ecelc ls2 ppt what is our role in making healthy changes 3
TRANSCRIPT
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Learning Session 2:What is Our Role in
Making HealthyMaking Healthy Changes?
Early Childhood Health Promotion
and Obesity Prevention
NationalEarly Care and Education
Nemours is currently funded by the Centers for Disease Control and Prevention (CDC) under a five-year Cooperative Agreement (1U58DP004102-01) to support states/localities in launching early care and education learning collaboratives focused on childhood obesity prevention. The views expressed in written materials or publications, or by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
National Early Care and Education Learning Collaboratives(ECELC)
Project
Acknowledgements
A special thank you to:
Centers for Disease Control and Prevention (CDC)
– For generous funding support and expertise
Nemours
– For their expertise, materials, support, and time spent on the project’s implementation
G t h S C t f N t iti Gretchen Swanson Center for Nutrition
– For the evaluation component of this national effort
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Part A:Part A: Healthy
Environments
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ECECommunity
Society
legislation
Department of Education
Health and Human Services
unemployment
economy
federal and state budgets
health department
child care licensing
healthcare providers
mental health services
CCR&R
QRIS
schools and colleges
The SocialEcological
Model
Child
Family
ECE Program Staff
ECEProgramEnvironment
ECE ProgramPolicies
workplace supports, benefits
and leave
rate
food and
WIC
CACFP
grocery
pre-service and professional development opportunities
central kitchens
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Child
media
urban planning
food and beverage industry
religious institutions
community gardensparks
grocery stores
culture
food service vendors
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ECEProgram
The SocialEcological
Model
Family
ECE Program Staff
ProgramEnvironment
Child
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Child
Healthy Environments Eating environment
– Provide visuals, use materials, serve food, and role model healthy choices and eating habits
Physical environment
– Create a safe and open space for children to move around
Breastfeeding environment
– Provide a quiet and relaxing space for breastfeeding mothers to use when at the center
Classroom environment Classroom environment
– Build nutrition and physical activity education in to the existing curriculum
Home environment
– Use parent newsletters to encourage parents to adopt healthy habits that are taught in the classroom6
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Creating a Healthy Eating Environment Family-style dining is considered best practice
– Enjoy each other at meal time– Enjoy each other at meal time
– Offer healthy choices: fruits and/or vegetables, whole grains, and lean protein at every meal
– Offer age-appropriate portion sizes and serving utensils consistent with CACFP guidelines
– Respond to hunger and feeding cues so children recognize them
– Role model at meal time
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Creating a Healthy Eating Environment Infants:
– Support breastfeeding moms with access to a private– Support breastfeeding moms with access to a private space to feed or pump
– Encourage and support the feeding of expressed breast milk
– Gently introduce solid foods, in collaboration with family, around 6 months of age
– Feed infants on demand rather than on a fixed schedule so they learn to eat when they are hungry
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Division of Responsibility in Feeding Who is responsible, the child or the provider?
1. Who decides what food will be served?
2. Who decides when food will be served?
3. Who decides where the food will be served?
4. Who decides how much food will be eaten?
5. Who decides whether or not a food is eaten?
Who is responsible, the infant or the provider?Who is responsible, the infant or the provider?
6. Who decides what food will be served?
7. Who decides when, where, how much, and whether food is eaten?
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Lesson Planning
Literacy: Use books on healthy foods that introduce healthy foods and model healthy eating habits
Math: Count fruits and vegetables, sort foods by color or shape
Science: Explore healthy food through senses (i.e. watch the growth of a potato, plant vegetables in a garden)
Art: Have children use their imagination and draw gpictures
Pretend Play: Have children pretend to grow and harvest food, grocery shop, go to the farmers market or prepare meals
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TA BreakoutTA Breakout Groups –
LS1 Action Period
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Physical Activity Break
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Part B: Best
Practices for Healthy
Eating
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Eating
ctive play
reastfeeding
ut down on screen time
rink milk and water
at healthy foods
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Goal Setting:
What eating habits would you personally like to
change?
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Considerations for Healthy Eating
Food groups
Healthier options within food group
– Example: whole grains vs. refined grains; low-fat dairy vs. full-fat dairy
Variety within food group
– Example: rotate protein source with beans, fish, poultry, red meat, etc.
How much (portion size)(p )
How often (over the course of a week)
How it is prepared
– Example: baked vs. fried 16
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Background Information Dietary Guidelines for Americans
– Updated every 5 years, last updated in 2010
– Developed for individuals age 2 and olderDeveloped for individuals age 2 and older
– Provides advice on how to maintain a healthy weight, reduce chronic disease, and maintain overall good health
Child and Adult Care Food Program (CACFP)
– Used in ECE settingsUsed in ECE settings
– Provides guidance for meal patterns and serving sizes
– Current guidelines are based on nutrition information from 1989 New recommendations should be released soon and
will align with the most recent Dietary Guidelines for Americans17
Current CACFP Meal Components
Milk (fluid) Meat and meatMilk (fluid)
Fruits and vegetables
Breads and grains
– Rice
– Bread
– Pasta
Meat and meat alternatives
– Meat (example: chicken, turkey, fish, beef, etc.)
– Eggs
– Cheese
– Beans
– Yogurt
– Nuts and nut butters
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Serving Sizes Use CACFP
recommended serving for each age groupeach age group
If children are still hungry, allow them more food:
– Encourage them to check in with their tummy (hunger cues)( g )
– Encourage fruits and vegetables first
Serving sizes are a minimum, not maximum
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rink Milk (fluid)
Infants (under 12 months of age)
– Should receive only breast milk or iron-fortified f l ’ ilkformula – no cow’s milk Whole cow’s milk does not provide enough Vitamin E,
iron, and essential fatty acids
Whole cow’s milk protein and fat are difficult for an infant to digest and absorb
Children (12-23 months of age)Children (12 23 months of age)
– Should receive breast milk or whole milk
Children (2 years of age and older)
– Should receive fat-free (skim) or 1% (low-fat) milk20
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100% Juice All juice served should be 100% fruit
or vegetable
Infants (under 12 months of age)
– Should not be served juice
Children (12-23 months of age)
– Limit 100% juice to 1 serving per dayj g p y Maximum ¼ cup per serving
Children (2 years of age and older)
– Limit 100% juice to 1 serving per day Maximum ½ - ¾ cup per serving
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Sugar Sweetened Beverages
Sugar sweetened beverages should never be offered:
J i h 100% j i– Juices that are not 100% juice
– Sport drinks and energy drinks
– Sweet tea
– Soda/Pop/Cola
– Specialty coffee drinks
Rationale
– Products high in sugar and calories may cause: Overweight/obesity
Tooth decay
Diarrhea
– May displace healthier beverages such as milk22
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rink Water
Drinking water should be:
– Visible
– Available to children inside and outside
– Available for self-serve
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Sugar Sweetened Beverages Activity g y
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at Fruits & Vegetables
Serve a fruit (not juice) and/or a vegetable at every meal and snack
F h f i d h h b d– French fries, tater tots, and hash browns do not count as vegetables
Fried or pre-fried fruits or vegetables are offered only once per month or never
– Example: French fries, tater tots, hash browns, potato chips, fried apples, fried okra, etc.
f i d f i d f i bl h ld b Rationale: fried or pre-fried fruits & vegetables should be avoided because they are high in calories and fat
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VS.
57 calories, 0.06 grams fat 180 calories, 5.35 grams fat
at Fruits & Vegetables
Serve vegetables of a variety of colors each week
– Example: dark green, red, orange, deep yellow, etc.
Serve fruits & vegetables that are fresh, frozen or canned
– Canned vegetables should be low in sodium or with “no salt added”
– Canned fruits should be in water, 100% juice, or drained
Rarely or never prepare with added:
– Meat fat
– Butter
– Margarine
– Sugar 26
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Breads & Grains
Breads and grains good sources of fiber, B vitamins, and mineralsminerals
Cereals should contain no more than 6 grams of sugar per serving
At least half of grains served should be whole grains Ingredients:
WHOLE WHEAT FLOUR WATER Grains high in fat or sugar
should be served rarely or never
– Donuts, Danishes, cupcakes, toaster pastries, granola bars, etc.
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WHOLE WHEAT FLOUR, WATER, SUGAR, WHEAT GLUTEN, CANE REFINERY SYRUP, YEAST, CONTAINS 2% OR LESS OF EACH OF THE FOLLOWING…
Meats & Meat Alternates
Limit fried, pre-fried, and processed meats
E l hi k d– Example: chicken nuggets and tenders, fish sticks, hot dogs, bologna, sausage, salami, spam
– Limit to once per month or less
– Processed and fried meats and fish are high in total and saturated fat and sodium
Choose a variety of beans and lean meat each week
– Example: baked or grilled chicken, fish, turkey, and beans, seeds, nuts, eggs, and tofu
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Cheese & Other Dairy Products
Serve only real cheese – no cheese food or cheese product
– No Velveeta® or Cheez Whiz®
Serve low-fat or fat-free dairy
– Example: milk, cheese, yogurt, etc.
Rationale: In general, cheese products contain more sodium and fewer nutrients than real cheese
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Physical Activity Break
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TestingTesting Your
Knowledge
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Test Your Knowledge
What type(s) of beverage should be served to infants?
What type(s) of milk should be served to children 12 throughserved to infants?
a) Whole milk
b) Fat-free (skim) milk
c) 1% (low-fat) milk
d) Breast milk or formula
) B h b d
children 12 through 23 months of age?
a) Whole milk
b) 2% (reduced-fat) milk
c) Fat-free (skim) milk
d) 1% (low fat) milke) Both b and c d) 1% (low-fat) milk
e) Any of the above
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Test Your Knowledge
What type(s) of milk should be served to children 2 years and
Children should receive no more than 1 serving per day (4 6children 2 years and
older?
a) Whole milk
b) 2% (reduced fat) milk
c) Fat-free (skim) milk
d) 1% (low fat) milk
1 serving per day (4-6 ounces) of what type(s) of juice?
a) 100% fruit & vegetable juice
b) Juice cocktail
c) Juice drink
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d) 1% (low-fat) milk
e) Both c and d
c) Juice drink
d) Any of the above
Test Your Knowledge
Children should never be served sugar sweetened beverages
Fried or pre-fried foods should be served:sweetened beverages.
These include:
a) Soda
b) Non-100% juice drinks
c) Sports drinks
d) Energy drinks
served:
a) Once a month or never
b) Once every two weeks
c) Once a week
d) Daily
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d) Energy drinks
e) Lemonade
f) All of the above
d) Daily
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Test Your Knowledge
What is the best type of cheese to serve?
) R l h
Cereals should contain no more than
grams of sugar pera) Real cheese
b) Cheese food
c) Cheese product
d) Low-fat or fat-free real cheese
__ grams of sugar per serving.
a) 5
b) 6
c) 8
d) 10
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Test Your Knowledge
How often should whole grains be served?
Drinking water should be:
) Vi iblserved?
a) Once per day
b) Twice per day
c) Half of grains should be whole grains
d) All grains should be whole grain
a) Visible
b) Available for self-serve
c) Outside and inside
d) All of the above
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whole grain
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Menu Analysis Activity
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Farm to Preschool
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Physical Activity Break
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Lunch
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Part C: Family-Style y y
Dining
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Discussion:
Are you ready for family-style dining?
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Family-Style Dining
Family-Style Dining with 2 Year Olds
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Starting Family-Style Dining
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Characteristics of Family-Style Dining Children help set the table
Child-size tables, utensils, and i di h tili dserving dishes are utilized
Food is passed in small containers
Beverages are served in small pitchers
Children serve themselves
Adults sit at the table with children Adults sit at the table with children and role model by eating the same foods
Children engage in conversation
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Tools for Family-Style Dining
Plastic wide lip bowls and platters
Measuring cups or short handled hard plastic serving spoons
Age appropriate:
– Cups
– Small pitchers
– Plates
– SpoonsSpoons
– Plastic tongs
Cleanup supplies
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Child Size Equipment
Developmentally appropriate equipment allows children to:
D l d h fi kill h ld d– Develop and enhance fine motor skills to grasp, hold, and manipulate small objects and tools
– Improve hand-eye coordination skills
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Provider’s Role in Family-Style Dining Display appropriate dining
manners
Make each moment a teachable moment
– Help expand children’s language skills
Educate and integrate
Ed t hild th i
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– Educate children on the various foods and proper ways to eat and serve
– Integrate the information learned into your every day activities
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Feeding Phrases
Phrases that hinder:
– “You have to eat that.”
– “Do not leave the table until everything is finished.”
– “Carli, look at Maria. She ate all of her bananas and you did not.”
– “You may not have seconds, we don’t have enough to give them to everyone.”
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Feeding Phrases
Phrases that help:
– “These radishes are crunchy!” What other vegetable i h ?is crunchy?
– “This is a kiwi. It is sweet. What fruits do you like that are sweet?”
– “What should you do when your stomach is full from eating?”
– “Thank you for trying a new vegetable its ok that you did not like it ”did not like it.
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Putting It All Together
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CACFP Supports Family-Style Dining Have all food on the table at the beginning of the
meal
Have enough food available to meet meal pattern requirements for all children
– Try measuring cups to help children serve appropriate portions
– Have enough for seconds
– Expect spilled food as children learn to serve– Expect spilled food as children learn to serve themselves
– Children must be offered all foods at the table
– An adult should sit with the children to facilitate and model
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H i t d
Goal Setting:
How can you introduce family-style dining techniques in the
classroom?
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Add to Exploratory Centers
Housekeeping: Child sized utensils for pretend play
Water Tables: Cups, spoons, bowls and pitchers available for use
Structured outdoor activities
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Housekeeping Center
Housekeeping is the most common exploratory center that children engage in pretend play
Children naturally demonstrate family-style dining in this area
Make this area family friendly
– Use household items such as healthy food containers from families to promote diversity and parent participation
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Family-Style Dining at Home
Encourage families to practices family-style dining at home
You can promote family-style dining by:
– Offering special days that parents can participate in eating family-style (Mother’s/Father’s Day Breakfast, Back to School Night, etc.)
– Sending home easy/quick recipes that allow less time for cooking and more time for eating together at the tabletable
– Taking photos of children eating family-style at the program and send home a conversation starter for ‘table talk’
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Tips for Success
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Mealtime Routine Sample Handout
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Physical Activity Break
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Part D:Breastfeeding g
Support
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Call to Action
“One of the most highly effective preventative measures a mother can take to protect the health of her infant and herself is to breastfeed The decisionher infant and herself is to breastfeed. The decision
to breastfeed is a personal one, and a mother should not be made to feel guilty if she cannot, or chooses not to breastfeed. The success rate among mothers who choose to breastfeed can be greatly improved
through activity support…”
Action: Ensure that all early care and education providers accommodate the needs of breastfeeding
mothers and infants.
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U.S. Department of Health and Human Services. Executive Summary: The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
Agree or Disagree Activity:
What do you think and feel about breastfeeding?
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Agree or Disagree?
Breastfeeding makes babies healthier.
I feel comfortable handling human milk.g
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Agree or Disagree?Formula is as good for babies as breastfeeding.
Supporting breastfeeding is part of my job.
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Agree or Disagree?I can have an impact on how parents in my
Talking about breastfeeding makes
program feed their children.
gmothers feel guilty.
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Agree or Disagree?
Breastfeeding is something that should
If I had another child, I would probably g
be done in private. y
breastfeed.
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Discussion:
Activity Discussion
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Why Do Moms Need Your Support?
81% of moms desire to breastfeed
76% of moms start out breastfeeding
60% of moms do not meet their breastfeeding goals
Returning to work is the primary reason for ending breastfeeding
Shorter duration of breastfeeding if baby is in an early care and education environmentearly care and education environment
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Breastfed Babies are Healthier
63-77% lower risk of respiratory infections
23-50% lower risk of ear infections
26-40% lower risk of asthma
36% lower risk of SIDS
30% lower risk of type 1 diabetes
40% lower risk of type 2 diabetes
24% less likely to become obesey
15-20% lower risk of leukemia
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Breastfeeding Mothers are Healthier
The longer and more exclusively a womanexclusively a woman breastfeeds, the lower her risk of:
– Type 2 diabetes
– Breast and ovarian cancer
– Osteoporosis
Rheumatoid arthritis– Rheumatoid arthritis
Increased weight loss
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Cultural Views of Breastfeeding
Many different cultures look at breastfeeding as a natural choice for feeding
Many countries have banned the practice of giving free or subsidized formula to new mothers
Accepting and understanding cultural differences allows staff to become culturally sensitive to those parents and families who decide to breastfeed
Some cultures discourage breastfeeding because it g g‘spoils’ babies and/or discourages babies from sleeping through the night
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Breast Milk Can Save Your Program Money Breast milk is part of the CACFP meal pattern
– It is reimbursable for infants if fed by a care provider
– It’s free! No equipment to purchase Cost effective for families as well
– For children over 12 months, breast milk may be substituted for cow’s milk Doctor’s note is required
Human milk is food Human milk is food
– You do not need to store human milk in a separate refrigerator
– You do not need to wear gloves to give a bottle of human milk or formula
– Contact with human milk is not hazardous exposure72
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Breastfeeding Report Card
National Healthy People 2020 Targets
E b tf d 76 9% 81 9%Ever breastfed 76.9% 81.9%
Exclusively BF at 3 months 36.0% 46.2%
Exclusively BF at 6 months 16.3% 25.5%
Breastfeeding at 6 months 47 2% 60 6%Breastfeeding at 6 months 47.2% 60.6%
Breastfeeding at 1 year 25.5% 34.1%
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General Infant Feeding Breastfed babies do not need solid food before 6
months
– Do not need solid food before 6 monthsDo not need solid food before 6 months
– Early solids replace breast milk, which should still be main source of food
Formula fed babies
– Do not need solid foods before 6 months
Introduce solids at signs of readiness
– Sits with good head control
– Opens mouth when food comes his/her way
– Can move food from spoon to back of throat
Don’t feed cereal in a bottle
– It’s bad for teeth and will not help a baby sleep longer74
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Hunger Cues Doctors recommend that all babies be fed when they are
hungry, rather than on a schedule
Hunger CuesHunger Cues
– Moving head side to side
– Opening mouth
– Sticking out tongue
– Puckering lips to suck
– Rooting reflex
Watch the baby, not the clocky,
It is normal for young babies to eat only 2-3 ounces of milk in one sitting
We want babies to learn that when they are hungry, they eat, and then they are full
– Scheduled feeding disrupts this learning
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What Do You Know About Breastfeeding?
True/False Activity
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10 Steps to a Breastfeeding-Friendly Program
1. Update/change program policies
6. Provide environmental supportprogram policies
2. Conduct staff trainings
3. Communicate with families
4. Provide learning and play opportunities for
support
7. Provide employee support
8. Create a feeding plan
9. Refer families to appropriate
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children
5. Practice proper storage and labeling
community programs
10. Continue to learn and provide updates to program staff
Breastfeeding-Friendly Child Care Centers Handout
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Resources for Providers and Parents La Leche League
National Resource Center for Health and Safety in Child Care and Early Education
International Board Certified Lactation Consultants
Baby-Friendly Hospital Initiative
Women, Infants, and Children (WIC)
CDC’ B f di d E l C d CDC’s Breastfeeding and Early Care and Education: Increasing Support for Breastfeeding Families
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CDC’s Breastfeeding and Early Care and Education: Increasing Support for Breastfeeding Families
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How to Support Breastfeeding Mothers
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Physical Activity Break
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Part E:Part E: Facilitating Change in
Your
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Program
LS2 Action Period
Why Should We Change?
How Can We Continue to Make Healthy Changes? Celebrating Success:
Our Plans in Action!
ActionPeriodLS1 Action
PeriodLS2 Action PeriodLS3 Action
PeriodLS4 Action PeriodLS5
We Change?
Go NAP SACC*Long-Term Action Plan & Storyboard
Our Plans in Action!
Continue Long-Term Action Plan
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What is Our Role in Making Healthy Changes?
Pilot Action PlanPilot Storyboard
How Can We Engage Families as Partners?
Continue Long-Term Action Plan (Emphasis on Parent Engagement)
*Go NAP SACC is a Nutrition and Physical Activity Self Assessment for Child Care for ECE settings comparing their current practices with a set of best practices
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Facilitating Change in Your Program: LS2 Action Period
Facilitated by the program Leadership Teamy p g p
– Training for program staff
– Mini-version of the Learning Session that the Leadership Team attended
Opportunity to:
Complete Action Tasks related to making healthy change– Complete Action Tasks related to making healthy change
– Use the five areas of improvement identified from the Go NAP SACC results to create your Pilot Action Plan
Trainers provide technical assistance (TA)
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LS2 Action Period
The Leadership Team will:
– Set up a time to train program staffp p g
– Guide program staff through completing the Learning Session 2 Group Discussion Worksheet
– Identify an area to improve for the program’s Pilot Action Plan
– Collaborate with program staff to create a storyboard demonstrating what area the program improved and how it
li h dwas accomplished
– Bring all Action Period materials back to LS3 Learning Session 2 Group Discussion Worksheet
Storyboard
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Creating a Storyboard
Programs will express their story of change by:
D ibi h t h ( ) d d h th did it– Describing what change(s) were made and how they did it
– Sharing who was involved in the process
– Explaining accomplishments and challenges faced
– Sharing photos of the implementation process
– Describing how participants reacted to the change(s)
– Outlining any program policies that were updated as a lresult
– Explaining the next steps they will take to sustain the change(s)
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TA Breakout Groups
Question & Answer
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Part F:Part F: Bringing It
All Together
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g
Staff Involvement & Environment
Have books, posters and toys that remind children of healthy foodshealthy foods
Teach about eating and enjoying healthy foods
Sit, eat, and engage with children during meals
Eat the same food and drinks children are eating
Talk about trying and enjoying new foods
E t l h lth f d d d i k i f t f Eat only healthy foods and drinks in front of children
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Feeding Best Practices for Children Serve meals family-style
Encourage self-feeding
Eat when seated at a table
Use appropriate serving sizes
– Serve more only if the child is still hungry
– Children will eat what they need
Engage children in mealtime prep and cleanup
S f ili d f d Serve familiar and new foods
Encourage children to try new foods, don’t force
Do not use food as punishment or reward
Integrate nutrition experiences for children in to program activities
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Bringing it Home
Encourage families to serve a variety of foods when they send lunches from home
Guide parents by sharing lists of foods that present a variety of whole grains , fruits, vegetables, lean protein, and low fat dairy
Use MyPlate to help families categorize foods and prepare lunches with a variety nutrients
Serve new foods in the classroom and encourage gparents to do the same at home
– Discuss the taste, smell, and touch of the food
– Offer a new food multiple times in a month so children become familiar
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Partnering with Families Get to know families and shared expectations:
– Communicate nutrition policies when children enroll and regularly throughout the year to avoid conflict andregularly throughout the year to avoid conflict and confusion
– Provide written menus
– Work together on feeding plan for each child Also, care plans for children with allergies
– Accommodate vegetarian, vegan, religious, and cultural dietsd ets
– Provide nutrition education for families throughout the school year in addition to using teachable moments
– When introducing new foods at meals, make sure parents know and encourage them to add that food to their home menus as well for consistency and exposure.
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Parents should be informed of what are inappropriate and appropriate foods to pack
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Healthy Fundraising
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Healthy Celebrations
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Policies and Procedures
Annual and on-going staff training
Food and nutrition services
– Use a Nutritionist/Registered Dietitian to develop written menus
– Written plan for requirements of: Foods served
Allergy considerations
Staff interaction with children during meals
Staff foods aligning with rules
Nutrition education for parents
Nutrition education for children integrated in to the classroom curriculum
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Resources
MyPlate for Preschoolers
– http://www.choosemyplate.gov/preschoolers.html
Nutrition and Wellness Tips for Young Children
– www.teamnutrition.usda.gov
Nemours’ Best Practices for Healthy Eating
– www.healthykidshealthyfuture.org
Child and Adult Care Food Program (CACFP)
f / f– www.fns.gov/cacfp
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Nemours’ Best Practices for Healthy Eating
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Questions?
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LS2LS2 Feedback
Forms
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