State Licensing Scorecards

Millions of young children attend licensed early care and education (ECE) programs each week in the United States, making ECEs an important setting for teaching healthy habits early in life. By embedding science-based obesity prevention standards into ECE policies and practices, states can equitably invest in a healthier future for their youngest children.

What information does the ECE licensing scorecard provide?

CDC’s State Licensing Scorecards assess how well a state’s child care licensing regulations support 47 high-impact obesity prevention standards. Scores are based on a state’s most recent licensing regulations and include four obesity prevention sub-domains:

  1. Healthy Infant feeding 
  2. Nutrition 
  3. Physical activity 
  4. Screen time limits 

How are the scorecards used?

Each state’s licensing scorecard can help identify where center-based ECE regulations support high-impact obesity prevention practices, and where there is room to improve. The scorecards can be used several ways:

  • Child care licensing officials and decision makers can plan and prioritize childhood obesity prevention efforts in their state. The scorecards provide detailed information on where ECE licensing regulations could be strengthened to more fully support healthy eating and physical activity policies and practices in licensed ECE programs. Decision makers can consult with their local public health department and healthcare professionals to learn about science-based recommendations for preventing obesity in ECE settings.
  • ECE directors and teachers can ensure that they are meeting all of their state’s obesity-prevention licensing standards. They can see where they can put into action additional standards not required by their state’s licensing regulations to support the health of the children in their care.
  • Parents and caregivers can learn about their state’s licensing regulations around infant feeding, nutrition, physical activity, and screen time in ECE programs. Parents and caregivers can discuss how these standards are being implemented with their child’s ECE providers.

Scoring Methods

State scores were calculated with a point-based algorithm developed by the CDC. Using annually published licensing ratings, an overall state score was determined by assessing how well licensing regulations for child care centers support each of the 47 high-impact obesity prevention standards. More points were awarded when a state’s licensing regulations fully supported each of the high-impact obesity prevention standards, and fewer points were awarded when licensing regulations only partially addressed, did not address, or contradicted the obesity prevention standard.

Regulatory Point-Based Algorithm

Licensing Regulation Fully Supports Standard= 100 points
Licensing Regulation Partially Supports Standard= 70 points
Licensing Regulation Does Not Address Standard= 30 points
Licensing Regulation Contradicts Standard= 0 points

CDC calculated two types of scores for different uses:

First, an overall licensing score was calculated for each state. It is a summary score, representing how well a state’s center-based licensing regulations include the 47 high-impact obesity prevention standards. States stakeholders can use this overall score to gauge how well their state supports obesity prevention in ECE regulations, and they can compare themselves to other states and the nation.

Next, to provide greater detail on where a state is doing well or may have room to improve, the 47 obesity prevention standards were organized into four obesity prevention sub-domains. State-specific sub-domain scores were calculated for each of the following:

  • Healthy Infant Feeding (11 standards)
    • Breastfeeding support (n=1)
    • Infant feeding practices(n=10)
  • Nutrition (21 standards)
    • Nutrition standards (n=15)
    • Healthy mealtime practices (n=6)
  • Physical Activity (11 standards)
  • Screen Time Limits (4 standards)

State ECE-Licensing Ratings

The National Resource Center for Health and Safety in Child Care and Early Education collects, analyzes, and rates licensing regulations in all 50 states and District of Columbia. These ratings describe how well regulations for center and home-based childcare programs include nationally recognized obesity prevention standards.

Find the 2021 national report below, as well as state-specific profiles highlighting ratings by care type.

An example of the infant feeding sub-domain scoring algorithm is provided below. It highlights how points are assigned and how a sub-domain score is generated.  This is the same scorecard methodology used to calculate the nutrition, physical activity, and screen time sub-domains.

Learn more about the scoring algorithm. [PDF-243KB]

Connect with Nutrition, Physical Activity, and Obesity