Limiting television and other media use, encouraging infants and young children in preschool and child care to spend more time in physically active play, and requiring child care providers to promote healthy sleeping practices are some of the actions needed to curb high rates of obesity among America's youngest children, says a new report from the Institute of Medicine.
The report recommends steps that should be taken by child care centers, preschools, pediatricians' offices, federal nutrition programs, and other facilities and programs that shape children's activities and behaviors. Although the recommendations are directed to policymakers and health care and child care providers, these professionals can counsel and support parents in promoting healthy habits in the home as well, said the committee that wrote the report.
About 10 percent of children from infancy to age 2 and slightly over 20 percent of children ages 2 through 5 are overweight or obese. The rates of excess weight and obesity among children ages 2 to 5 have doubled since the 1980s.
"Contrary to the common perception that chubby babies are healthy babies and will naturally outgrow their baby fat, excess weight tends to persist," said committee chair Leann Birch, Distinguished Professor of Human Development and director, Center for Childhood Obesity Research, Pennsylvania State University, University Park. "This is a national concern because weight-related conditions such as diabetes and high blood pressure once occurred almost exclusively in adults but are now occurring at rising rates among teens and young adults. Child care providers, health professionals, and policymakers can be helpful partners to parents in reducing obesity risk by creating healthy environments and implementing positive practices during the crucial early years of development."
Obesity cannot be solved by tackling only one factor, the committee said. It requires a multipronged approach that includes identifying when young children show signs of excess weight, promoting healthy eating, increasing physical activity, and ensuring adequate sleep.
Identifying At-Risk Children
Studies show that many parents do not understand the consequences of excess weight in infants and young children or are not concerned about early excess weight or obesity, the committee found. Health professionals should measure infants' weight and length and the body mass index of young children as a standard procedure at every well-child visit. They should identify children at risk for obesity and discuss with parents their children's measurements and the risks linked to excess weight.
Evidence points to a relationship between insufficient sleep and obesity. Data indicate that over the past two decades there has been an overall decrease in the amount of sleep infants and children get, with the most pronounced declines among children less than 3 years old. Regulatory agencies should require child care providers to promote healthy sleep durations in their facilities, the report recommends. Pediatricians, early childhood educators, and other professionals who work with parents need to be trained to counsel them about age-appropriate sleep times and good sleep habits.
Physically Active Play and Sedentary Activities
Agencies that regulate child care facilities should require child care providers and early childhood educators to create opportunities and environments that encourage infants, toddlers, and preschoolers to be physically active thoughout the day, the committee said. It is up to regulatory agencies to determine appropriate standards, but potential actions child care providers could take to achieve this include engaging children in physically active play for a cumulative average of at least 15 minutes per hour spent in care, joining children in their activities, and getting children outdoors to play when and where possible. They also could avoid using restriction of play as a disciplinary measure. Infants should be allowed to move freely with appropriate supervision. Potential steps to achieve this goal include using cribs, car seats, and high chairs only for their intended purposes and limiting use of strollers, swings, and bouncing chairs.
Child care providers should also limit television viewing and use of computers, mobile devices, and other digital technologies to less than two hours per day for children ages 2 to 5, the report adds. Child care facilities and preschools could advance this goal by restricting screen time of any form to 30 minutes in half-day programs and one hour in full-day programs. Health care providers could counsel parents on the benefits of restricting screen time. The appropriate federal agencies -- including the Federal Trade Commission and Centers for Disease Control and Prevention -- will need to monitor industry compliance with voluntary national nutrition and marketing standards for children, which are currently being developed by an interagency task force.
Given that only 13 percent of mothers breast-feed exclusively for six months after birth, and only 22 percent continue breast-feeding up to a year, health care providers and organizations should step up efforts to encourage breast-feeding, the report says. A potential way to achieve this goal is all hospitals adopting the World Health Organization's International Code of Marketing of Breast Milk Substitutes and the Baby Friendly Hospital Initiative, which limit samples and depictions of formula and help mothers initiate and continue breast-feeding.
All child care facilities and preschools should be required to follow the meal patterns established by the federal Child and Adult Care Food Program (CACFP), which reflect age-appropriate amounts of sugar, salt, and fat and necessary nutrients. CACFP standards promote fruits, vegetables, and whole grains and provide guidance on appropriate portion sizes for children at different ages.
To refine the nation's understanding of what constitutes a healthy diet for the youngest population group, the U.S. departments of Health and Human Services and Agriculture should establish dietary guidelines for children from birth through age 2, the committee said. The U.S. Dietary Guidelines currently apply to age 2 and up. Government officials should take steps to boost participation in nutrition assistance programs. More than one-third of those eligible for the Supplemental Nutrition Assistance Program and 40 percent of those eligible for WIC -- a nutrition program aimed at women, infants, and children -- do not take advantage of them.