By the end of this section, you should be able to:
Explain the 5-2-1-0 recommendation.
Discuss physical activity recommendations for young children.
Describe ways early care and education programs can educate children about nutrition.
Distinguish food allergies from food intolerances.
Introduction
Healthy active living includes eating healthy foods, staying physically active, and getting enough rest. Developing healthy habits starts in early childhood. Eating well and being physically active helps a child continue to grow and learn.588
Healthy Active Living
Research tells us that the way young children eat, move, and sleep can impact their weight now and in the future. Early childhood is an ideal time to start healthy habits before unhealthy patterns are set.589
Many children in the United States do not follow the nutrition recommendations of the Dietary Guidelines for Americans. According to the CDC, on average, children consume too much fat, saturated fat, and sodium and not enough fruits, vegetables, or calcium. Children obtain 33%-35% of their calories from fat and 12%-13% from saturated fat (above the recommended levels of 30% and 10%, respectively). Only 16% of children ages 6-11 years meet the recommendation for total fat intake; only 9% of children meet the recommendation for saturated fat intake.590
Young children depend on parents, caregivers, and others to provide environments that foster and shape healthy habits. Early care and education programs have a responsibility to promote growth and development, make healthy foods available, and provide safe spaces for active play. Staff can help children and families by encouraging and modeling healthy eating and physical activity at the center and by providing suggestions for small, healthy steps at home.591
5-2-1-0 Message
The American Academy of Pediatrics (AAP) recommends that pediatricians counsel parents and patients at every well-child check on diet and lifestyle goals as a part of obesity prevention initiatives (Hassink, 2010). These recommendations, initially put forth by the Maine Youth Overweight Collaborative obesity prevention program “Let's Go! 5-2-1-0”, have been promoted locally and nationally for broad consumption (Rogers & Motyka, 2009).592
Figure 13.1 – The 5-2-1-0 Recommendations593
Physical Activity
Good activity habits begin early in children’s lives. As early as infancy, adults can help children grow lifelong healthy play habits. Children learn from adults, they should model being active and participate with children when possible.
Infants should spend a lot of time on the floor (and out of equipment that limits mobility). This time allows them to reach, and kick so they can reach important milestones like crawling and sitting up.
Even very active toddlers need environments that support movement and activity and intentional opportunities to be physically active. Things like dancing, jumping, and taking walks are great ways to keep them moving.595
Childhood and adolescence are critical periods for developing movement skills, learning healthy habits, and establishing a firm foundation for lifelong health and well-being. Regular physical activity in children and adolescents promotes health and fitness. Compared to those who are inactive, physically active youth have higher levels of cardiorespiratory fitness and stronger muscles. They also typically have lower body fat and stronger bones. Physical activity also has brain health benefits for school-aged children, including improved cognition and reduced symptoms of depression. Evidence indicates that both acute bouts and regular moderate-to-vigorous physical activity improve the cognitive functions of memory, executive function, processing speed, attention, and academic performance for these children.
Youth who are regularly active also have a better chance of a healthy adulthood. Children and adolescents do not usually develop chronic diseases, such as heart disease, hypertension, type 2 diabetes, or osteoporosis. However, current evidence shows that obesity and other risk factors for these diseases, such as elevated insulin, blood lipids, and blood pressure, are increasingly appearing in children and adolescents. Exercise training in youth with overweight or obesity can improve body composition by reducing overall levels of body fat as well as abdominal fat. Regular physical activity also makes it less likely that these risk factors will develop and more likely that children remain healthy when they become adults.
Children and adolescents should meet the key guidelines by doing activities that are appropriate for their age. Their natural patterns of movement differ from those of adults. For example, children are naturally active in an intermittent way, particularly when they do unstructured active play. During recess and in their free play and games, children use basic aerobic and bone-strengthening activities, such as running, hopping, skipping, and jumping, to develop movement patterns and skills. They alternate brief periods of moderate- and vigorous-intensity activity with periods of light-intensity physical activity or rest. For preschool-aged children, activity of any intensity counts, including light intensity. Any episode of moderate- or vigorous-intensity physical activity, however brief, counts toward the key guidelines for children and adolescents ages 6 through 17 years. 597
One practical strategy to promote activity in children is to replace sedentary behavior with activity whenever possible. For example, where appropriate and safe, families should walk or bicycle to school or the bus stop instead of riding in a car. Rather than only watching sporting events on television, children should participate in age-appropriate sports or games.
Children with disabilities are more likely to be inactive than those without disabilities. Families of children with disabilities should work with a health care professional or physical activity specialist to understand the types and amounts of physical activity appropriate for them. When possible, children with disabilities should meet the key guidelines. When they are not able to participate in the appropriate types or amounts of physical activities needed to meet the key guidelines, they should be as active as possible and avoid being inactive.
Nutrition Education
Lifelong eating habits are shaped during a child’s early years. Early childhood professionals have a special opportunity to help children establish a healthy relationship with food and lay the foundation for sound eating habits. Nutrition education and activities help set children on the path to a healthful lifestyle. Providing nutritionally balanced meals and snacks and integrating nutrition education and healthy eating habits in the home and early childhood.
Nutrition education for preschoolers fosters children’s awareness of different types of foods and promotes exploration and inquiry into food choices. Lifelong habits with foods are developed during early childhood. Through nutrition education in preschool, teachers encourage children to include a wide variety of foods that provide adequate nutrients in their daily diet.
Through knowledge, children become aware of different foods and tastes, some of which are familiar and others that are new. As they explore various foods and food preparations, they develop likes and dislikes and begin to make choices based on preference. Both nutrition choices and self-regulation of eating—that is, eating when hungry, chewing food thoroughly, eating slowly, and stopping when full— involve decision-making skills.
As children begin to understand the concepts of food identification and categorizing, teachers may describe how specific foods help our bodies. Children may better understand the overall benefit of food in terms of it helping them grow, giving them the energy to run and play, and helping them to become strong. As children begin to understand internal body parts, teachers can initiate discussion of more specific food benefits.
Children need to understand that various foods help the body in different ways and that some children have specific food allergies.
For those with allergies, certain foods are potentially harmful to them. Teachers should encourage tasting and eating a variety of foods to obtain adequate nutrients for growth and development. “Variety” may mean foods of different color, shape, texture, and taste.
As children gain an understanding of different foods, they can begin to categorize foods in other ways, such as by food groups (e.g., bread, fruits, meat) or the U.S. Department of Agriculture (USDA) MyPlate food guide for young children. MyPlate reflects the 2010 Dietary Guidelines and replaces the MyPyramid for Preschoolers. Every food is all right, but some foods help the body more than others; therefore, people may eat some foods more often than others. Food models, combined with visual aids such as the Food Pyramid and integration of the topic with daily nutrition activities (e.g., mealtime, snack time, cooking activities), can help children begin to understand that some foods are eaten more frequently than others.
Here are some things that professionals can do to help educate children about nutrition:
Introduce many different foods.
Recognize and accommodate differences in eating habits and food choices.
Provide opportunities and encouragement in food exploration.
Integrate nutrition with other areas of learning through cooking activities.
Show children where food is produced.
Set up special areas to represent nutrition-related environments, such as grocery stores, restaurants, open-air markets, food co-ops, and picnics.
Integrate nutrition education with basic hygiene education.
Model and coach children’s behavior by eating from the same menu and encouraging conversations during mealtimes.
Encourage children to share information about family meals.
Serve meals and snacks family-style.
Encourage tasting and decision-making.
Provide choices for children.
Offer a variety of nutritious, appetizing foods in small portions.
Encourage children to chew their food well and eat slowly.
Teach children to recognize signs of hunger.
Discuss how the body uses food.
Children learn about food and develop food preferences through their direct experiences with food (i.e., handling, preparing, eating) and by observing the eating behaviors of adults and peers. The goal in preschool is that children will learn to eat a variety of nutritious foods and begin to recognize the body’s physical need for food (i.e., hunger and fullness).
Through modeling, repeated and various exposures to food, and social experiences, children begin to develop eating behaviors that can prevail throughout life.602
When children do not receive proper nutrition it affects their physical health and wellness. Malnutrition refers to one not receiving proper nutrition and does not distinguish between the consequences of too many nutrients or the lack of nutrients, both of which impair overall health. Undernutrition is characterized by a lack of nutrients and insufficient energy supply, whereas overnutrition is characterized by excessive nutrient and energy intake. Overnutrition can result in obesity, a growing global health threat.603 And if the cause of overnutrition is a diet that features food that is not nutrient-dense, a child could experience both overnutrition (too many calories) and undernutrition (inadequate micronutrients).
Food Insecurity
Food insecurity is defined as the disruption of food intake or eating patterns because of a lack of money and other resources. In 2014, 17.4 million U.S. households were food insecure at some time during the year. Food insecurity does not necessarily cause hunger, but hunger is a possible outcome of food insecurity.
The United States Department of Agriculture (USDA) divides food insecurity into the following 2 categories:
Low food security: “Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.”
Very low food security: “Reports of multiple indications of disrupted eating patterns and reduced food intake.”
Food insecurity may be long-term or temporary. It may be influenced by a number of factors including income, employment, race/ethnicity, and disability. The risk of food insecurity increases when money to buy food is limited or not available. In 2016, 31.6% of low-income households were food insecure, compared to the national average of 12.3%. children with unemployed parents have higher rates of food insecurity than children with employed parents. Racial and ethnic disparities exist related to food insecurity. In 2016, black non-Hispanic households were nearly 2 times more likely to be food insecure than the national average (22.5% versus 12.3%, respectively). Among Hispanic households, the prevalence of food insecurity was 18.5% compared to the national average (12.3%).
Neighborhood conditions may affect physical access to food. For example, people living in some urban areas, rural areas, and low-income neighborhoods may have limited access to full-service supermarkets or grocery stores.Predominantly black and Hispanic neighborhoods have fewer full-service supermarkets than predominantly white and non-Hispanic neighborhoods. Communities that lack affordable and nutritious food are commonly known as “food deserts.” Convenience stores and small independent stores are more common in food deserts than full-service supermarkets or grocery stores. These stores may have higher food prices, lower quality foods, and less variety of foods than supermarkets or grocery stores. Access to healthy foods is also affected by a lack of transportation and long distances between residences and supermarkets or grocery stores.609
Overweight and Obesity in Childhood
Obesity means having too much body fat. It is different from being overweight, which means weighing too much. Both terms mean that a person's weight is greater than what's considered healthy for his or her height. Children grow at different rates, so it isn't always easy to know when a child is overweigh or obese.612 Obesity is defined as a body mass index (BMI) at or above the 95th percentile of the CDC sex-specific BMI-for-age growth charts (See Appendix O).613
In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s.614 Obesity prevalence was 13.9% among 2- to 5-year-olds, and 18.4% among 6- to 11-year-olds. Childhood obesity is also more common among certain populations.
Hispanics (25.8%) and non-Hispanic blacks (22.0%) had higher obesity prevalence than non-Hispanic whites (14.1%).
Non-Hispanic Asians (11.0%) had lower obesity prevalence than non-Hispanic blacks and Hispanics.615
Many factors contribute to childhood obesity, including:
Genetics.
Metabolism—how your body changes food and oxygen into energy it can use.
Eating and physical activity behaviors.
Community and neighborhood design and safety.
Short sleep duration.
Negative childhood events.
Genetic factors cannot be changed. However, people and places can play a role in helping children achieve and maintain a healthy weight. Changes in the environments where children spend their time—like homes, early care and education programs, schools, and community settings—can make it easier for children to access nutritious foods and be physically active. Early care and education programs and schools can adopt policies and practices that help young people eat more fruits and vegetables, eat fewer foods and beverages that are high in added sugars or solid fats, and increase daily minutes of physical activity.616
Food Allergies and Food Intolerance
Food allergies impact four to six percent of young children in America. Common food allergens include peanuts, eggs, shellfish, wheat, and cow’s milk.617 Recent studies show that three million children under age eighteen are allergic to at least one type of food.
An allergy occurs when a protein in food triggers an immune response, which results in the release of antibodies, histamine, and other defenders that attack foreign bodies. Possible symptoms include itchy skin, hives, abdominal pain, vomiting, diarrhea, and nausea. Symptoms usually develop within minutes to hours after consuming a food allergen. Children can outgrow a food allergy, especially allergies to wheat, milk, eggs, or soy.
Anaphylaxis is a life-threatening reaction that results in difficulty breathing, swelling in the mouth and throat, decreased blood pressure, shock, or even death. Milk, eggs, wheat, soybeans, fish, shellfish, peanuts, and tree nuts are the most likely to trigger this type of response. A dose of the drug epinephrine is often administered via a “pen” to treat a person who goes into anaphylactic shock.
Some children experience a food intolerance, which does not involve an immune response. Food intolerance is marked by unpleasant symptoms that occur after consuming certain foods. Lactose intolerance, though rare in very young children, is one example. Children who suffer from this condition experience an adverse reaction to the lactose in milk products. It is a result of the small intestine’s inability to produce enough of the enzyme lactase, which is produced by the small intestine. Symptoms of lactose intolerance usually affect the GI tract and can include bloating, abdominal pain, gas, nausea, and diarrhea. An intolerance is best managed by making dietary changes and avoiding any foods that trigger the reaction.619
Figure 13.6 – Hives can be a sign of an allergic reaction618
Caring for Children with Food Allergies
Staff who work in programs serving children should develop plans for how they will respond effectively to children with food allergies. Although the number of children with food allergies in any one school or program may seem small, allergic reactions can be life-threatening and have far-reaching effects on children and their families, as well as on the schools or programs they attend. A program's plan for preventing and responding to a food allergy emergency is often included with other emergency management plans.
Studies show that 16%–18% of children with food allergies have reacted to accidentally eating food allergens while at school. In addition, 25% of the severe and potentially life-threatening reactions (anaphylaxis) reported at schools happened in children with no previous diagnosis of food allergy. School and ECE program staff should be ready to address the needs of children with known food allergies. They also should be prepared to respond effectively to the emergency needs of children who are not known to have food allergies but who exhibit allergic signs and symptoms.
The symptoms of allergic reactions to food vary both in type and severity among individuals and even in one individual over time. Symptoms associated with an allergic reaction to food include the following:
Mucous Membrane Symptoms: red watery eyes or swollen lips, tongue, or eyes.
Skin Symptoms: itchiness, flushing, rash, or hives.
Gastrointestinal Symptoms: nausea, pain, cramping, vomiting, diarrhea, or acid reflux.
Upper Respiratory Symptoms: nasal congestion, sneezing, hoarse voice, trouble swallowing, dry staccato cough, or numbness around mouth.
Lower Respiratory Symptoms: deep cough, wheezing, shortness of breath, difficulty breathing, or chest tightness.
Cardiovascular Symptoms: pale or blue skin color, weak pulse, dizziness or fainting, confusion or shock, hypotension (decrease in blood pressure), or loss of consciousness.
Mental or Emotional Symptoms: a sense of “impending doom,” irritability, change in alertness, mood change, or confusion.
Children sometimes do not exhibit overt and visible symptoms after ingesting an allergen, making early diagnosis difficult. Signs and symptoms can become evident within a few minutes or up to 1–2 hours after ingestion of the allergen, and rarely, several hours after ingestion.
Children might communicate their symptoms in the following ways:
It feels like something is poking my tongue.
My tongue (or mouth) is tingling (or burning).
My tongue (or mouth) itches.
My tongue feels like there is hair on it.
My mouth feels funny.
There’s a frog in my throat; there’s something stuck in my throat.
My tongue feels full (or heavy).
My lips feel tight.
It feels like there are bugs in there (to describe itchy ears).
It (my throat) feels thick.
It feels like a bump is on the back of my tongue (throat).
Some children may not be able to communicate their symptoms clearly because of their age or developmental challenges.
Summary
Early care and education programs can create environments that protect children’s nutrition and physical wellness by following dietary guidelines and providing nutritious foods that appeal to children and keeping them active. It is important to understand forms of malnutrition that can affect families and children and to understand and plan for nutritional concerns that may affect children, such as food allergies and intolerances.
