Know

Child development professionals are models for children and youth. They play a major role in helping children develop healthy habits that can last a lifetime. As a manager, you can help staff foster healthy habits in themselves and in the children they care for. Understanding what to eat, how much to eat, and how to stay fit are important skills for all of us to learn.

This learning happens from the very beginning of life when infants enter our programs. It is critical that you ensure staff members know how to feed infants appropriately. This includes:

• Storage and serving guidelines for human milk
• Procedures for warming milk and preparing bottles
• Nurturing and responsive feeding routines that include holding infants for feeding, never propping a bottle, etc.

As children get older, it is important for staff to know how and when your program introduces solid foods. Support staff as they maintain communication with families. As children enter the toddler and preschool years, you can communicate with staff about family style dining, portion control, and healthy eating habits.

Infant Nutrition and Feeding

Providing infants with proper nutrition is essential to their development and learning. Regardless of whether that nutrition comes from their mother (human breast milk) or from another source (formula), what matters is that infants get the nutrients they need. Nutritional requirements for infants change over time, so it's important your staff understand what is needed nutritionally at each stage of development.

Infant feedings should be done in nurturing and responsive ways (e.g., with a staff member holding an infant, while seated in a glider, and talking with the infant while feeding them a bottle individually). As a manager, you can play a critical role in helping staff engage in quality infant feeding practices. With help from trainers and coaches, make sure staff know what nurturing feeding routines look like and that they understand infant cues with regards to feeding (see Infants & Toddlers Healthy Environments Lesson 5). Commend staff members when you see them engage in responsive feeding care. Lastly, by ensuring adequate staffing in infant rooms and comfortable spaces to sit and rock, you can help provide the tools and support staff need to engage in nurturing one-on-one infant feedings.

Breastfeeding

Although human milk provides the healthiest start for infants (American Academy of Pediatrics, 2012), group care is not always conducive to breastfeeding as working mothers often struggle to produce enough breastmilk to cover the hours that infants are in care. Supporting breastfeeding mothers is important for the health of infants and for promoting a family-friendly and family-centered practice as well. You can read more about the benefits of breastfeeding for infants and mothers here: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/Benefits-of-Breastfeeding.aspx

Supporting breastfeeding benefits for your program in that it:

• Supports infant-parent attachment
• Assists maternal transition back to work
• Provides natural immunities helpful with group care

Breastfeeding Timelines

The length of time during which mothers breastfeed varies as it is a personal decision. Breastfeeding timelines may be driven by family expectations, cultural norms, or biological factors. Staff working with a breastfeeding family must be aware of any biases they may feel about breastfeeding. The decision whether to stop and when to stop is up to the family, so it's important for your staff to remain supportive and nonjudgmental regardless of a family's breastfeeding choices.

This is also true for families who choose not to breastfeed. Their choice not to breastfeed should be honored and supported. Some mothers are nervous or uncertain about breastfeeding and may feel that they are doing a poor job as a mother if they are not able to successfully breastfeed. It is important for your staff to remain positive and supportive toward mothers, families, and their decisions about breastfeeding.

Handling of Breastmilk and Formula

It is essential that staff are trained on the safe handling and storage of breast milk and formula. Staff must use a tracking system to ensure that breast milk or formula is not given after the expiration date or is given to the wrong child.

You can support families who choose to breastfeed by making the process of labeling and storing human milk as easy for them as possible; e.g., providing pre-printed labels where they only need to write the date expressed. You can read more about how to properly handle and store human milk by visiting: http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm. As a manager, you need to develop a system that supports families and fulfills all the guidelines for safe handling and storage of human milk and formula.

When following proper bottle preparation techniques, the chance of feeding breastmilk to the wrong infant is small. In the case of an infant being fed another child's breastmilk by mistake, however, there is a possibility that the infant would have been exposed to hepatitis B, hepatitis C, or HIV. If this mistake should ever happen in your program, you should immediately do the following:

1. With the reporting staff member, inform the mother who expressed the breastmilk about the error and discuss with her how the milk was handled before it was delivered to your program. You will also need to ask if she has ever had hepatitis B, hepatitis C, or an HIV blood test. It will be important to ask if she is willing to discuss this information with the family of the child who was mistakenly fed her milk.
2. Next, you will need to discuss the mistake with the family of the infant who was fed the wrong bottle. Let them know that the risk of transmission of infectious disease is low, but that it would be best to notify their child's primary care provider of the mistake. Provide as much information as you can about the time and date the milk was expressed and how the milk was handled before coming to your program. Depending on the health history of the mother whose milk was given, the child who received the wrong bottle may need to have baseline blood tests for hepatitis B, hepatitis C, or HIV.
3. You will need to assess how the wrong milk was given and create a plan to prevent future mistakes from happening. This plan should be shared with families.

Staff must be properly trained in the handling and distribution of breastmilk and formula.
It may be helpful for you to refer to the Infants & Toddlers Healthy Environments course, Lesson 5 (or Lesson 5 in the Healthy Environments course in the Family Child Care track) for more information on feeding the youngest children in your program. 

For a comprehensive resource on feeding infants, see the U.S. Department of Agriculture (USDA) resource, Feeding Infants in the Child and Adult Care Food Program at https://www.fns.usda.gov/tn/feeding-infants-child-and-adult-care-food-program.

Supervise & Support

Program Supports for Breastfeeding Families

You can help support families who choose to breastfeed by providing spaces in your program where mothers can comfortably nurse, or even express milk with the use of a breast pump. Some mothers may need to nurse before they leave their child in the morning, when they pick-up, or some may even be able to visit the program briefly during the day to breastfeed. Some mothers may feel comfortable nursing in the classroom environment, but others may prefer privacy. A rocker or armchair, pillows for support, soft lighting, a side table and a door or curtain are some things to consider when developing your breastfeeding space. Work with your staff to help support these moments as much as you can, keeping communication open between families and staff as to when a mother may be able to visit and breastfeed.

The Importance of Communication

All information about infant feeding is important and should be documented on daily activity sheets. Families should document when and how much their infant ate prior to coming to the program and your staff need to document the same information throughout the day and have the sheet available for families at pick up time. The daily sheets can be instructive for discovering any patterns of behavior or changes in bodily functions that might need to be shared with health providers. Daily communication ensures that everyone is on the same page when it comes to infant nutrition. It can also help identify when children are ready for the next step (e.g., larger bottles, cereal, baby food or table food).

Watch this video to review the ways your program can properly support infant feeding and your role in ensuring staff members safely and sensitively feed infants.

Child and Youth Nutrition

The focus for children and youth is on healthy growing, which is not solely dependent on weight or weight gain. The promotion of healthy weight is related to the food consumed (input) and the energy used (output), or eating and exercise. Finding the balance between input and output allows children and youth to grow properly and maintain a healthy weight. Consuming an appropriate amount of calories and proper nutrients is essential for growth and development, resistance to illness, and prevention of disease. Follow your program guidelines with regard to the regularity of meals and snacks offered to infants and older children. Dietary guidelines suggest that a healthy eating plan is one that:

• Emphasizes fruits, vegetables, and whole grains
• Includes low-fat milk products
• Is low in saturated fats, trans fats and cholesterol
• Is low in sodium and added sugars

When reviewing your program's menu, look at the food being served. Does the food promote the guidelines above? Keep in mind that children should have access to second helpings of nutritious foods, like fruits, vegetables, and whole grains. Follow your program’s guidelines as to how your program should create, post, and update menus; remember also that menu substitutions should be noted on the posted menu before serving so that parents have ample time to plan accordingly. Your program may have a nutritionist or other health care professional that can help plan a healthy menu.

Balance Between Food Intake and Exercise

It is essential that children find a balance between food consumption and physical activity. When a balance is achieved, the likelihood of excessive weight gain decreases. Generally, children and youth should engage in at least 60 minutes of physical activity on most, preferably all, days of the week. You and your staff can play a critical role to help to achieve this balance by modeling healthy eating habits, providing nutritional meals and snacks, and ensuring that children and youth engage in physical activity every day. The importance of physical activity and supporting motor development is discussed in further detail in the Physical Development course.

Within their respective tracks, staff members have learned about the importance of family style dining. You can help support family style dining by making sure staff members and children have the appropriate materials to serve themselves (e.g., the appropriate sized serving dishes and utensils). You can also help model family style dining and healthy eating by incorporating a family dining experience complete with healthy food choices into your staff meetings or events.

Make sure staff members understand their roles and responsibilities related to physical fitness. Talk to staff members about what they have learned about modeling healthy habits, and make sure they understand the importance of outdoor play. With help from trainers and coaches, discuss how much physical activity children should be offered during your program day. Talk to staff about their own physical activity. Encourage them to move around the active play spaces and to engage in physical activity with the children in your program. Remember that the information you share with staff, family child care providers, parents, and guardians is valuable to children’s trajectory. When parents make an effort to improve or maintain their good health, those benefits are strongly related to their children's good health. (Murphey, Cook, Beckwith, & Belford, 2018). 

Current Dietary Guidelines

Dietary guidelines for Americans are jointly updated every five years by the US Department of Agriculture (USDA) and US Department of Health and Human Services (HHS). The newest guidelines was published in 2015. These guidelines include MyPlate, which replaced the former Food Pyramid.

MyPlate Highlights

A healthy diet includes a mix of grains, fruits, vegetables, dairy, and protein. The MyPlate guide helps you visualize the relative amounts of food you--and children--need each day. Half the plate should be covered with fruits and vegetables. The other half is split between grains and protein. This balance of food groups, in these proportions, helps children develop healthy eating habits from the very beginning.

Visit http://www.choosemyplate.gov/ for more details on MyPlate.

Updates in the 2015-2020 USDA Guidelines

Fat intake is not as critical for children 2 years and older as it is for infants. The fat that is naturally present in breast milk and formula supports healthy early development. 

For children 2 years and older, a high intake of fat could lead to childhood obesity. Childhood obesity is linked to disease, poor self-esteem, and social concerns. Reducing saturated and solid fat intake can help to reduce this risk. However, remember that healthy eating can include as many as up to 35% of total calories per day from fat. There are several ways that your staff can increase healthy menu planning:

• Children 2 years and older must be served low-fat or fat-free milk
• Prohibit deep-fat frying as a way of preparing food on-site
• Reduce use of saturated and trans fats through use of unsaturated, healthy fats such as olive oil (see guideline 4 here https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf for details)
• Cook rice, grains and beans in broth and add herbs and seasonings for flavor
• See Lesson One of the Focused Topics course, Essential in Child Care Food Service for a summary of key updates affecting Child and Adult Care Food Program (CACFP) by food groups for details.

Create Healthy Menus

Nutritious meals can be fun and delicious with the right planning. The following five principles will support your efforts in planning healthy menus:

1. Strive for balance. Balance nutrition and taste by using all parts of MyPlate and make sure that water is always available.
2. Emphasize variety. Include sweet and sour, spicy and bland. Include a variety of shapes and sizes, and new and familiar foods.
3. Add contrast. Add contrasts in taste, texture and temperature to add interest and satisfy the palate.
4. Think about color. Include foods of different colors and textures on the same plate. Color and taste can be added to foods naturally by stirring in cinnamon to applesauce, chives to mashed potatoes, etc.
5. Consider visual appeal. The food should be aesthetically pleasing as well as good tasting and nutritious. Children might be more satisfied with food that pleases the eyes.

Staff and Equipment Considerations

• Kitchen space and equipment : Does your program have enough workspace? Is the space well-organized? Is there enough cooking equipment, such as pots and pans, to accommodate the number of meals served to children and youth in your program? Is the kitchen and food prep area clean and sanitary before, during, and after meal service?
• Balance and workload : From prep to clean-up, is your kitchen well-staffed and streamlined for efficiency? Do you have more than one person who is responsible? What systems are in place when kitchen staff are sick, on vacation, or at a meeting?
• Realistic preparation time : Are meals prepared within the time parameters needed? Are schedules created so that there is adequate time between breakfast, lunch and snacks to allow for prep and cooking time?
• Balance convenience with economy : Balance packed meals with fresh or made-from-scratch food items. Chopping fruits and vegetables takes time but using frozen alternatives may cut back on time. A balance of ready-made with fresh alternatives can provide nutrition, save time, and balance the food budget.

Food Ordering and Purchasing Considerations

• Consider the frequency of deliveries; what needs to be ordered weekly versus monthly?
• Pre-cost your menus and make substitutions as necessary. Check prices and when items are over budget, substitute where necessary to maintain cost and nutrition guidelines.
• Stay current on price trends and identify extremes in price and balance cost. Consider ordering fruits and vegetables when they are in season and less expensive and more readily available.
• Keep a current inventory of foods and consider what's on hand before making new purchases to counter over-ordering or under-ordering. Use the inventory as a reference when planning the next menu cycle.

Considerations for Tracking Meals

Systems should be in place to ensure correct portion control in food preparation and serving practices. Accurate meal counts are important for two reasons. First, it's important that children and youth are provided what they need nutritionally; and second it's important that food costs stay within budget.

Staff play an important role in the meal count process. While meal counts are based on average daily attendance, it is also important that you collect the actual number of children present on a daily basis to ensure that food is not wasted. For example, putting out sign-up sheets asking families their plans around the holidays is a good way to ensure that food isn't over-prepared.

To create your own system for collecting and reporting meal counts, consider the following questions:

• How will the food count information be collected (on attendance sheets or on a separate form)?
• Who collects the food count information and what system is in place if that person is not available?
• When will the food count information be collected from the classrooms?
• How are food counts modified if children come in late or leave early?
• How is that information collected and conveyed?

The Child and Adult Care Food Program

The Child and Adult Care Food Program (CACFP) is the federally funded program that provides free or reduced meals for income-eligible children in child care settings. Regardless of whether your program participates in this program, you can still follow the guidelines to ensure that children receive the nutrients they need. To find out more about the CACFP guidelines go to https://www.fns.usda.gov/cacfp/meals-and-snacks. If your program does participate in CACFP, additional training for staff is needed to ensure reporting requirements are accurate and complete.

Promoting Oral Health

Good oral health is associated with improved overall health. It is important that staff members are trained on how to promote children's oral health and on hygiene practices related to the storage and use of oral health materials (e.g., proper storage of toothbrushes and application of toothpaste to diminish the spread of infectious diseases). After meals, staff should encourage children and youth to brush their teeth. See the Apply activity below for more information on the ways you can support strong oral health in your program.

Model

How Can You Model Healthy Habits in Your Workplace?

Food is a major characteristic of many cultures. Sharing a meal is often seen as a way to build relationships and a sense of community. It is easy, though, for groups to fall into unhealthy habits. One special event turns into a month of special events. Think about the following scenarios. Do any of them happen in your program? What could be done to make these events healthier? Are healthier alternatives or adaptations available?

How Can You Help Staff Promote Healthy Eating and Movement?

Get involved during mealtimes by joining children and staff at the table. Sit and have a conversation. Model healthy habits: serve yourself healthy portions of fruits, vegetables, and healthy grains. Talk about the choices you make and how those foods make you feel. If you are no longer hungry, stop eating. It's OK not to clean your plate! Together, you and the staff members can help children learn lifelong healthy habits.

You can also make sure staff understand your expectations and Service or program guidelines about eating and drinking in classrooms or program areas. If staff members eat with the children, they should model healthy eating and drinking habits (e.g., no soda cans or candy in the classroom). As a manager, you can model these same healthy habits as you visit program spaces.

You can also help preschool and school-age staff members reflect on the messages they send during cooking activities. Make sure you help staff get the ingredients they need for healthy cooking options. With help from trainers and coaches, review activity plans and ask staff members to branch out from the usual cookies, muffins, and cupcakes. Cooking is a valuable skill, and children can learn from making whole grain breads or granola, vegetable dishes, and healthy fruit-based desserts.

Help model healthy fitness habits in your program. Hold walking meetings: discuss issues or topics while walking around the building with a staff member. You can also set goals for staff fitness. For example, consider starting a walking, running, or biking club for staff members and/or school-age children and their families. If your school-age program offers Zumba classes or other organized fitness activities for children, encourage staff to join in--and join in yourself! It's also important to help staff remember that fitness is not seasonal--it's essential all year long. In locations with severe weather in the winter (or extremely hot summers) help staff think of indoor options to keep themselves and children fit. Dance classes, yoga, volleyball, basketball, or weightlifting clubs can be good alternatives to outdoor sports. As a manager, one of the strongest supports you can offer staff is to ensure they have the materials they need to make physical fitness (e.g., balls, a music stereo, weights, etc.) a regular part of the programing day for children and youth.

Watch this video to learn more about how to create healthy menus for your program and how to promote physical activity in your setting.

Management Practices That Support Healthy Nutrition and Physical Activity

The chart below summarizes your key responsibilities when it comes to ensuring that your Service's nutritional and physical activity standards are met.