Beyond the Fundamentals: HEALTHY AND SAFE ENVIRONMENTS module Nutrition and Physical Activity in Child Care (2 hours) - Peggy Poppe April

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1 Beyond the Fundamentals: HEALTHY AND SAFE ENVIRONMENTS module Nutrition and Physical Activity in Child Care (2 hours) - Peggy Poppe April Table of contents of this document: A. Instructor qualifications B. Competencies related to this module C. Activity outline with resources D. Sample Activities E. Instructor background notes A. Instructor Qualifications: Health Care Professionals with Knowledge of National Child Care Health and Safety Standards as outlined in Caring for Our Children Vermont Child Care Licensing regulations and knowledge of the context of working with children and families from birth through school age in group care. Note to the instructor: This is an outline of consistent, yet flexible curriculum to use to teach early childhood professionals across Vermont about the specific Northern Lights Core Competencies for Early Childhood Professionals listed in the Outline of content and Northern Lights Core Competencies for Early Childhood Professionals. The materials here are not intended to be a canned curriculum, but rather a guide to use as you plan for instructing on these concepts. This curriculum outline and agenda correspond with the core competencies. The outline of topics must be addressed; however, the teaching methodology and format of delivery are flexible. Links to model lesson plans as well as sample activities are provided as resources. Background information about the topic is provided as a reference for talking points. Information changes periodically. The instructor is expected to check current resources to assure that information is current and up to date. Two references California Child Care Health Advocate: Health Nutrition and Physical Activity Instructor s Guide and Manual (also available in hard copy) are included. For further information, please contact the Vermont Northern Lights Career Development Center ( B. Northern Lights Core Competencies for Early Childhood Professionals HEALTHY AND SAFE ENVIRONMENTS. The following competencies relate to this training. Nutrition Provides space and options for breastfeeding in privacy if necessary Provides meals and snacks that are appealing, nutritionally balanced, and developmentally appropriate

2 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 2 of 20 Recognizes that infants and toddlers have individualized schedules for eating and resting Teaches children about healthy food choices Communicates with families about healthy food choices and foods children prefer, while cultural preferences Physical Activity Plans age appropriate opportunities for children to be active and have adequate rest Provides information for families about children s need for physical activity C. Module Outline Time Objectives Nutrition and Physical Activity Outline 2 hrs. This training is designed so that participants will acquire the knowledge and skills needed for them to: Consider participation in the Child and Adult Care Food Program CACFP Describe procedures for safe food storage and food preparation Describe opportunities for child care providers to promote physical activity in infants and children Review and adapt a nutrition policy for your child care facility in compliance with Vermont Licensing rules and regulations and Caring for Our Children Standards Discuss ways to work with parents to promote healthy eating and physical activity Identify components of a Breast Feeding friendly child care program Recognize personal signs and symptoms of stress and use stress reduction strategies Training Techniques Equipment Topics/ Content Lecture, small group work, video, demonstration DVD, LCD projector and lap top computer Nutrition (1.25 hrs) Standards/Guidelines Nutrition o Obesity risks and prevention o USDA dietary guidelines o Portion sizes o Developmental feeding needs of infants and young children

3 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 3 of 20 Key References o Breast feeding o Food storage and preparation o Food allergies and special needs o Snacks and juice Policies Communicating with parents Physical Activity (.75 hr.) Standards Curriculum ideas Engaging parents Caring for Our Children Dietary Guidelines for Americans Early Childhood Program Licensing Regulations State of Vermonthttp://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/Early_Child hood_program.pdf (section V G) From Playpen to Playground: The Importance of play for the Motor Development of Young Children. ex.cfm Head Start Body Start I am Moving I am Learning: mmovingiam.htm Preventing Childhood Obesity in Early Care and Education USDA Child and Adult Food Program: ns.htm Vermont Department of Health: Breast Feeding Friendly Child Care Vermont Department of Health Food Safety e.html

4 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 4 of 20 Sample Activities Handouts Nutrition Policy Activity Estimating Food Portions Nutrition scenarios small groups Physical Activity small group activity 15 simple Ways to get Moving eweek/upload/15simplewaystogetmoving.pdf Nutrition Checklist Physical Activity Checklist Play Space Assessment ces/upload/play-space-assessment-aug_2010-with-cover.pdf Model Lesson Plans Handouts for Families California Child Care Health Advocate: Health Nutrition and Physical Activity Instructor s Guide CHA_IG_14_Nutrition_v4.pdf (Also available in hard copy at Child Care Resource Offices) California Child Care Health Advocate: Nutrition and Physical Activity Participant Manual Nutrition_0406_v2.pdf (Also available in hard copy at Child Care Resource Offices) Be Active Healthy Homes dex.cfm Curriculum Ideas for Teachers Color Me Healthy Head Start Body Start Lead Structured Activities structuredactivities.cfm USDA. Two Bite Club Eat Well Play Hard in Child Care Settings Curriculum riculum/

5 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 5 of 20 Color Me Healthy Preschoolers Eating and Moving Motion Moments videos D. Sample Agenda: 2 hours Beyond the Fundamentals: HEALTHY AND SAFE ENVIRONMENTS NUTRITION AND PHYSICAL ACTIVITY Time Content Method 10 minute s Welcome /Introductions Icebreaker Review Objectives 10 minute s Overview of Obesity in Child Care Settings Standards 1 hour Nutrition Guidelines Eating Environment Standard Food Safety/Storage Breast Feeding Lecture/Power Point ECKERS video observation Lecture/Power Point Lecture/Discussion /Handout sample WIC policy 30 minute s 10 minute USDA requirements (including food allergies and special needs, snacks and juice, communicating with parents) Physical Activity Standards/Guidelines Planning for Activity Wrap up Nutrition Scenarios Nutrition Policy Portion sizes (optional) Lecture/Power Point Video Motion Moments Videos Small Group planning Activity

6 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 6 of 20 E. SAMPLE ACTIVITIES Nutrition Scenarios Participants can work in groups of 2-4. Read the scenario and discuss the questions below. One person will share highlights with the larger group. Nutrition Scenarios: A parent of a child in your program requests that you add cereal to her infant s bottle twice a day. A parent of a child in your program expresses concern that her 2 year old is not getting enough to eat in your program. (You serve meals and snacks) A parent of an infant in your program packs two bottles of juice for her infant everyday. A parent in your program wants you to provide a vegetarian meal for her child. It is extra work and expensive for you to make this accommodation. Questions: What do the licensing regulations, standards and dietary guidelines recommend/require? Consider the parents perspective. Why might the parent be asking you to do this? Does your program have a policy that addresses the issue? What can you do? What are your goals in discussing this with the parent? Adapted from: Nutrition and Physical Activity: v2.pdf 2/28/2011 PP

7 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 7 of 20 Sample Activity Reviewing A Child Care Health And Safety Policy Instructions: Read/review the attached policy. Does the policy address the eleven criteria for what a health policy should include. The policy should meet the minimum licensing requirements but can exceed them based upon current research and guidelines. 1. Title 2. Belief Statement 3. Intent Statement 4. Background 5. Procedure/Practice 6. Application 7. Communication 8. References 9. Review 10. Effective Date 11. Review Date Adapted from: Cimino J and The National Training Institute for Child Care Health Consultants. Building consultation skills: policy development trainer s guide: version 1. Chapel Hill (NC): The National Training Institute for Child Care Health Consultants, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill; 2007.

8 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 8 of 20 Nutrition Policy (Part Two) ABC Child Care Center believes that eating patterns develop early in life. We believe that when some children bring in snacks and deserts that are high in fat, sugar, and salt it creates challenges at meal times for children who bring in foods that meet the USDA nutrition guidelines. We also believe that children may be more willing to try new healthy foods when they see their peers trying them. This policy is intended to promote healthy eating habits for all children enrolled at ABC Child Care Center. ABC Child Care Center requires all meals include the four basic food groups based upon the dietary guidelines. Milk (or alternative for special diets) Fruits/vegetables Meat or meat alternative Bread or other grain Foods that are high in fat, sugar, and sodium should be reserved for special events like Birthdays and Holidays and enough should be provided to share with all children. Candy Sweetened drinks, Favored milk Chips Cakes ABC Child Care will provide suggestions for healthy foods to bring to school on request. Preventing Childhood Obesity in Early Care and Education Programs Dietary Guidelines for Americans 01/10/2011 PP

9 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 9 of 20 Sample Activity: Structured Play Ask participants to work in small groups of three or four. This activity can be done as a brainstorming activity or even better provide equipment and ask groups to design a creative way to use the supplies in a structured activity appropriate to one of the age groups. Infants (Tummy Time) Toddlers Preschoolers Each group can either share their idea or demonstrate it. Examples of objects might include small or large beach balls, paper plates, jump rope, or chalk for example. Provide age group guidelines and provide references for them to use in their planning: Preventing Child hood Obesity in Early Care and Education Programs (page 51) Head Start Body Start ities.cfm Color me Healthy Preschoolers Eating and Moving 30/02/2011 PP HANDOUT A NL website HANDOUT C- NL website

10 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 10 of 20 Sample Activity: Estimating Portion Sizes for Toddlers and Preschoolers 1) Set aside a measuring cup, set of measuring spoons, and small scale (if available) 2) Assemble large and small sizes of glasses, bowls, and plates for each of the foods listed in step 3 below. 3) Assemble the following foods and drinks: Cereal (dry) Raw vegetables (chopped) Rice or pasta, etc. (cooked) Yogurt, pudding, or applesauce Water or other liquid Pre-packaged cheese slices Peanut butter Meat (cooked ham, hamburger, roast, etc.) 4) Estimate (do not measure) the following toddler/preschool food portions and place in or on the larger glasses, bowls and plates and set aside. ¼ cup cereal ¼ cup raw vegetables ½ cup rice or pasta 2 oz. yogurt ¾ cup water or other liquid 2 oz. cheese (sliced) 2 tbsp. peanut butter ½ oz. meat 5) Repeat step 4, but use the smaller size containers for estimating portions (do not measure) of each food. 6) Using the measuring cup, spoons and scale, measure the portions of food listed in step 4 and place on the containers used in step 4. 7) Compare the results of steps 4, 5, and 6; and answer the following questions: How accurate were your food portion estimates? How many were too large? Too small? Just right? Were you more accurate with some foods than with others? Which ones? Research indicates that people are more accurate in measuring solid foods

11 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 11 of 20 (cereal, pasta) than liquids or amorphous foods (e.g., yogurt, peanut butter) [Yuhas et al., 1989]. Did the container size make a difference in the accuracy of your estimates? If yes, with which foods? Did the method of measurement used (e.g., cup, ounce, tablespoon) affect the accuracy of your estimates? Some evidence indicates that portion estimates are more accurate when smaller containers are used [Yuhas et al, 1989]. Evidence suggests that estimates measured in ounces are less accurate than those measured in cups [Weber et al, 1997]. Sample Activity Food Bingo Create a grid of 4X4 squares. Write a couple of different combinations of the names of food products and vitamins, other concepts relating to infant and toddler/preschool nutritional requirements, etc. On the squares, copy them, and distribute a game card and some little scraps of paper, paper clips, pennies, or other game pieces to each person. After your presentation, wrap up by asking questions which participants answer by playing Bingo. The winner(s) can assist you with another activity in the session! HANDOUT B NL website HANDOUT C NL website

12 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 12 of 20 F. Background Information for Instructors to Use in Preparing Presentations: Materials adapted and used with permission from: National Training Institute for Child Care Health Consultants Staff. Caring for the health and safety of child care staff. Chapel Hill, NC: National Training Institute for Child Care Health Consultants, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill; CHILD NUTRITION Three critical areas of child care nutrition: 1. The food served must be safe. Even a small amount of improperly stored or prepared food can cause serious infection to children. 2. The food served must meet children s nutritional needs. The Child and Adult Care Food Program CACFP Meal Pattern and the USDA Food Guide Pyramid for Young Children (USDA, 1999) provide guidelines for nutritious meal and snack planning. Because children can ingest only small servings of food at a time, they require nutrient dense food to be healthy. 3. The nutrition program must promote a healthy eating environment. Encourage children to try new foods and familiar foods prepared in new ways. Children who eat a variety of foods at a young age may continue to eat a wide variety of foods and, in doing so, are more likely to meet their nutritional needs. By making meals fun, colorful, and participatory, the child care provider contributes to the current and future health of children in care. Meeting the nutritional needs of infants Breast Milk and Formula The nutrient content of breast milk and iron-fortified infant formula is best suited to meet the nutritional needs of an infant exclusively from birth until 4 to about 6 months of age. Breastfeeding provides infants with complete nutrition as well as increased resistance to infection. Breastfed infants generally need to eat more often than infants on formula because they frequently take in less per feeding and breast milk is absorbed more quickly than formula. For infants who are not breastfed, the CACFP Meal Pattern and the American Academy of Pediatrics (AAP) allow only fortified infant formula for infants up to 12 months of age. Infants and sweetened beverages

13 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 13 of 20 Almost 90% of infants (under 12 months) consume fruit juice (American Academy of Pediatrics, 2001b). However, the AAP has recently stated that fruit juice provides no apparent nutritional benefit to infants under six months, and may, in fact, be detrimental. Fruit juice given to infants under six months replaces milk or iron-fortified formula in the diet and decreases important proteins, fats, vitamins, and minerals. Natural sugars in fruit juice may also cause diarrhea in some children. Only pasteurized juice is safe for infants, young children, and adolescents (American Academy of Pediatrics, 2001b). Providers should be encouraged to offer juice in a cup, rather than a bottle for all infants and toddlers. Children should always be held during feeding time Bottle propping and children carrying bottles should not be allowed. Prolonged bottle propping can result in otitis media (ear infection), orthodontic problems, speech disorders, and possible psychological problems Solid foods for infants Solid food should not be introduced to infants younger than 4-6 months of age for the following reasons: It interferes with the intake of breast milk or iron-fortified formula that is needed to promote growth during the earliest months Infants digestive, immune, oral and neuromuscular systems are not developmentally ready to handle solid food before 4-6 months (Kendrick, Kaufman, Messenger, 1991). The introduction of solid foods depends on the infant s individual nutritional and developmental needs. When solid foods are introduced, they should be offered slowly (one at a time at least one week apart) to assist in the detection and prevention of food allergies. By trying new solid foods, the infant will become familiar with different textures, sizes, shapes, smells, and tastes. Around 8-10 months, finger feeding provides the opportunity for the infant to develop eye-hand skills and coordination. At this time it is especially important that foods are cut up in pieces no larger than 1/4 inch cubes to prevent choking.

14 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 14 of 20 Eating characteristics of toddlers and preschoolers All children need to consume adequate calories for the energy needed for active play, and drink plenty of fluids (before, during, and after play) to reduce the risk of dehydration (Trahms and Pipes, 1997). Water is one of the best drink choices to prevent dehydration. Children have smaller stomachs than adults and therefore need to eat more frequently. Serving small portions and permitting toddlers and preschoolers to have additional servings will help meet individual needs. Children should be offered meals and snacks in accordance with the number of hours present in care (8 hrs=1 meal/2 snacks or two meals/one snack; 9 or more hrs=2 meals/2 snacks). The meal/snack schedule should be regular enough for children to learn what to expect, but flexible enough to meet their needs. Children at this age may eat more at one time than another, may like a food one day, but not the next, and may resist trying new foods. It is important to remember that adults choose which foods to offer children, and children choose which foods and how much of them to eat.. Forcing children to try new foods or eat more of any food creates an unhealthy eating environment. Nutrition requirements for Toddlers and Preschoolers Nutrients include vitamins, minerals, protein, carbohydrate or starch, and fats. These are substances that are necessary for the body to build bone and muscle. One of the most important guides for meals and snacks served in a child care facility is the CACFP Requirements for Children Ages 1 through 12. This program specifies the types of food and serving sizes appropriate for children during the time they are typically in child care. As mentioned earlier, for children aged 1-12, this normally corresponds to two meals and one snack or one meal and two snacks during child care hours. The Food Guide Pyramid is designed to aid in selecting a variety of foods with an array of different colors, textures, shapes, and sizes for children. The Food Guide Pyramid emphasizes the five major categories or groups of food and specifies the

15 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 15 of 20 amounts/servings of foods from each of the categories a child needs during a 24 hour period. The Food Guide Pyramid is designed to aid in selecting a variety of foods with an array of different colors, textures, shapes, and sizes for children. The Food Guide Pyramid emphasizes the five major categories or groups of food and specifies the amounts/servings of foods from each of the categories a child needs during a 24 hour period. Dietary Guidelines for Americans Beverages for toddlers and preschoolers Young children are often offered fruit juices to drink for snacks and meals as an alternative to less nutritious sugared beverages or to water. While many fruit juices are a good source of Vitamin C, the recommended intake of fruit juice for children aged 1-6 years is approximately 4-6 ounces per day. Over consumption of fruit juice can lead to diarrhea and increased risk for dental caries. Children who consume large amounts of sugared beverages, including fruits juices, may fill up on those foods and not eat more nutrient-dense foods. (American Academy of Pediatrics, 2001b; Story et al, 2000). Water and milk are great choices for beverages. Water is good for hydration and reduces acid in the mouth (which can contribute to childhood dental caries). It reduces the intake of extra calories (from fruit juice or sugar sweetened beverages) that can be associated with childhood overweight. Milk offered within the child care setting meets the CACFP requirements. It is important to note that child care facilities should not serve cow s milk to children under one year of age. Whole, pasteurized milk should be served to children between the ages of one and two years, and lower fat milk (1% or skim) is the best choice for children over two years of age. Sweets and Fats The USDA and US DHHS Dietary Guidelines for Americans (USDA and USDHHS, 2000) recommend a diet that is low in the use of sugar in both foods and beverages

16 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 16 of 20 and low in saturated fat and cholesterol and moderate in total fat Sugar and fat are often added to enhance flavor so children will eat their food. However, because children s taste buds are in their cheeks, on the roof of their mouths, and on their tongues, they are much more sensitive to sweet tastes and do not need extra flavoring (American Dietetic Association, 1999). Sugar also promotes tooth decay and, therefore, sweets (doughnuts, toaster pastries, sweet cereals, cookies, cake, brownies, etc.) should be limited to twice per week (or less!). Fat intake should only be restricted for children older than 2 years of age (Story et al, 2000). When a high fat food (e.g., hot dogs) is served in a meal, it should be balanced by foods with a low fat content (e.g., raw vegetables). The provider should avoid serving several high fat foods together (e.g., hot dogs and French fries), or at all. Fruits and Vegetables The current Dietary Guidelines for Americans suggest that children consume at least 5 servings of fruits and vegetables a day. Nutrition for Children with Special Needs Special nutrition or feeding requirements of children with special needs should be obtained in writing prior to their entry into the facility. This information should be reviewed and used by the child care team and the child care nutrition specialist. Planning and Evaluating Child Care Snacks and Menus Menus should be planned in advance and under the guidance of the child care nutrition specialist. Advanced menu planning is essential to ensure effective and efficient delivery of food. Menu planning: allows for more variety, so food is less repetitious; facilitates meeting the CACFP meal pattern requirements; takes advantage of seasonal food bargains; facilitates purchase of bulk priced items; saves time at the store by having an organized shopping list; reduces number of last minute trips to the store; facilitates planning food items for children with special needs; insures that infants and children are served a variety of culturally familiar and diverse foods; and improves communication with parents about what foods are being served, and when. (Any changes in food actually served should be made available to

17 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 17 of 20 parents.) (National Foodservice Management Institute, 1997) Snacks Many people think of snacks as being unhealthy; however, a variety of nutritionally balanced snacks served in moderation are a healthful, essential part of a child s diet. Since children have small stomachs and need to eat small amounts more frequently, snacks become an important contributor to their nutrition. Snacks can provide up to 20% of children s daily energy and nutrient needs. By providing the same physical and emotional environment for snacks as for regular meals, children will consider snacking to be a healthy, acceptable part of their daily eating routine (Trahms and Pipes, 1997). To help prevent tooth decay in addition to promoting healthy eating habits, snacks that have a high sugar content or are sticky (like dried fruit) should be avoided. Food Allergies Food allergy refers to a condition in which a person s immune system responds to the ingestion of a particular food protein. Non-immune reactions to foods are described as food intolerances and are due to conditions such as lack of an essential enzyme, or reactions to chemicals or toxins in foods (Story et al, 2000).Infants and young children are more susceptible to food allergies because their digestive and immune systems are still developing. PHYSICAL ACTIVITY Regular physical activity is key to healthy growth and development in all children, including infants and toddlers (National Association for Sport and Physical Education [NASPE] (2002). Physical activity provides important health benefits such as weight management, increased strength and coordination, and stress reduction. It also helps children build self-confidence. Regular physical activity, started in early childhood and continued throughout life, helps reduce the risk of heart disease, high blood pressure, and diabetes. Guidelines and policies Infants (See also Handout E, Back to Sleep, Tummy to Play pamphlet also available online at

18 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 18 of 20 Daily physical activities should promote the development of movement skills and the exploration of the environment. Infants should be placed in safe settings that facilitate physical activity and do not restrict movement for prolonged periods of time. Infants should have access to a safe environment that promotes large muscle activities. Parents and caregivers should be aware of the importance of physical activity and should facilitate movement. Toddlers Toddlers should accumulate at least 30 minutes daily of structured physical activity (such as a dance class). Toddlers should engage in at least 60 minutes (and up to several hours) daily of unstructured physical activity (such as playing on the playground); and they should not be sedentary for more that 60 minutes at a time except when sleeping. Toddlers should develop movement skills that are building blocks for more complex movement tasks. Toddlers should have access to safe indoor and outdoor areas that promote gross motor activities. Parents and caregivers should be aware of the importance of physical activity and should facilitate movement skills. Preschoolers Preschoolers should accumulate at least 60 minutes daily of structured physical activity. Preschoolers should engage in at least 60 minutes (and up to several hours) daily of unstructured physical activity; and they should not be sedentary for more than 60 minutes at a time except when sleeping. Preschoolers should develop competence in movement skills that are building blocks for more complex movement tasks. Preschoolers should have access to safe indoor and outdoor areas that promote gross motor activities. Parents and caregivers should be aware of the importance of physical activity and should facilitate movement skills. (Adapted from NASPE, 2002). Themes and Activities for Physical Education of Infants, Toddlers, and Preschoolers Some active games to play with infants and toddlers are: pat-a-cake, hide and seek, and duck, duck, goose (Trahms and Pipes, 1997) the possibilities are endless. Encourage upper-body strength in toddlers (NAPSE 2002) by

19 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 19 of 20 preparing structured activities that require supporting body weight with hands (pushing against a wall) instead of feet (skipping) Turn off the TV/VCR and invite toddlers and preschoolers to roll around on a big, soft, colorful ball, dance to music, play chase, tumble on soft mats, or ride tricycles. Engage a group of preschoolers in throwing a ball around in a circle remembering to keep the activity non-competitive (NAPSE, 2002). Take preschoolers on walks around the local environment (NAPSE, 2002). LIFELONG HEALTHY HABITS Ways the child care provider can help children to develop lifelong healthy eating and physical activity habits are described below. Model healthful eating and trying new foods. Eliminate interference at mealtimes by making sure children are comfortably seated around the table and that the TV/VCR is off. Sit down with the children, eat the same food they eat, and be sure to practice good table manners (Trahms and Pipes, 1997). Make nutrition and physical activity part of the daily learning environment. Encourage children to learn by doing. Invite them to help wash and prepare foods and create new ways to be physically active (Trahms and Pipes, 1997). Encourage children to eat, but don't force them. Providers are responsible for what, when and where the child eats. Children are responsible for deciding whether to eat and how much (Story et al, 2000). Coordinate with parents and caregivers to encourage healthy eating habits. Encourage staff to provide parents and caregivers with information about the nutrition and physical activity learning activities in the facility so they can reinforce and enhance what their child has been taught. The provider may also choose to supplement learning sessions with nutrition and physical activity articles in the child care program's newsletter. References Kendrick AS, Kaufman R, Messenger KP, editors. Healthy young children: A manual for programs. Washington, DC: National Association for the Education of Young Children; National Association for Sport and Physical Education. Active start: A statement of physical activity guidelines for children birth to five years. Reston (VA): National Association for Sport and Physical Education Publications: 2002.

20 Beyond the Fundamentals: Healthy and Safe Environments Module- Nutrition and Physical Activity Page 20 of 20 National Foodservice Management Institute. Care connection. Oxford (MS): National Foodservice Management Institute; [A copy of the CARE Connection Directory is included in Appendix A]. Story M, Holt K, Sofka D, editors. Bright futures in practice: Nutrition. Arlington (VA): National Center for Education in Maternal and Child Health. [online] 2000 [cited 2005 Jun 1]. Available from: URL: Trahms C, Pipes P. Nutrition in infancy and childhood. 6th ed. McGraw-Hill; U.S. Department of Agriculture. Food guide pyramid for young children [online] 1999 [cited 2005 Jun 1] Available from: URL: U.S. Food and Drug Administration; Center for Food Safety and Applied Nutrition, FDA Federal Register Documents, Code of Federal Regulations and Food, Drug and Cosmetic Act. USDA Title 7, Chapter II, Food and Nutrition Service, Part 226 Child and Adult Care Food Program, 1997:224. [online] 1997 [cited 2005 Jun 1] Available from: Weber JL, Tinsley AM, Houtkooper LB, Lohman TG. Multimethod training increases portion-size estimation accuracy. J Amer Diet Assoc 1997; 97(2): Young Children, May 2006, Volume 61 (3). Yuhas JA, Bolland JE, Bolland TW. The impact of training, food type, gender, and container size on the estimation of food portion sizes. J Amer Diet Assoc 1989;89(10):