Medicine & Science in Sports & Exercise:
APPLIED SCIENCES: Symposium
Physical Activity in Young Children: The Role of Child Care
WARD, DIANNE S.
Department of Nutrition and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, NC
Address for correspondence: Dianne S. Ward, Ed.D., Department of Nutrition, University of North Carolina, 1700 Martin L. King Jr. Blvd., CB#7426, Chapel Hill, NC 27599-7426; E-mail: firstname.lastname@example.org.
Submitted for publication December 2008.
Accepted for publication March 2009.
Young children's regular participation in physical activity is important not only to prevent excess weight gain and avoid chronic health problems but also to promote optimal physical, social, and psychological development. Given the large number of children enrolled in some form of out-of-home child care, this setting holds great potential to make important contributions to the welfare and health of young children, including the promotion of physical activity. The five articles included in this series were originally presented as a symposium at the 2008 American College of Sports Medicine Annual Meeting. Papers review the current evidence on levels of physical activity at child care, techniques for measuring physical activity in this setting, use of outdoor space for physical activity, the influence of child care environment and policies on children's activity, and child care-based physical activity intervention strategies.
Experts agree that physical activity is critical to the health and well-being of children (19,23), more specifically, as a means to combat the recent and dramatic rise in obesity in the United States (9), other developed nations (24), and countries undergoing nutrition transition (12). This increase in obesity has been observed in children of all ages, including the very young (16). In the United States, nationwide prevalence data indicate that the number of children age 2-5 yr who are classified as obese (body mass index ≥ 95th percentile for age and gender) increased threefold during the past 20 yr (8). More than 25% of preschool-aged children in the United States are considered overweight or obese (9), and more than 8% of 2- to 5-yr-olds are significantly obese (body mass index ≥ 97th percentile) (10). Accumulation of excess body fat creates risk for several chronic health conditions, such as diabetes, hypertension, and hyperlipidemia (5), and also results in unfortunate social and behavioral problems during these important early developmental years (14,18). Moreover, obesity seems to track from childhood to adulthood, creating even more serious health risks (3,6,15). On the basis of the seriousness of these issues, prevention-oriented strategies are needed.
Early childhood physical activity is important not only to prevent excess weight gain and avoid chronic health problems but also for other aspects of a young child's physical, social, and psychological development (21). From the earliest age, physical activity experiences allow a young child to explore and interact with the surrounding environment and, through this interaction, learn to crawl, stand, and ultimately, walk. As children proceed from toddlers to preschoolers, physical activities continue to play an important role in the development of gross and fine motor skills as well as social skills, therefore care should be taken to ensure that children have generous amounts of active experiences (7).
Nationally, 60% of mothers with preschool-aged children are in the workforce (2), which, in turn, necessitates their use of out-of-home child care. (For this series, we use the term "child care" to refer to any type of organized out-of-home care for children between the ages of 0 and 5 yr, including preschool, nursery school, day care, child care center, and family child care home.) Whether that child care is provided by a center, home, or other arrangement, out-of-home child care settings can make important contributions to the welfare and health of young children because of the many children who are enrolled and spend considerable time at such sites. Overall, 56% of 3- to 6-yr-olds are cared for in a center-based setting (2). Further, there is some indication that the amount of time children spend in care seems to be increasing (17). A 2005 report from the Department of Education noted that children aged 3-5 yr who attend center-based child care at least once per week spend an average of 22.5 h·wk−1 there (4). Moreover, recent evidence suggests that an inverse relationship may exist between time spent in child care and time spent in active play (20).
Despite the recognized value of regular physical activity to the health and development of children, experts fear children may not be receiving adequate experiences. Previous evidence of a sharp decline in physical activity in school-aged children (13) was recently validated by objectively monitored physical activity data collected for the National Health and Nutrition Examination Survey (22). Although preschool-aged children were not assessed for this component of the National Health and Nutrition Examination Survey, other studies suggest that physical activity levels are very low even among young children during their time at child care settings (1,11).
Because of the many children they enroll, child care settings offer a unique opportunity to help younger children obtain the necessary amount of physical activity and to reinforce adoption of a physically active lifestyle that could mitigate the decline in activity often seen in child-to-adolescent transition. In 2002, the National Association for Sport and Physical Education (NASPE) published recommendations for physical activity for infants, toddlers, and preschoolers (7). For preschool children, NASPE recommends at least 60 min, and up to several hours per day, of unstructured play time. In addition, their guidelines address structured physical activity, sedentary time, movement skill, environment, and the role of adult supervision. For a more complete listing of the NASPE standards, see Table 1.
Although the NASPE standards do not specifically address child care settings, physical activity provided at child care can contribute to the accumulation of recommended levels of activity, provide important time out-of-doors, develop motor skills, and provide interaction with staff that can facilitate physical activity. Research studies that address these issues, however, are limited.
At the 2008 American College of Sports Medicine Annual Meeting, a symposium titled, "Role of Child Care in the Young Child's Physical Activity," included five presentations describing several issues critical to the role child care plays in the development of physical activity in young children. In this special series, we present four review articles that address these physical activity-related topics that are relevant for the child care setting. Reilly updates the literature in this area by reviewing available studies of physical activity at preschool, nursery school, or other child care settings. Pate et al. share strategies for measuring physical activity in this age group and make recommendations for obtaining quality assessments. Integrating strategies from landscape architecture and planning, Cosco and associates describe methods for determining how outdoor spaces, or "behavior settings," afford physical activity to children in the outdoor settings provided at organized child care. The role of environment and policy in promotion of physical activity at child care is reviewed by Trost et al. Specifically, they explore the environmental and policy characteristics at child care that have been found to increase physical activity. Finally, Ward et al. critically review physical activity interventions implemented in child care and make recommendations regarding their potential to change young children's physical activity levels through programs, policies, or practices. Collectively, these five articles provide a compilation of the most up-to-date research findings available about key aspects of the physical activity development of young children at child care settings.
Funding disclosure: None.
Results presented in this article do not constitute endorsement by American College of Sports Medicine.
1. Brown WH, Pfeiffer KA, McLver KL, Dowda M, Almeida MJ, Pate RR. Assessing preschool children's physical activity: The observational system for recording physical activity in children-preschool version. Res Q Exerc Sport
2. Federal Interagency Forum on Child and Family Statistics. America's Children in Brief: Key National Indicators of Well-Being, 2006
. Washington (DC): U.S. Government Printing Office; 2006. 18 p.
3. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study. Pediatrics
. 1999;103(6 Pt 1):1175-82.
4. Iruka IU, Carver PR. Initial Results From the 2005 NEHS Early Childhood Program Participation Survey
. (NCES 2006-075). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 84p.
5. Must A, Anderson SE. Effects of obesity on morbidity in children and adolescents. Nutr Clin Care
6. Nader PR, et al. Identifying risk for obesity in early childhood. Pediatrics
7. National Association for Sport and Physical Education. Active Start: A Statement of Physical Activity Guidelines for Children Birth to Five Years
. Reston (VA): NASPE Publications; 2002. 26 p.
9. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA
10. Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, 2003-2006. JAMA
11. Pate RR, McIver K, Dowda M, Brown WH, Addy C. Directly observed physical activity levels in preschool children. J Sch Health
12. Popkin BM. The world is fat. Sci Am
13. Sallis JF. Epidemiology of physical activity and fitness in children and adolescents. Crit Rev Food Sci Nutr
14. Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA
15. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med
16. Sherry B, Mei Z, Scanlon KS, Mokdad AH, Grummer-Strawn LM. Trends in state-specific prevalence of overweight and underweight in 2- through 4-year-old children from low-income families from 1989 through 2000. Arch Pediatr Adolesc Med
17. Story M, Kaphingst KM, French S. The role of child care settings in obesity prevention. Future Child
18. Strauss RS. Childhood obesity and self-esteem. Pediatrics
19. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activity for school-age youth. J Pediatr
20. Sturm R. Childhood obesity-what we can learn from existing data on societal trends, part 1. Prev Chronic Dis
21. Timmons BW, Naylor PJ, Pfeiffer KA. Physical activity for preschool children-how much and how? Can J Public Health
. 2007;98(2 suppl):S122-34.
22. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc
23. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity
. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001. 60 p.
24. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes
PRESCHOOL; ACTIVITY LEVEL; MEASUREMENT OF ACTIVITY; OUTDOOR PLAY SPACE; ENVIRONMENT; POLICY; INTERVENTIONS
©2010The American College of Sports Medicine
What does "Remember me" mean?
By checking this box, you'll stay logged in until you logout. You'll get easier access to your articles, collections,
media, and all your other content, even if you close your browser or shut down your
To protect your most sensitive data and activities (like changing your password),
we'll ask you to re-enter your password when you access these services.
What if I'm on a computer that I share with others?
If you're using a public computer or you share this computer with others, we recommend
that you uncheck the "Remember me" box.
Highlight selected keywords in the article text.
Data is temporarily unavailable. Please try again soon.
Readers Of this Article Also Read