January 12, 2016

 

Virginia Department of Social Services

Division of Licensing – Children’s Programs

801 East Main Street, 9th Floor

Richmond, VA 23219

 

RE: Notice: 7357 - Proposed Repeal of Standards for Licensed Child Day Centers (VAC 40-185) and Promulgate New Standards for Licensed Child Day Centers (VAC 40-186). 

The American Heart Association (AHA) appreciates the opportunity to comment on proposed repeal of the current Standards for Licensed Child Day Centers (VAC 40-185) in order to propose new standards that will meet best practices in child nutrition and physical activity standards. AHA advocates for strong nutrition, physical activity, and screen time standards in early childhood education settings as an integral part of the comprehensive effort needed to address and intervene in childhood obesity in the Commonwealth. AHA applauds the Virginia Department of Social Services (VDSS) for seeking comments to update the current standards for licensed child care centers and urge the agency to support the nutrition, physical activity, and wellness of our youngest residents. Creating healthy habits early in life is an important component in ensuring that Virginia is a healthy, livable community for all residents.

Background

Child care is an important environment for forming good health habits around children's dietary intake, physical activity, and energy balance, thus combating the childhood obesity epidemic.[i] Child care providers are in a unique position to educate parents about the importance of healthy eating and physical activity, while also supporting a healthy environment for children to learn and grow. The 2012 National Household Education Survey reports that 60% of all U.S. children five years and younger not yet in kindergarten were in some form of non-parental care. Of those children, 56% were in a center-based child care program, making this an ideal setting for obesity interventions.[ii] Furthermore, it has been reported that many children from low-income backgrounds consume 50% to 100% of their Recommended Dietary Allowances (RDA) in a child care setting.[iii] Reaching young children and their families is an essential strategy for primary prevention of obesity, cardiovascular disease, and its associated risk factors. 

Obesity in childhood and adolescence increases the risk of obesity in adulthood. Research shows that overweight five year olds are four times as likely as normal weight children to become obese moving into adolescence.[iv] This sets the stage for an unhealthy future for these children considering obesity generally tracks into adulthood.[v] These findings illustrate why it is imperative to intervene in early childhood to prevent obesity and related cardiovascular disease risk factors.

Research has shown that preschool-aged children consume too much sodium, saturated fat, and added sugar and have inadequate consumption of fruits, vegetables, and whole grains. Roughly 85% of preschoolers consume a sugary beverage, dessert, or a sweet or salty snack each day.[vi] The American Heart Association recommends a heart healthy diet that emphasizes fruits and vegetables, whole grains, low-fat dairy products, poultry, fish, legumes, non-tropical oils and nuts and limits intake of sodium, sweets, sugar-sweetened beverages and red meat.[vii] Assuring that healthy foods are served in age-appropriate portion sizes is extremely important for overall health and effective dietary patterns. Because children's food preferences and practices originate in the first years of life, early dietary interventions may have immediate nutritional benefit and reduce chronic disease risk if these healthful habits are carried into adulthood.[viii] 

In general, sedentary behaviors are associated with higher body weight.[ix] One of the most common sedentary activities preschoolers participate in is screen time, such as viewing computers or television.[x] In addition to reducing screen time, the American Heart Association recommends that children participate in at least 60 minutes of enjoyable, moderate-intensity physical activities every day that are developmentally appropriate and varied.[xi] Given that the early years play a vital role in the development of health-related behaviors, early intervention around screen-viewing and physical activity is required to prevent sedentary behaviors from carrying into adolescence and adulthood.[xii]

Like much of the nation, Virginia faces staggering rates of obesity among children, with disparities exacerbating these challenges in underserved communities. [xiii][xiv] Therefore, ensuring that proper nutrition and healthy lifestyles begin in early childhood is essential.

AHA’s Recommendations

Proposing new Standards for Licensed Child Day Centers is an important step to help reverse these numbers by supporting the development of healthy early childhood habits surrounding diet, physical activity, and screen time. By enhancing licensed child care standards to meet national guidelines and practices, Virginia is poised to become a leader in early care and education. Virginia is already meeting the infant requirement for physical activity and partially meets the outdoor component in part as defined by the YMCA’s Healthy Eating and Physical Activity Standards for Early Childhood. However, the current standards lack requirement for moderate to vigorous exercise for at least 60 minutes per day and screen time standards are absent completely. To most effectively improve the health of Virginia’s children, the American Heart Association recommends the following inclusions in future licensing standards.

Physical Activity

• Require licensed child care centers to follow the physical activity and screen time standards of the YMCA’s Healthy Eating and Physical Activity Standards for Early Childhood
  • Provide opportunities for moderate to vigorous physical activity for at least 60 minutes per day while children are in care for a full-day program and 30 minutes for half-day day program.
    • Provide daily outdoor time for physical activity when possible.
  • For infants: Provide daily opportunities for infants to move freely under adult supervision to explore their indoor and outdoor environments;
    • Engage with infants on the ground each day to optimize adult−infant interactions; and
    • Provide daily “tummy time” (time in the prone position) for infants less than six months of age.
  • Screen Time
    • Limit screen time, including television, cell phone, or digital media, for preschoolers (aged two−five) to less than 30 minutes per day for children in half-day programs or less than one hour per day for those in full-day programs.
    • Eliminate screen time for children under two years old.

Nutrition

• Require providers to meet the Child and Adult Care Food Program (CACFP) nutrition standards.

The American Heart Association is confident that by adopting these recommendations, VDSS will create an early childhood physical activity and nutrition environment that will help accelerate Virginia’s reduction in the troubling rate of childhood obesity. The American Heart Association is committed to working with VDSS and other governmental stakeholders to achieve this shared goal.

Thank you for the opportunity to comment on these proposed regulations. Should you have questions or require additional information, please contact:

Robin Gahan

Senior Director, Government Relations, Virginia

804-965-6521

robin.gahan@heart.org

 

 

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[i] Kumanyika, S.K., et al. (2008). Population-based prevention of obesity: The need for comprehensive promotion of healthful eating, physical activity, and energy balance. Circulation, 118(4), 428-464. doi: 10.1161/circulationaha.108.189702.

[ii] U.S. Department of Education. (2013). Early childhood program participants, from the national household education surveys program of 2012. Washington, D.C.: U.S. Government Printing Office. Retrieved from http://nces.ed.gov/pubs2013/2013029.pdf.

[iii] Natale, R., Scott, S.H., Messiah, S.E., Schrack, M.M., Uhlhorn, S.B., & Delamater, A. (2013). Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. BMC Public Health, 13(1), 78.

[iv] Cunningham, S.A., Kramer, M.R., & Narayan, K.V. (2014). Incidence of childhood obesity in the United States. New England Journal of Medicine, 370(5), 403-411. doi: 10.1056/NEJMoa1309753.

[v] Serdula, M. K., Ivery, D., Coates, R. J., Freedman, D. S., Williamson, D. F., & Byers, T. (1993). Do obese children become obese adults? A review of the literature. Preventive medicine, 22(2), 167-177. doi: 10.1006/pmed.1993.1014.

[vi] Fox, M.K., Condon, E., Briefel, R.R., Reidy, K.C., & Deming, D.M. (2010). Food consumption patterns of young preschoolers: Are they starting off on the right path? Journal of the American Dietetic Association, 110(12), S52-S59.

[vii] American Heart Association. (2014). The American Heart Association’s Diet and Lifestyle Recommendations. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp.

[viii] Nicklas, T.A., Baranowski, T., Baranowski, J.C., Cullen, K., & al, e. (2001). Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption. Nutrition Reviews, 59(7), 224-35. doi: 10.1111/j.1753-4887.2001.tb07014.

[ix] Prentice-Dunn, H., & Prentice-Dunn, S. (2012). Physical activity, sedentary behavior, and childhood obesity: a review of cross-sectional studies. Psychology, Health & Medicine, 17(3), 255-273. doi: 10.1080/13548506.2011.60880.

[x] De Decker, E., De Craemer, M., De Bourdeaudhuij, I., Wijndaele, K., Duvinage, K., Koletzko, B., … & Cardon, G. (2012). Influencing factors of screen time in preschool children: An exploration of parents' perceptions through focus groups in six European countries. Obesity Reviews, 13(s1), 75-84. doi: 10.1111/j.1467-789X.2011.00961.x.

[xi] Pate, R.R., Davis, M.G., Robinson, T.N., Stone, E.J., McKenzie, T.L., & Young, J.C. (2006). Promoting physical activity in children and youth a leadership role for schools: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in collaboration with the councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation, 114(11), 1214-1224.

[xii] Vanderloo, L. M. (2014). Screen-viewing among preschoolers in childcare: A systematic review. BMC Pediatrics, 14(1), 205. doi: 10.1186/1471-2431-14-205.

[xiii] Data Resource Center for Child and Adolescent Health, a project of the Child and Adolescent Health Measurement Initiative (CAHMI), State Obesity Profiles (2011). National Survey of Children’s Health. Retrieved from: http://www.childhealthdata.org/browse/allstates?q=2415

[xiv] Centers for Disease Control and Prevention (2012). “Basics About Childhood Obesity.” Retrieved from: http://www.cdc.gov/obesity/childhood/basics.html