, DVDs, video games)  Children age 2 and older: Less than two hours of screen time per day (2,4,6,7)2467  Children under the age of 2: Avoid television watching/screen time (8)8 Make children’s bedrooms TV-free, by not putting a TV in the bedroom or removing televisions that are there (2,4,6,7)2467 Avoid putting an Internet connection in children’s bedrooms (8)8 Turn off the television during mealtimes (9)9 Ensure children get adequate sleep, and establish healthy sleep habits early on (4,7,10)4710

6. Family Physical Activity, Screen Time, and Sleep 1. American Academy of Pediatrics – Council on Sports Medicine and Fitness and Council on School Health Policy Statement. Active healthy living: prevention of childhood obesity through increased physical activity. Pediatrics. 2006;117:1834-42.Pediatrics 2. Institute of Medicine. Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: The National Academies Press; 2005.Preventing Childhood Obesity: Health in the Balance 3. U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation 2010 Rockville: U.S. Department of Health and Human Services, Office of the Surgeon General; 2010.The Surgeon General’s Vision for a Healthy and Fit Nation 2010 4. Let's Move. Active Families. 2011. Accessed January 30, 2012.Let's Move. Active Families 5. American Heart Association. Overweight in Children. 2011. Accessed January 30, 2012.Overweight in Children 6. American Academy of Pediatrics. Prevention and Treatment of Childhood Overweight and Obesity: What families can do. 2011. Accessed January 30, 2012.Prevention and Treatment of Childhood Overweight and Obesity: What families can do 7. White House Task Force on Childhood Obesity. Solving the Problem of Childhood Obesity within a Generation : White House Task Force on Childhood Obesity Report to the President: White House Task Force on Childhood Obesity; 2010.Solving the Problem of Childhood Obesity within a Generation 8. Strasburger VC. Children, adolescents, obesity, and the media. Pediatrics. 2011;128:201- 8.Pediatrics 9. Let's Move. Reduce Screen Time and Get Active. 2011. Accessed January 30, 2012.Reduce Screen Time and Get Active 10. Office of the Surgeon General. Childhood Obesity Prevention: Parents and Caregivers Checklist. U.S. Department of Health and Human Services, 2011.

7. The Obesity Prevention Source Early Child Care 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)123 Remove barriers to outdoor play, for example, by keeping a change of clothes at the center and providing shade (1,2,3)123 Ensure that restricted playtime (for example, limiting outdoor play) is never used as a punishment for children who misbehave (1,2,3)123 Provide child care staff with ongoing training on age- appropriate activities (1,2,3)123 Maintain a written policy on promoting physical activity and share these policies with parents (1,2,3)123

8. The Obesity Prevention Source Early Child Care 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)123 Limit the time that infants spend in restricted seating (swings, strollers, exersaucers, high chairs) (1,2,3)123 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)123 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)123

9. Model active play Lead at least two structured games or activities that require movement each day, such as Simon Says (1,2,3)123 Encourage children through positive words, such as “Nice catch!” (1,2,3)123 Energetically participate in indoor and outdoor play throughout the day (1,2,3)123 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)123 The Obesity Prevention Source Early Child Care

10. 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)123  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)123  Ensure that children of all ages are not sitting longer than 15- to 30-minute intervals, unless during meals or naptime (1,2,3)123 Support healthy sleeping habits  Remove any screen media from children's sleeping areas (3)3  Maintain calming naptime routines such as reading a book (3)3  Put infants to sleep while they are drowsy but still awake, so that they can learn to fall asleep without assistance (3)3 The Obesity Prevention Source Early Child Care

11. Healthy Activity, Screen Time, and Sleep— Source Lis t 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.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 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.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 3. Institute of Medicine (IOM). Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011.Early Childhood Obesity Prevention Policies 4. Position of the American Dietetic Association: Benchmarks for Nutrition in Child Care. J Am Diet Assoc. 2011;111:607-615.J Am Diet Assoc

12. The Obesity Prevention Source Early Child Care Infant Feeding and Mealtime Habits early child care obesity prevention recommendations. Promote ideal and age-appropriate fluid intake among infants Educate parents on breastfeeding resources and services within the community (1,2,3,5)1235 Provide a welcoming, private place for mothers to breastfeed on site (1,2,3,5)1235 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)1235 Do not serve fruit juice to children under 1 year of age (1,2,3)123 Do not bottle feed an infant formula mixed with any cereal, juice, or other foods without documentation from a medical provider (1,2,3123

13. Practice responsive feeding Initiate feedings based on an infant’s cue (opening mouth, making suckling sounds) (1,2,3)123 Pay attention to an infant’s fullness cues to avoid overfeeding (turning away from the nipple, keeping mouth closed) (1,2,3)123 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)123 Bottle feed only one infant at a time (1,2)12 The Obesity Prevention Source Early Child Care Infant Feeding and Mealtime Habits

14. Introduce complementary foods at the appropriate age  Create a plan for introducing solids in consultation with child’s parent (1,2)12  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)123 Encourage children to enjoy meals and regulate their own food intake  Offer meals and snacks every 2 to 3 hours (1,2,3,4)1234  Serve meals family style so older children can serve themselves (1,2,3,4)1234  Provide small, age-appropriate portions using child-sized utensils and dishes (1,2,3,4)1234  Ensure that children are seated and undistracted during mealtime (e.g., no television during meals) (1,2,4)124  Allow children to eat to their own fullness without pressure to overeat (1,2,3,4)1234  Avoid the use of food as a reward or punishment (1,2,4)124 The Obesity Prevention Source Early Child Care Infant Feeding and Mealtime Habits

15. Model healthy mealtime behaviors to children Sit and eat with children at meal time (1,2,3,4)1234 Say positive things about foods during meals (1,2,3,4)1234 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.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 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.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 3. Institute of Medicine (IOM). Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011.Early Childhood Obesity Prevention Policies 4. Position of the American Dietetic Association: Benchmarks for Nutrition in Child Care. J Am Diet Assoc. 2011;111:607-615.J Am Diet Assoc 5. World Health Organization. Global Strategy for Infant and Young Child Feeding. 200Global Strategy for Infant and Young Child Feeding The Obesity Prevention Source Early Child Care Infant Feeding and Mealtime Habits

16. The Obesity Prevention Source Early Child Care Early Child Care Nutrition 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)1234 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)1234 Serve 100 percent juice with no added sweeteners in cups, and only at mealtimes (1,2,4)124 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)124

17. 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)1234  Serve a variety of whole fruits, rather than juice (1,2,4)124  Ensure all breads, cereals, and pastas served are whole grain (1,2,3,4)1234  Choose heart-healthy lean protein such as beans, chicken, legumes, and low- fat yogurt or cottage cheese (1,2,3,4)1234  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)124 The Obesity Prevention Source Early Child Care Early Child Care Nutrition

18. 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)124  Avoid salty, low-nutrient foods like chips or pretzels (1,2,3,4)1234  Avoid high-sugar foods such as flavored milk, fruit nectars, soda, or candy (1,2,3,4)1234 Encourage family involvement in healthy eating at the child care facility  Provide written nutrition guidelines and posted menus for parents (1,4)14  Ensure food brought from home meets written standards (1,4)14  Engage in conversations about healthy eating, including taking menu suggestions from parents consistent with healthy guidelines (1,4)14 The Obesity Prevention Source Early Child Care Early Child Care Nutrition

19. 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.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 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.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 3. Institute of Medicine. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011. Early Childhood Obesity Prevention Policies 4. Position of the American Dietetic Association: Benchmarks for Nutrition in Child Care. J Am Diet Assoc. 2011;111:607-615.J Am Diet Assoc