Limiting television and other media use, encouraging infants and children in preschool and child care to be more physically active, 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, according to a new report from the National Institute of Medicine.
"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 of the Center for Childhood Obesity Research, Penn State. "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."
The report recommends steps for child care centers, preschools, pediatricians' offices, federal nutrition programs and others. The committee said these professionals can counsel and support parents in promoting healthy habits in the home as well.
According to the committee, tackling only one factor cannot solve obesity. The solution requires a multi-pronged approach that includes identifying when young children show signs of excess weight, promoting healthy eating, increasing physical activity and ensuring adequate sleep. The recommendations include identifying at risk children, fostering sufficient sleep, encouraging active play and discouraging sedentary play, and encouraging healthy eating.
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, according to the committee. Health professionals should measure infants' weights and lengths and the body mass indexes 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, the amount of sleep infants and children get has decreased, 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 need to be trained to counsel parents about age-appropriate sleep times and good sleep habits.
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 throughout the day. Engaging children in physically active play for a cumulative average of at least 15 minutes per hour, joining children in their activities and getting children outdoors to play when and where possible are potential actions child care providers could take. 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 the 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 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.
Health care providers and organizations should step up efforts to encourage breastfeeding, the report says. A way to achieve this goal is to encourage all hospitals to adopt 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 breastfeeding.
All child care facilities and preschools should be required to follow the meal patterns established by the federal Child and Adult Care Food Program, which reflect age-appropriate amounts of sugar, salt and fat. The program's 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. Government officials should take steps to boost participation in nutrition assistance programs.
The Robert Wood Johnson Foundation sponsored this study.