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Journal Issue: Childhood Obesity Volume 16 Number 1 Spring 2006

The Role of Child Care Settings in Obesity Prevention
Authors: Mary Story Karen M. Kaphingst Simone French

Regulations Governing Food, Physical Activity, and Media Use

The National Resource Center for Health and Safety in Child Care, part of the U.S. Department of Health and Human Services, Health Resources and Services Administration, maintains a website that provides links to the complete child care licensing standards for all fifty states and the District of Columbia.97 Using this website, we recently conducted an analysis of state child care licensing standards for nutrition, physical activity, and media use. We examined licensing regulations for child care centers, small family child care homes (typically caring for six or fewer children), and large family and group child care homes (usually with seven to twelve children).

We found not only that regulations vary considerably from state to state but that, within a state, regulations may vary for different types of child care settings. Typically child care centers are most heavily regulated, followed by large family and group child care homes, with small family child care homes the least heavily regulated. As noted, many states exempt small family child care homes from licensing requirements and instead rely on voluntary registration. Five states—Delaware, Georgia, Illinois, Mississippi, and Tennessee—have particularly comprehensive policies on nutrition, physical activity, and media use. In the following discussion of licensing regulations in these areas, we describe a state as having a specific regulation if the regulation is mandatory in at least one child care setting.

Nutrition
State nutrition regulations vary widely. Thirty states require the Child and Adult Care Food Program meal patterns or have similar requirements. Fifteen states specify the share of children's daily nutritional requirements to be provided per meal or based on the length of time in care, and twenty-one states specify the number of meals and snacks to be offered to children based on length of time in care. Just two states, Michigan and West Virginia, require that meals and snacks must follow the Dietary Guidelines for Americans. Mississippi regulations refer to the Dietary Guidelines, noting that they can “provide assistance in planning meals for ages two (2) and older, which will promote health and prevent disease.”98 Ten states limit foods and beverages of low nutritional value. Five states regulate vending machines. Alabama, Georgia, and Louisiana prohibit vending machines in areas used by children. Arkansas permits vending machines in school-age settings provided they are not the only source of snacks and beverages. Mississippi requires food in vending machines to meet the state's nutrition regulations for meals and snacks in child care settings.

Physical Activity
Most states specify that the daily program should promote physical development, including large and small muscle activity; have a balance of active and quiet activities, indoor and outdoor activities, and individual and group activities; include age- and developmentally appropriate activities, equipment, and supplies; and provide enough materials and equipment to avoid excessive competition and long waits. Thirty-three states and the District of Columbia require that the program provide large muscle, or gross motor, activity or development. Nine states require “vigorous” physical activity for children. No states use the term “moderate” to describe the appropriate level of activity. Just two states, Alaska and Massachusetts, specify how long children should engage in physical activity. Alaska mandates “a minimum of 20 minutes of vigorous physical activity for every three hours the facility is open between the hours of 7:00 a.m. and 7:00 p.m.” Massachusetts calls for “thirty minutes of physical activity every day.” Alaska's regulations pertain to all types of child care settings; the Massachusetts rule affects only child care homes.

Thirty-eight states and the District of Columbia require that children in child care centers and homes have time outdoors each day, health and weather permitting. Eight of these states and the District of Columbia specify how long children should be outdoors; most require at least one hour a day. The District of Columbia and Mississippi require the most daily outdoor time—two hours for a full-day program and at least thirty minutes for a part-day program.

Media Use
Twenty-two states regulate media use, including television, computer, video, video game, radio, and electronic game use. Most simply define appropriate or inappropriate content or define acceptable use of media within the program of activities (for example, media should be used with discretion and not as a substitute for planned activities). Only nine states specify time limits on screen time. Five set a maximum of two hours a day; the others allow less time.