Advancing Early Child Nutrition in Early Care and Education

Early Care and Education (ECE) settings can help children develop lifelong healthy dietary behaviors. Early Child Nutrition (ECN) includes several best practices designed to ensure children have the healthiest start possible, such as:

• Breastfeeding support.
• Opportunities for children to eat a variety of nutrient-dense foods.
• Responsive feeding, which includes feeding infants when showing signs of hunger.

ECN Benefits

Early child nutrition practices are important for the healthy growth of infants, toddlers, and young children. When ECE programs support breastfeeding, children are more likely to be breastfed longer. Although many infants start breastfeeding, only 1 in 4 are exclusively breastfed for the first 6 months, despite recommendations.

ECN practices can help children learn to recognize their hunger and fullness cues and establish healthy eating patterns.

If you are working to promote and support ECN in ECE settings, the information here can help you focus your efforts.

Getting Started With ECN

There are several ways states and communities can promote and support ECN in ECE settings. Described below are a few action steps states and communities can take to get started.

State-Level Actions

• Learn about your state’s efforts to support ECN. Identify current policies, activities, and programs that support and promote ECN.
• Identify where more work is needed. Identify disparities by reviewing state data on breastfeeding and children’s consumption of fruit, vegetable, and sugar-sweetened beverages [PDF-422KB]. Use CDC’s ECE Licensing Scorecards and the National Resource Center’s Achieving a State of Healthy Weight Report and Supplements to see how well your state supports ECN through childcare licensing regulations. Review CDC’s Breastfeeding Report Card for a compilation of data on breastfeeding practices and supports.
• Partner for expansion. Work with other groups to implement ECN best practices. Organizations to consider include statewide breastfeeding coalitions, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) breastfeeding coordinators, statewide breastfeeding hotlines, La Leche League, Child and Adult Care Food Program (CACFP) state agencies and CACFP sponsoring organizations. You can also use the following CDC resources to help you identify potential partners:
  • State Obesity Prevention Efforts Targeting the Early Care and Education Setting [PDF-550KB]
  • The Spectrum of Opportunities Framework for State-Level Obesity Prevention Efforts Targeting the Early Care and Education Setting [PDF-665KB]
• Establish or strengthen ECE recognition programs. Many states have recognition programs for ECE programs that meet criteria on a particular topic, like breastfeeding. If your state doesn’t have a recognition program, consider creating one. If your state does have a program, look for ways to promote its use or strengthen it. Review examples such as Connecticut’s Breastfeeding Friendly Child Care, Wisconsin’s Breastfeeding Friendly Child Care, and Ohio’s Healthy Programs.
• Promote or create professional development trainings for ECE providers. Use trainings to strengthen provider knowledge about ECN best practices. Better Kid Care and the US Department of Agriculture (USDA) offer professional development courses and resources for ECE providers. State-developed trainings include Arizona’s Creating a Breastfeeding Friendly Child Care Environment
• Use evidence-based interventions that include ECN best practices. Interventions provide direct support to ECE programs and providers to help them develop action plans and improve policies and practices. Evidence-based interventions supporting ECN in ECE include Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) and others which can be found in the SNAP-Ed Toolkit.

Community-Level Actions

• Promote partnerships between local organizations that have expertise in ECN. Examples include Extension Services, SNAP-Ed educators, and groups that support breastfeeding families, such as La Leche League and WIC clinics.
• Work with Childcare Resource and Referral Systems to provide professional development and resources to ECE programs and childcare providers.
• Encourage ECE programs in your community to:
  • Participate in statewide recognition programs or evidence-based interventions.
  • Develop policies that support breastfeeding employees.
  • Incorporate best practices from Caring for Our Children and the High Impact Obesity Prevention Standards (HIOPS) into their policies and day-to-day care practices.

• • • Provide a private space to breastfeed or express milk.
    • Feed infants when they show signs of hunger and allow them to stop feeding when they show signs of fullness.
    • Hold infants while bottle feeding.
    • Serve whole, mashed, or pureed fruits to infants aged 7 months to 1 year.
    • Train all staff to prepare, feed, and store breast milk properly.

Advancing Health Equity

Research has found disparities in breastfeeding and in the consumption of fruits, vegetables, and sugar-sweetened beverages among young children. States and communities can help reduce health disparities by:

• Expanding and diversifying ECE partnerships through collaboration and community engagement.
• Creating materials in different languages and ensuring that they are culturally relevant.
• Promoting federal programs that support ECE providers that serve low-income families, such as CACFP and the Child Care Development Fund.
• Offering services and interventions to communities with the greatest disparities in breastfeeding, early child nutrition, and infant feeding.

We Are Making a Difference

CDC provides funding and technical assistance to states and communities to advance ECN policies and best practices in ECE programs and monitors state policies and practices through the Breastfeeding Report Cards and ECE Licensing Scorecards.

Other federal agencies are also working to advance ECN, including USDA and the Administration for Children and Family Services. Learn more about leveraging federal programs to support ECN.

Supporting ECN Across the Nation

New York SPAN: Breastfeeding Friendly Child Care Designation

From 2018 to 2022, the New York State Physical Activity and Nutrition Program (SPAN) worked to increase the number of ECE programs that achieve the New York Breastfeeding Friendly Child Care designation. SPAN worked with local contractors in communities with the most need to help them achieve and measure progress toward becoming Breastfeeding Friendly. SPAN and local contractors recruited 141 new programs, the majority of which participated in CACFP. They also provided technical assistance to 136 programs and helped 93 programs get designation status. About 3,100 children benefited from these activities.

Kentucky SPAN: Childcare Licensing and Evidence-Based Interventions

In early 2020, Kentucky passed new childcare licensing regulations, that included breastfeeding support and early child nutrition for center-based programs. These licesning regulations align with HIOPS, which experts identify as most likely to prevent childhood obesity when embedded in ECE policies and practices.

To help ECE programs implement these new licensing regulations, Kentucky SPAN aquired a statewide license for Go NAPSACC. This intervention provides technical assistance, trainings and professional development, and self-assessments to track progress. Further, in Kentucky, ECE providers can receive continuing education credits for completing Go NAPSACC’s trainings and professional development. These licensing changes could reach 1,835 ECE centers, which serve more than 195,000 children.

Alabama Healthy Kids, Healthy Future: Breastfeeding Recognition

In 2018, the Alabama Partnership for Children, Alabama Cooperative Extension System, Alabama Department of Public Health, and Alabama Breastfeeding Committee developed the statewide Breastfeeding Friendly Child Care Recognition Program. The program has five key requirements based on existing guidance, such as the Carolina Global Breastfeeding Institute’s 10 Steps to Breastfeeding Friendly Child Care, and HIOPS. To be recognized, ECE programs must also complete the Go NAPSACC Breastfeeding and Infant Feeding self-assessment and an approved training through the Alabama Child Care Licensing division. ECE programs can also receive funding from the Alabama Child Care Development Fund to create breastfeeding-friendly environments including a small refrigerator, books on breastfeeding, a comfortable chair, and supplies such as milk storage bags. As of January 2023, 99 ECEs have been recognized, potentially reaching more than 3,700 children in Alabama.