1. This training module offers an overview of Lets Move! Child Care for child care and early education providers. The module is intended for use by trainers, and may be adapted for specific needs and audiences. For questions, please email LMCCHelp@cdc.gov.LMCCHelp@cdc.gov Training Module: Lets Move! Child Care Overview

2. www.HealthyKidsHealthyFuture.org

3. What is Lets Move! Child Care? One component of the First Ladys Lets Move! initiative to solve the obesity problem Supports providers to adopt best practices for physical activity, screen time, foods, beverages, and breastfeeding through free resources and interactive, online tools Recognizes providers who meet best practices

4. Learning Objectives By the end of this training, you will understand: 1) Basics about childhood obesity prevention and why you have an important role 2) How participating in Lets Move! Child Care can help you prevent obesity among children in your care 3) Where to find free tools and tips to help you meet the Lets Move! Child Care goals and be recognized for your efforts

5. Basics about Obesity

6. Obesity Common Costly Solvable Photo source: www.obesityinamerica.org

7. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%–14%

8. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%–14% 15%–19% 20%

9. (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% 30% Obesity Trends* Among U.S. Adults BRFSS, 2010

10. Childhood Obesity 24% - 33% of 2 – 5 year olds are overweight or obese. Obesity rates for young children doubled in about a 20 year period of time (1980s – 2000). Obese children are more likely to become obese adults. If children are overweight, obesity in adulthood is likely to be more severe.

11. What Is Obesity? How Is It Measured? Excess body fat Indirectly: Excess weight for height Body mass index (BMI) Weight (kg)/height(m) 2

12. How do you know if a child is obese? CDC growth charts are used to determine a childs BMI. For children 2 and older: Obesity = BMI 95 th percentile for children of the same age and sex It can be hard to tell if a child is becoming obese just by looking.

13. Knowledge Check Children who are obese are more likely to develop: Heart disease Diabetes Cancer Sleep Problems All of the above

14. Knowledge Check Children who are obese are more likely to develop: Heart disease Diabetes Cancer Sleep Problems All of the above

15. Health Consequences Heart disease Type 2 diabetes Cancer Sleep apnea and respiratory problems Hypertension High blood cholesterol Stroke Osteoarthritis Gynecological problems Liver and Gallbladder disease Obesity increases the likelihood of certain diseases and health problems, such as:

16. Education Consequences Children who are overweight or obese can be undernourished at the same time. Nutrition deficiencies Impair brain development and cognitive functioning, including learning

17. Education Consequences (2) Physical inactivity Activity promotes brain development, improves sleep, builds self confidence, and reduces stress & depression Children who are not active have more behavioral and disciplinary problems, shorter attention spans in class and do worse in school compared to active children Screen Time Interferes with exploration, playing, interaction with others, which promote social development Competes with being active, social interaction, reading, and doing homework

18. You Play an Important Role in Preventing Obesity!

19. Moving Forward to Reverse the Obesity Trends … we know the cure for this. This isn't like putting a man on the moon or inventing the Internet - it doesn't take some stroke of genius or feat of technology.... Rarely in the history of this country have we encountered a problem of such magnitude and consequence that is so eminently solvable. Michelle Obama February 9, 2010

20. Video Message from First Lady Michelle Obama [For the video, please email LMCCHelp@cdc.gov.]

21. Why obesity prevention in child care and early education programs? Prevention must start early. Children spend many hours in your care. You can provide a healthy environment for children to eat, play, and grow.

22. Why obesity prevention in child care and early education programs? (2) You can help children build healthy habits for life Food preferences and physical activity habits develop during early childhood and continue into adulthood You are a role model. Kids do as you do, especially when theyre young. You are in a unique position to educate parents about healthy eating and activity

23. What You Can Do to Prevent Obesity

24. Preschool Teacher Builds Healthy Habits [To show the video, go to: http://www.cdc.gov/CDCTV/ChildObese/index.html] http://www.cdc.gov/CDCTV/ChildObese/index.html

25. 5 Lets Move! Child Care Goals 1 Physical Activity 2 Screen Time 3 Food 4 Beverages 5 Infant Feeding

26. 1 Physical Activity

27. Knowledge Check What is the recommended amount of physical activity for toddlers in full day care? 15 - 30 min 30 - 45 min 60 - 90 min 90 - 120 min

28. Knowledge Check What is the recommended amount of physical activity for toddlers in full day care? 15 - 30 min 30 - 45 min 60 - 90 min 90 - 120 min

29. Physical Activity Best Practices Infants: Short supervised periods of tummy time several times each day Toddlers & Preschoolers: Active play time every day, both indoor and outdoor Toddlers: 60 – 90 minutes or more (for half-day programs, 30 minutes or more) Preschoolers: 120 minutes or more (for half-day programs, 60 minutes or more) REMINDER: Make sure that kids with special needs can participate in activities too!

30. Benefits of Physical Activity Helps children stay at a healthy weight In childhood In adulthood – physical activity habits learned in early childhood can last a lifetime Helps children: Develop motor skills and build their strength, flexibility, and endurance Develop and maintain strong bones Improves social skills and brain development Sleep better Feel confident about themselves and their bodies Reduce their risk of feeling stressed or depressed

31. Benefits of Physical Activity (2) Children who are active tend to have fewer behavioral and disciplinary problems, do better in school, and have longer attention spans in class.

32. Ways to Get Kids Moving Add physical activity into your daily routine Have children act out a story as you read it to them. Encourage kids to move like different animals during transitions from one activity or room to another. Mix up the usual hokey pokey and head, shoulders, knees and toes with a dance party or obstacle course Encourage working together to come up with games and activities

33. Keep infants active too During tummy time: Encourage them to see, touch, and feel whats around them Try putting their favorite toys just out of reach REMINDER: Always make sure infants have tummy time when theyre awake and alert and placed on a solid surface on the floor (never on a surface thats soft or up high like a mattress or sofa).

34. 2 Screen Time

35. Knowledge Check How much screen time should children under 2 years be allowed? None 20 minutes 30 minutes 40 minutes

36. Knowledge Check How much screen time should children under 2 years be allowed? None 20 minutes 30 minutes 40 minutes

37. Screen Time Best Practices Infants: No screen time Toddlers: No more than 3 – 4 times per year, or never Preschoolers: Only for educational or physical activity purposes No more than 30 minutes per week or never, while in your care Work with families to ensure no more than 1 - 2 hours per day Provide screen time reduction and/or media literacy education to parents at least twice a year, e.g. special programs, newsletters, or information sheets

38. Reasons for Reducing Screen Time Gets in the way of exploring, playing, and social interaction. As kids get older, screen time can get in the way of being active, reading, doing homework, playing with friends, and spending time with family. Kids who spend more time watching TV are more likely to be overweight or obese.

39. Ways to Reduce Screen Time Keep the TV/computer out of sight Put it in rooms not used by children Hide it with a blanket or sheet Get rid of it Replace screen time with fun, interactive activities Turn on the radio or a CD and dance Play outside Bring kids into the kitchen and let them help you set the table, cook, and clean up

40. When screen time is allowed: Make it quality programming by choosing shows or computer games that are educational or get kids moving. Track screen time with a simple scheduling sheet so you know how much screen time a child has and when theyve reached their limit for the week.

41. 3 Food

42. Knowledge Check Do French fries, tater tots, or hash browns count as vegetables? Yes No

43. Knowledge Check Do French fries, tater tots, or hash browns count as vegetables*? Yes No *Referring to foods counted as vegetables within LMCC best practices, not current creditable foods for CACFP.

44. Food Best Practices Toddlers and preschoolers Serve a fruit and/or a vegetable at every meal (Juice doesnt count as fruit, and French fries, tater tots, and hash browns dont count as vegetables!) Limit fried and pre-fried foods French fries, tater tots, hash browns, potato chips, frozen and breaded meats or fish to no more than once a month Preschoolers: Serve all meals family style so that children are encouraged to serve themselves with limited help.

45. Benefits of Healthy Food Helps children stay at a healthy weight Opportunity to teach kids taste buds to appreciate healthy foods. Food preferences develop at an early age, even in infancy.

46. Ways to Promote Healthy Eating Have taste tests for kids to try new veggies and fruits Serve veggies with yogurt, hummus, or low-fat dressing. Buy healthy alternatives. Many healthy options cost the same as the not-so- healthy choices (like whole wheat bread vs. white bread)

47. Ways to Promote Healthy Eating (2) Offer healthy alternatives in place of fried foods INSTEAD OF fries TRY potatoes sliced and baked INSTEAD OF potato chips TRY baked vegetable chips INSTEAD OF chicken nuggets TRY baked chicken Be creative and find ways to have healthy holiday and birthday celebrations REMINDER: Hang in there! It may take 10 to 15 tries for young children to accept a new food.

48. Basics about Family Style Dining Let children serve themselves with limited help Talk with children about the foods theyre eating Adults sit at the table and eat the same foods Role model healthy eating Prevent fighting, feeding each other, choking, etc.

49. Benefits of Family Style Dining Improves self-feeding skills and recognition of hunger cues Supports social, emotional, and motor skill development Children learn about the food theyre eating and are more likely to enjoy and eat healthy food Language skills improve as adults and children talk with each other Positive role modeling

50. Ways to Make Family Style Dining Work Let kids practice serving themselves first Use play food, like plastic fruits and veggies. Use the right equipment Use child size pitchers, tongs, and serving bowls and plates. Put dressings and dips in child size squeeze bottles. Be prepared for spills! Show kids you enjoy eating healthy foods. They will follow your example!

51. 4 Beverages

52. Knowledge Check What kind of milk should children 2 years and older drink? Whole milk 2% (reduced fat) 1% or non-fat (skim) milk Flavored milk

53. Knowledge Check What kind of milk should children 2 years and older drink? Whole milk 2% (reduced fat) 1% or non-fat (skim) milk Flavored milk

54. Beverages Best Practices Water: visible and available inside and outside for self-serve Fruit juice: Only100%; limited to no more than 4 – 6 oz. per day per child and encourage parents to support this limit Sugary Drinks: Never (includes fruit drinks, sports drinks, sweet tea, and soda) Milk: Serve only 1% or non-fat (skim) milk to children 2 years and older (unless otherwise directed by the childs health provider) REMINDER: Dont provide water in sippy cups or bottles!

55. Benefits of Drinking Water Keeps kids hydrated best Reduces acid in the mouth that can cause cavities Water instead of sugary drinks reduces the amount of calories children consume. REMINDER: Infants less than 6 months should not be given water

56. Benefits of Skim or 1% Milk Milk is packed with nutrients like calcium and vitamin D that help kids grow and build healthy bones Skim and 1% milk have the same amount of calcium and vitamin D as whole milk, but without the extra fats. Kids over 2 no longer need those extra fats.

57. Ways to Promote Healthy Drinks Take water jugs and cups with you outside. Try adding fruit slices or berries to water for an extra fun taste! Try diluting 100% fruit juice with water to train childrens palette to enjoy less sweetness. Model healthy drinking by avoiding sugary drinks in front of children. Instead of juice, serve fresh fruit, which includes important dietary fiber and is a natural source of energy.

58. 5 Infant Feeding

59. Knowledge Check How long should babies be breastfed exclusively? 3 months 4 months 5 months 6 months

60. Knowledge Check How long should babies be breastfed exclusively? 3 months 4 months 5 months 6 months REMINDER: The American Academy of Pediatrics recommends that babies should not receive formula, water, juice, non-breast-milk, or food for the first six months and nursing continue until 12 months (or longer).

61. Infant Feeding Best Practice Have a private room for moms to breastfeed or pump other than a bathroom appropriate seating and privacy

62. Benefits of breastfeeding Prevents obesity Defends against infections (keeping infants from getting sick with things like diarrhea and ear infections) Protects against a number of conditionslike asthma, diabetes, and sudden infant death syndrome (SIDS)

63. Ways to Support Breastfeeding Educate teachers and staff about the importance of breastfeeding and how to properly handle breast milk. Respect parents wishes to give breast milk, infant formula, or both. Reassure nursing mothers. Create an ideal environment to pump or nurse.

64. Participating in Lets Move! Child Care

65. www.HealthyKidsHealthyFuture.org Why Participate? You can make a difference You can be a champion for healthy choices Youre a role model You care Youre a partner in parenting Its easier than you might think!

66. www.HealthyKidsHealthyFuture.org 1. Sign up online at www.HealthyKidsHealthyFuture.org to receive a participation certificate and resource updateswww.HealthyKidsHealthyFuture.org 2. Take the Checklist Quiz to see how you are doing on the 5 goals 3. Build an Action Plan to reach the goals 4. Use the free online resources to help implement your action steps 5. Retake the Checklist Quiz once you meet the goals and earn the LMCC Provider Recognition Award 6. Share your success story LMCC Steps to success

67. www.HealthyKidsHealthyFuture.org

68. Post your participation certificate to let families know the goals youre working towards!

69. Updates from LMCC New resources and website features Online training announcements How to tips, activity sheets, & ideas from providers like you

70. See where you are and make a manageable action plan to achieve the LMCC goals Take the Checklist Quiz Look for the Take Action box on the homepage.

71. Checklist Quiz: Part 1 Answer questions to see which best practices you are meeting and which goals you need to work on Available in English and Spanish

72. Build your action plan Action Planning is an important step to help you make changes You choose your prioritiesstart with whatever is going to be easiest, then build on your success Be ready to create individual action steps Samples are available Checklist Quiz: Part 2

73. Sample Action Plan

74. Easy Drag & Drop!

75. www.HealthyKidsHealthyFuture.org LMCC Process Snapshot Make Action Plan NO Implement Steps in Plan Free online tools, resources, webinars, help from trainers Take Checklist Quiz Meet all best practices? Sign Up on Website CONGRATULATIONS! LMCC Recognition Award YES

76. www.HealthyKidsHealthyFuture.org

78. Finding resources and tips

79. www.HealthyKidsHealthyFuture.org Visit www.HealthyKidsHealthyFuture.org

80. Curriculum Menu Planning & Recipes Training videos Activity Sheets Parent Handouts And more! Resources

81. Kid-friendly recipes, menu planning guides, healthy eating tips, shopping lists, and more! Healthy Eating

82. Physical Activities Fun activity ideas, tips for incorporating physical activity into your daily routine, activity sheets, and more!

83. Ideas and Resources One stop shop for nutrition and physical activity resources for all providers, including centers and family child care homes Resources in Spanish Resources for providers serving tribal communities

84. Videos Articles from KidsHealth.org Sample Resources

85. Nutrition & Physical Activity Curriculum (with DVD)

86. Tip Sheets

87. Activity sheets eXtension Alliance for Better Child Care Hands-on Activities Database Songs to get kids dancing

88. Resources for families Tips for parents

89. Available in English and Spanish

90. Healthy eating and activity tips for you! Healthy recipes

91. Posters Breastfeeding Resource Kit

92. Nutrition and physical activity resources for tribal communities

93. Mini poster para niños preescolares Recurso para Actividades Físicas

94. Free Online Trainings One for every LMCC goal Special topics Farm to Preschool Using LMCC resources

95. Share your Success!

96. For more information Visit www.HealthyKidsHealthyFuture.orgwww.HealthyKidsHealthyFuture.org Contact the Lets Move! Child Care Help Desk LMCChelp@cdc.gov Share your success stories! www.healthykidshealthyfuture.org/resources/ testimonials.html

97. Local Resources [insert any local resourcese.g. contact information for technical assistance like Child Care Resource & Referral Agencies, Cooperative Extension, child care health consultants; grant opportunities; nutrition and physical activity websites created by your local health department; and upcoming training opportunities]

98. The following slides are intended to offer trainers ideas on interactive activities that they can lead during training sessions. Use them to break up the presentation to help keep peoples attention and reinforce messages Activity Ideas for Trainers

99. Build in physical activity breaks Physical activity break ideas: Read a story with action verbs and act out the actions as a group as you read the story. (see example in a following slide) Sing a song that gets providers moving (see example in a following slide) Physical activity breaks help to energize providers throughout your session so they can stay engaged! Activity breaks are especially important for longer presentations, but they are good to include for presentations of all lengths. Plus, the activities can serve as fun examples of activities they can do with their children.

100. Activity Break Get on your feet for a fun activity! (that can be also be used with kids!)

101. Action Story New Fruits and Veggies at the Market

102. My Bonnie Lies Over the Ocean My Bonnie lies over the ocean, my Bonnie lies over the sea, My Bonnie lies over the ocean, O bring back my Bonnie to me. Bring back, bring back, O bring back my Bonnie to me, to me. Bring back, bring back, O bring back my Bonnie to me.

103. Come up with games 1) Break providers up into groups of 3 – 5. 2) Ask them to come up with a game using bean bags that they can play with their children. 3) Give providers 15 minutes to come up with the game. 4) Ask each group to present the game to the larger group. This activity should be done after reviewing the physical activity slides. It encourages providers to be creative and come up with a low-cost activity to get kids moving. It also gives providers an opportunity to share their ideas and take home new activity ideas that they can implement in their programs. This is also a great way to get providers moving around the room and get their energy up!

104. Best Practices in Review Pop Quiz! Can you recite all of the [insert goal area here – e.g. food] best practices without looking at your notes?

105. Role play After presenting information on action planning, have participants come up with different scenarios that may present challenges and have providers act them out. Try having a few scenarios ready prior to the session and then coming up with the rest as a group during the session. Example scenarios: How would you respond to a parent who wants their child to have screen time while in care? Ask for a volunteer to play the provider and one to play the parent. How would you talk to families about packing healthy beverages for their child? Ask for a volunteer to play the provider and one to play the parent. How would you talk with your director about incorporating more physical activity into the day? Ask for a volunteer to play the director and one to play the teacher. This activity helps providers think about potential challenges and practice how they would overcome them.

106. Play Videos to Reinforce Goal Messages Insert videos throughout the presentation to reinforce the messages on the goals Embed the videos in your presentation so they will play on demand Family Style Dining: http://www.youtube.com/wat ch?v=nj_s89ydnBs http://www.youtube.com/wat ch?v=nj_s89ydnBs Physical Activity: http://youtu.be/k55liTC7sGI http://youtu.be/k55liTC7sGI Screen Time: http://youtu.be/cogJkMgIjs0 http://youtu.be/cogJkMgIjs0 Trying New Foods: http://www.sesamestreet.org /parents/topicsandactivities/t oolkits/food (Available on DVD) http://www.sesamestreet.org /parents/topicsandactivities/t oolkits/food

107. Take the Checklist Quiz 1) Print out the paper version of the LMCC Checklist Quiz and pass one out to each provider (For the paper version, go to http://www.healthykidshealthyfuture.org/content/hkhf/home/startearly/quiz.html or email LMCCHelp@cdc.gov) http://www.healthykidshealthyfuture.org/content/hkhf/home/startearly/quiz.htmlLMCCHelp@cdc.gov 2) Give providers 10 – 15 minutes to complete the quiz. 3) Have providers create an action plan. You may want to encourage providers to work with others who are working towards the same best practices. 4) Have providers share examples of action steps they plan to take with the larger group. Often, providers are most excited about implementing the LMCC best practices right after theyve learned about the importance of nutrition and physical activity and ways to promote healthy habits in their programs. Take advantage of this window of opportunity by making time for providers to take the Checklist Quiz during your session. Plus, when youre in the room, you can help answer questions they might have about the best practices or how to make changes in their programs.

108. Have small group discussions After taking the LMCC Checklist Quiz this activity gives providers an opportunity to identify common challenges, share ideas, and learn from others who have already overcome these challenges. 1) Break providers up into groups of 5 – 7. 2) Ask them to talk about their current challenges related to promoting nutrition and physical activity. 3) Give providers 20 minutes to discuss their challenges and come up with solutions. 4) Ask each group to share what they discussed with the larger group.

109. Identify next steps 1) At the end of the session, pass out pieces of paper or note cards and pens. 2) Encourage providers to write down 1 to 3 action steps they will take when they go back to their programs. 3) Ask for volunteers to share what they wrote with the larger group. By identifying clear action steps, providers will be ready to make changes when they return to their programs.

110. We compiled some of our best ideas and tips based on our experience conducting presentations and training providers across the country. We hope these tips will be helpful to you! Presentation Tips for Trainers

111. Presentation tips To help maintain providers interest and focus, break up slides by playing videos or having physical activity breaks. Weve placed videos throughout this training module at points where providers typically need breaks. Use visualse.g. bring examples of low-cost physical activity props like bean bags and yoga flashcards, show 4 oz. and 6 oz. cups (its often hard for people to visualize these amounts), and show examples of equipment for family style dining like child size pitchers and tongs. Bring one or more computers and set up a station where providers can sign up to participate in LMCC and explore the LMCC website. Make sure to check with the hotel ahead of time to see if you need to purchase internet access.

112. Presentation tips Bring hand outse.g. tip sheets from the LMCC website, recipe ideas, activity tips (see Ideas for Handouts slide). Pass out the LMCC promotional flyer, which includes the LMCC goals, steps for participating in the initiative, and the LMCC website and contact information for help. Download the flyer in English or Spanish, at http://www.healthykidshealthyfuture.org/content/hkhf/home/resources.h tml (see the promotional materials section). http://www.healthykidshealthyfuture.org/content/hkhf/home/resources.h tml Give away participation prizese.g. if a provider helps you lead an activity, give him/her a prize like a CD with songs for kids or a printed version of the Head Start Body Start Activity Calendar, a recipe book, or other resources you find on the LMCC website. Prizes can incentivize providers to actively participate!

113. Presentation tips Encourage providers to eat healthy and drink water during the session. If you bring snacks, make sure theyre healthy! If possible, have pitchers of water and cups available. At the end of the session, ask providers to evaluate the session by filling out a short survey on what they found to be most/least useful and what they plan to do as a result of the session. You can use these evaluations to show the value of the training and to help you make improvements.

114. Ideas for Handouts Water & Juice Tip Sheet: http://nrckids.org/TipSheet/JuiceTipSheet.pdfhttp://nrckids.org/TipSheet/JuiceTipSheet.pdf Family-style dining tip sheet: http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/resources/familydining tips.pdf http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/resources/familydining tips.pdf Healthy Eats from A to Z: http://www.kcfb.info/chicka/ChickaChicka_HealthyEats.pdfhttp://www.kcfb.info/chicka/ChickaChicka_HealthyEats.pdf Healthy Menu Planning: http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/naccrra/newnaccrra/m enuplan.pdf http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/naccrra/newnaccrra/m enuplan.pdf Making the Most of Meal Times: http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/naccrra/newnaccrra/m akingmealtime.pdf http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/naccrra/newnaccrra/m akingmealtime.pdf Healthy Moves from A to Z: http://www.kcfb.info/chicka/ChickaChicka_HealthyMoves.pdfhttp://www.kcfb.info/chicka/ChickaChicka_HealthyMoves.pdf Get Moving Today! Activity Calendar: http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/kidshealthsheets/FinalE NGLCalendarFULL.pdf http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/kidshealthsheets/FinalE NGLCalendarFULL.pdf Non-Competitive and Active Games for Preschoolers: http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/naccrra/newnaccrra/n oncomgames.pdf http://www.healthykidshealthyfuture.org/content/dam/hkhf/filebox/naccrra/newnaccrra/n oncomgames.pdf

115. We are always excited to learn about local efforts to train providers on LMCC. Let us know about your training activities by emailing us at LMCCHelp@cdc.gov. You can also share your story by filling out a short online form at http://www.healthykidshealthyfuture.org/content/hkhf/h ome/resources/success.html. Your story may be featured on the LMCC website.LMCCHelp@cdc.gov http://www.healthykidshealthyfuture.org/content/hkhf/h ome/resources/success.html Thank you for all you do to support childrens health! We look forward to hearing from you. Share Your Training Success Story