High-Impact Obesity Prevention Standards

High-Impact Obesity Prevention Standards for Early Care and Education

To improve uptake of nutrition and physical activity policies and practices in early care and education (ECE) programs, a national advisory committee was convened in 2010. Through a consensus panel and review of emerging scientific evidence, 47 high-impact standards were identified as most likely to prevent childhood obesity when embedded in policies and practices for ECE programs (including center-based and home-based facilities).  These 47 standards are a sub-set of Caring for our Children’s special collection, Preventing Childhood Obesityexternal icon.

To prevent obesity among our youngest children, and encourage healthy habits early in life, public health practitioners, licensing officials, and child care providers can adopt these evidence-based obesity prevention standards into statewide ECE licensing regulations.  When included in state licensing regulations, these standards shape the policies and practices of ECE providers in facility-level policies and ECE provider level practices.

View the standards by clicking on the tabs below:

Kids holding carrots in a vegetable garden

By embedding these standards in statewide ECE systems, we can impact the health and well-being of MILLIONS OF our youngest children attending licensed ECE programs each week.

Breastfeeding Support

  1. Encourage and support breastfeeding and feeding of breast milk by making arrangements for mothers to feed their children comfortably on-site.

Infant Feeding Practices

  1. Serve human milk or infant formula to at least age 12 months, not cow’s milk unless written exception is provided by primary care provider and parent/guardian.
  2. Feed infants on cue.
  3. Do not feed infants beyond satiety; allow infant to stop the feeding.
  4. Hold infants while bottle feeding; Position an infant for bottle feeding in the caregiver/teacher’s arms or sitting up on the caregiver/teacher’s lap.
  5. Develop a plan for introducing age-appropriate solid foods in consultation with the child’s parent/guardian and primary care provider.
  6. Introduce age-appropriate solid foods no sooner than 4 months of age, and preferably around 6 months of age.
  7. Introduce breastfed infants gradually to iron-fortified foods no sooner than 4 months of age, but preferably around 6 months.
  8. Do not feed an infant formula mixed with cereal, fruit juice or other foods without the primary care provider’s written instruction.
  9. Serve whole fruits, mashed or pureed, for infants 7 months up to 1 year of age.
  10. Serve no fruit juice to children younger than 12 months of age.

Nutrition standards

Children eating fruit at a nursery with their carer
  1. Limit oils by choosing monounsaturated and polyunsaturated fats and avoiding trans fats, saturated fats and fried foods.
  2. Serve meats and/or beans – chicken, fish, lean meat, and/or legumes such as dried peas and beans, avoiding fried meats.
  3. Serve other milk equivalent products such as yogurt and cottage cheese, using low-fat varieties for children 2 years of age and older.
  4. Serve whole pasteurized milk to 12- to 24-month-old children who are not on human milk or prescribed formula, or serve reduced fat (2%) pasteurized milk to those who are at risk for hypercholesterolemia or obesity.
  5. Serve skim or 1% pasteurized milk to children 2 years of age and older.
  6. Serve whole grain breads, cereals, and pastas.
  7. Serve vegetables, specifically, dark green, orange, and deep yellow vegetables and root vegetables.
  8. Serve fruits of several varieties, especially whole fruits.
  9. Use only 100% juice with no added sweeteners.
  10. Offer juice (100%) only during meal times.
  11. Serve no more than 4 to 6 oz juice per day for children 1-6 years of age.
  12. Serve no more than 8 to 12 oz juice per day for children 7-12 years of age.
  13. Make water available both inside and outside.

Healthy mealtime practices

A child gardening with an adult
  1. Teach children appropriate portion size by using plates, bowls and cups that are developmentally appropriate to their nutritional needs.
  2. Require adults eating meals with children to eat items that meet nutrition standards.
  3. Serve small-sized, age-appropriate portions.
  4. Permit children to have one or more additional servings of the nutritious foods that are low in fat, sugar, and sodium as needed to meet the caloric needs of the individual child; teach children who require limited portions about portion size and monitor their portions.
  5. Limit salt by avoiding salty foods such as chips and pretzels.
  6. Avoid sugar, including concentrated sweets such as candy, sodas, sweetened drinks, fruit nectars, and flavored milk.
  7. Do not force or bribe children to eat.
  8. Do not use food as a reward or punishment.
  1. Children running

    Provide children with adequate space for both inside and outside play.

  2. Provide orientation and annual training opportunities for caregivers/teachers to learn about age-appropriate gross motor activities and games that promote children’s physical activity.
  3. Develop written policies on the promotion of physical activity and the removal of potential barriers to physical activity participation.
  4. Require caregivers/teachers to promote children’s active play and participate in children’s active games at times when they can safely do so.
  5. Do not withhold active play from children who misbehave.
  6. Provide daily for all children, birth to 6 years, 2 to 3 occasions of active play outdoors, weather permitting.
  7. Allow toddlers 60 to 90 minutes per 8-hour day for moderate to vigorous physical activity.
  8. Allow preschoolers 90 to 120 minutes per 8-hour day for moderate to vigorous physical activity.
  9. Provide daily for all children, birth to 6 years, 2 or more structured or caregiver/ teacher/ adult-led activities or games that promote movement over the course of the day—indoor or outdoor.
  10. Ensure that infants have supervised tummy time every day when they are awake.
  11. Use infant equipment, such as swings, stationary activity centers, infant seats, and molded seats, only for short periods, if at all.
  1. Multi-ethnic group of preschool students in class

    Do not utilize media viewing (such as television, video, DVDs) and computers with children younger than 2 years.

  2. Limit total media time for children 2 years and older to not more than 30 minutes once a week; limit screen time with televisions, DVDs and computers.
  3. Use screen media with children age 2 years and older only for educational purposes or physical activity.
  4. Do not utilize television, video, or DVD viewing during meal or snack time.
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