Want to know how the five healthy goals came to be the focus of Healthy Kids, Healthy Future? Read about why each healthy goal was selected. Related references are also provided.

Healthy Foods

A fruit or vegetable should be served to toddlers and preschoolers at every meal.

Fruits and vegetables are an important part of a child’s diet, but most children are not eating the recommended amount each day.(1)  Fruits and vegetables provide many nutrients, including fiber, vitamin A, vitamin C, folate, and potassium.  Dark colored vegetables are particularly important because they contain more vitamins and minerals. Those who eat more fruits and vegetables have lower risk of chronic diseases such as obesity, heart disease, certain cancers, and stroke.  Also, diets low in vegetables tend to be higher in calories.

Introducing fruits and vegetables to children when they are young will help them develop taste preferences for these healthy foods.  Remember to be patient; children may need to be exposed to new foods up to 8-10 times before they consider the new food to be normal.

Chips, french fries, fried potatoes, chicken nuggets, fish sticks and fried meats should be offered once a month or less.

Fried and pre-fried potatoes and meats (such as French fries, tater tots, hash browns, chicken nuggets, and fish sticks) contribute a lot of saturated fat and calories to the diet.  Over-consumption of these foods by children has led to intakes that exceed the dietary guidelines recommendations for saturated fat and calories. Reduction of these food items can significantly reduce calories consumed.  Fried and pre-fried foods are often also high in salt, so cutting back will also help children reduce their total salt intake. An added benefit of switching out fried and pre-fried foods is that it provides an opportunity to offer children healthier alternatives, including nutrient-rich vegetables, lean proteins, and healthier fats.

All meals to preschoolers should be served family-style.

Family style dining is a wonderful opportunity to enrich a child’s learning environment. Pouring, serving and passing food helps children practice independence and it can promote language and motor skills. Learning to use serving utensils allows children to develop fine motor skills.  Family style meals provide the opportunity to teach concepts of sharing, taking turns, and table manners.  This provides social interaction and can enhance language development.

Family style meals give children the opportunity to take an active role in their feeding as it allows them to make decisions and to take responsibility for their food choices. When children are allowed to decide their own portion sizes they generally serve themselves a smaller amount and are less likely to overeat.(2)  This decision making process helps to reinforce children’s eating according to their internal hunger and fullness cues. While family style meals present a wonderful learning opportunity for children through self-discovery, it also creates a unique opportunity for us to model healthy food choices and proper table manners.

References:

  1. Guenther PM, Dodd KW, Reedy J, Krebs-Smith SM. Most Americans eat much less than recommended amounts of fruits and vegetables. Journal of the American Dietetic Association. Sep 2006;106(9):1371-1379.
  2. Orlet Fisher J, Rolls BJ, Birch LL. Children’s bite size and intake of an entree are greater with large portions than with age-appropriate or self-selected portions. American Journal of Clinical Nutrition. May 2003;77(5):1164-1170.

Healthy Beverages

Drinking water should be available inside and outside for self-serve.

Water makes up over half of a child’s body weight and it is essential for their health.  Most importantly water helps keep a child growing appropriately and all parts of the body working properly. To stay hydrated, water should be consumed throughout the day.  To encourage children to drink water, it is important to have water visible and available both inside and outside.  By making water available, children will turn first to water to quench their thirst after play time.  This will help children to develop healthy drinking habits.

Water satisfies thirst without adding extra calories.  When used in place of sugar-sweetened beverages and fruit juice, water can help reduce the amount of calories and sugar that children consume during the day and thereby help decrease their risk of becoming overweight.(1)  Drinking more water and less sugary beverages will also prevent dental caries by decreasing the amount of acid in the mouth.(2)

Children two years and older should be served skim or non-fat milk.

Milk is a great source of calcium, vitamin D, potassium, protein and other nutrients essential for growth of bones and teeth.  The American Academy of Pediatrics recommends low-fat or non-fat milk for children ages 2 or older.(8)  Low-fat and non-fat milk contain as much protein, calcium, and Vitamins D and A as whole milk.  The only difference is a reduction in saturated fat and calories.

100% fruit juice should be limited to no more than 4-6 oz per day.

The American Academy of Pediatrics (AAP) recommends that children six months and older consume no more than 4-6 ounces of 100% fruit juice per day.(3)  This amount includes juice that children are receiving at both home and at child care.  In addition to this, the AAP recommends that juice is not served in bottles or sippy cups as this can encourage overconsumption.

Excessive juice consumption in children has been linked to multiple problems.  Drinking too much juice may lead children to have decreased appetites for more nutritious foods required for growth and development.(4)  This may result in feeding problems and consequently an increased risk of obesity.(5)  The high amount of sugar in fruit juice will also increase a child’s risk of tooth decay, diarrhea and stomach cramps.(6,7)

Sugary drinks (sports drinks, sweet tea, soda) should never be offered.

Sweetened drinks, including fruits drinks, sports drinks, sweet tea, and soda, are packed with calories and sugar, but offer little to nothing in terms of nutrients.  Children who drink sugar sweetened beverages are at an increased risk for obesity and tooth decay and drinking sugary drinks is associated with calcium deficiency.(1,4,6)

References:

  1. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. August 1, 2006 2006;84(2):274-288.
  2. Armfield JM, Spencer AJ, Roberts-Thomson KF, Plastow K. Water fluoridation and the association of sugar-sweetened beverage consumption and dental caries in Australian children. American Journal of Public Health. Mar 2013;103(3):494-500.
  3. American Academy of Pediatrics Committee on Nutrition. The use and misuse of fruit juice in pediatrics. Pediatrics. May 2001;107(5):1210-1213.
  4. Dennison BA. Fruit juice consumption by infants and children: a review. Journal of the American College of Nutrition. Oct 1996;15(sup5):4S-11S.
  5. Dennison BA, Rockwell HL, Baker SL. Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. Pediatrics. Jan 1997;99(1):15-22.
  6. Tinanoff N, Palmer CA. Dietary determinants of dental caries and dietary recommendations for preschool children. Refuat Hapeh Vehashinayim. Apr 2003;20(2):8-23, 78.
  7. Doucette RE, Dwyer JT. Is fruit juice a “no-no” in children’s diets? Nutrition Reviews. Jun 2000;58(6):180-183.
  8. American Heart Association, Gidding SS, Dennison BA, et al. Dietary Recommendations for Children and Adolescents: A Guide for Practitioners. Pediatrics. February 1, 2006;117(2):544-559.

Physical Activity

Preschoolers need two or more hours of active play time every day. Toddlers should have at least an hour of active play time each day.

Children of all ages can benefit from regular physical activity – it improves children’s physical and mental health, learning of social skills, and cognitive development.

  • Physical activity helps children stay at a healthy weight and reduces their risk of developing obesity-related illnesses, such as type 2 diabetes, high blood pressure, and high cholesterol.(4-6)
  • Physical activity has been shown to help relieve feelings of stress and depression and reduce behavioral problems.(7)
  • Active play provides children with the opportunity to learn to communicate with others and develop social skills.(8)
  • Physical activity has been shown to promote cognitive development.(9)  Children have been shown to learn better after bursts of physical activity due to improved attention and focus.
  • In special needs children, physical activity can help control or slow the progression of their condition or disability, or minimize its side effects.(10)

Outdoor play is an important part of children’s physical activity.  Children should be encouraged to go outdoors daily because they tend to be more active when they are outdoors.(11,12)  It also allows children to learn about nature.  Exposure to sunlight also promotes the production of Vitamin D, which is essential for bone growth. It is important to encourage young children to be active because the behaviors learned in early childhood often become lifelong habits.  Promoting enjoyment, confidence and competence in being physically active early in life will help to encourage continued participation in physical activity.(1)

Babies should have short periods of “tummy time” every day.

Tummy time for infants has many benefits, such as promoting motor skill and cognitive development.

  • Tummy time helps infants build strength, particularly in their neck and shoulder muscles.  This, in turn, helps infants reach early movement milestones like rolling over, sitting up, and crawling.(13,14)
  • Tummy time helps infants explore their environment – to see, touch, and feel what’s around them.  It is through active play with objects and people that infants acquire basic cognitive understandings, such as cause-and effect and symbolic representation, which are necessary for later academic learning.
  • Active motor play helps infants develop communication and language skills.  Infants and toddlers with more advanced motor skills have greater language fluency in later childhood and adolescence.(15)

Furthermore, confining infants and toddlers to strollers, play pens, car and infant seats for hours at a time may delay their motor skill and cognitive development.(16) In addition to these many benefits, tummy time also decreases the risk of Sudden Infant Death Syndrome (SIDS) and minimizes the risk of developing a flat head (positional plagiocephaly).(17,18)

References:

  1. National Association for Sport and Physical Education. Active Start: a statement of physical activity guidelines for children birth to five years. 2nd ed. Reston, VA: NASPE Publications; 2009.
  2. Strasburger VC. Children, adolescents, obesity, and the media. Pediatrics. Jul 2011;128(1):201-208.
  3. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health, Safety in Child Care and Early Education. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd ed: Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association; 2011.
  4. Loprinzi PD, Cardinal BJ, Loprinzi KL, Lee H. Benefits and environmental determinants of physical activity in children and adolescents. Obes Facts. 2012;5(4):597-610.
  5. Guinhouya BC, Samouda H, Zitouni D, Vilhelm C, Hubert H. Evidence of the influence of physical activity on the metabolic syndrome and/or on insulin resistance in pediatric populations: a systematic review. International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity. Oct 2011;6(5-6):361-388.
  6. Andersen LB, Riddoch C, Kriemler S, Hills AP. Physical activity and cardiovascular risk factors in children. British Journal of Sports Medicine. Sep 2011;45(11):871-876.
  7. Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. British Journal of Sports Medicine. Sep 2011;45(11):886-895.
  8. Iverson JM. Developing language in a developing body: the relationship between motor development and language development. J Child Lang. Mar 2010;37(2):229-261.
  9. Fedewa AL, Ahn S. The effects of physical activity and physical fitness on children’s achievement and cognitive outcomes: a meta-analysis. Research Quarterly for Exercise and Sport. Sep 2011;82(3):521-535.
  10. Murphy NA, Carbone PS. Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics. May 2008;121(5):1057-1061.
  11. Sallis JF, Nader PR, Broyles SL, et al. Correlates of physical activity at home in Mexican-American and Anglo- American preschool children. Health Psychology. 1993;12(5):390-398.
  12. Baranowski T, Thompson WO, DuRant RH, Baranowski J, Puhl J. Observations on physical activity in physical locations: age, gender, ethnicity, and month effects. Research Quarterly for Exercise and Sport. 1993;64(2):127-133.
  13. Chizawsky LL, Scott-Findlay S. Tummy time! Preventing unwanted effects of the “Back to Sleep” campaign. AWHONN Lifelines. Oct-Nov 2005;9(5):382-387.
  14. Johnson K. Reduced tummy time can slow motor development. Med Post. 2003;39(38):51.
  15. Oudgenoeg-Paz O, Volman MC, Leseman PP. Attainment of sitting and walking predicts development of productive vocabulary between ages 16 and 28 months. Infant Behav Dev. Dec 2012;35(4):733-736.
  16. Garrett M, McElroy AM, Staines A. Locomotor milestones and babywalkers: cross sectional study. Bmj. Jun 22 2002;324(7352):1494.
  17. Adams SM, Good MW, Defranco GM. Sudden infant death syndrome. American Family Physician. May 15 2009;79(10):870-874.
  18. Mortenson P, Steinbok P, Smith D. Deformational plagiocephaly and orthotic treatment: indications and limitations. Childs Nerv Syst. Sep 2012;28(9):1407-1412.

Screen Time

Limit screen time to 30 minutes a week or less for preschoolers during child care. Screen time for toddlers and babies should be limited to four times or less a year, preferably none, in child care. Child care providers should provide media literacy education to parents of preschoolers at least twice a year.

The American Academy of Pediatrics (AAP) discourages the use of screen time for children under two  years and recommends a limit of 1-2 hours a day for children two years and older.(1)  Screen time is not just watching television; it also includes time spent playing on or with a computer, cell phone, tablet, or video game.  Knowing that children accumulate quite a bit of screen time at home, it is recommended that screen time in child care is limited to 30 minutes per week for children over two.(2)

Screen time is a sedentary activity that often does very little to stimulate the brain.  Several studies have linked excessive screen time to childhood obesity and lowered cognitive development.(3)  Instead, children should be engaging in physical activity or educational activities. Children under 2 years old are in a critical period for brain development and activities that are active, social, and engage a child’s senses – such as touching, exploring, and playing – are more beneficial than watching television.(4)  Children exposed to too much screen time may also experience language delays and sleep problems.(4,5)

For preschoolers, screen time can increase their risk of being overweight or obese and can have a negative impact on their psychological health, specifically greater hyperactivity and antisocial behaviors.  Screen time may also lead to greater aggressive and violent behavior because these young children cannot tell the difference between fantasy and reality on television and may become desensitized to violence.(6)  While watching television may be an enjoyable activity, they lack the ability to gain educational value out of it.(7)

References:

  1. Strasburger VC. Children, adolescents, obesity, and the media. Pediatrics. Jul 2011;128(1):201-208.
  2. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health, Safety in Child Care and Early Education. Caring for our children: National health and safety performance standards; Guidelines for early care and education programs. 3rd ed: Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association; 2011.
  3. LeBlanc AG, Spence JC, Carson V, et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years). Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. Aug 2012;37(4):753-772.
  4. Christakis DA. The effects of infant media usage: what do we know and what should we learn? Acta Paediatr. Jan 2009;98(1):8-16.
  5. Jolin EM, Weller RA. Television viewing and its impact on childhood behaviors. Curr Psychiatry Rep. Apr 2011;13(2):122-128.
  6. Wilson BJ. Media and children’s aggression, fear, and altruism. Future of Children. Spring 2008;18(1):87-118.
  7. Richert RA, Robb MB, Smith EI. Media as social partners: the social nature of young children’s learning from screen media. Child Development. Jan-Feb 2011;82(1):82-95.

Breastfeeding Support

Breastfeeding mothers should be provided a private area for breastfeeding or pumping.

The American Academy of Pediatrics recommends that babies be breastfed exclusively for the first six months of life, introduced to complementary foods around 6 months of age, and continue breastfeeding until at least 12 months of age.(1)  Breastfeeding provides positive benefits to both baby and mother. Breast milk protects infants against multiple health problems, including diarrhea, ear infections, severe lower respiratory infections, asthma, leukemia, sudden infant death syndrome (SIDS), type 2 diabetes, and obesity. Breastfeeding mothers have lower risks of breast and ovarian cancer, and emerging evidence shows that breastfeeding may also protect women from high blood pressure, diabetes, cardiovascular disease, and postpartum depression.

On average, mothers who work outside the home breastfeed for a shorter length of time.  Therefore, child care settings are crucial supports for mothers who wish to continue to breastfeed while working outside the home.

Reference: Eidelman AL, Schanler RJ. Breastfeeding and the use of human milk. Pediatrics. Mar 2012;129(3):e827-841.