Early Care and Education (ECE)

Why is this setting important?

• With more than 1 in 5 U.S. children ages 2 – 5 years already overweight or obese, prevention efforts must target our youngest children. ¹, ²
• Most young children spend time in care outside of their home, making the ECE setting one of the best places to reach young children with obesity prevention efforts. The use of ECE facilities – including child care centers, day care homes, Head Start programs, preschool and pre-kindergarten programs – has become the norm in the U.S. ³
  • More than 60% of children under 6 years of age are in a non-parental care arrangement on a weekly basis.
  • More than 11 million children under age 6 spend an average of 30 hours in non-parental care, with children of working mothers spending almost 40 hours a week in such care. ⁴
• Improving the ECE environment of child care and early education facilities may directly impact what children consume and how active they are, as well as help them develop a foundation of healthy habits for life.
• ECE is identified as a priority setting for obesity prevention in the “Surgeon General’s Vision for a Healthy and Fit Nation [PDF-840KB].

What is CDC’s framework for obesity prevention in the ECE setting?

CDC’s framework for obesity prevention, in the ECE setting is known as the Spectrum of Opportunities [PDF-287KB]. The Spectrum identifies ways that states, and to some extent communities, can support child care and early education facilities to achieve recommended standards and best practices for obesity prevention. Each opportunity represents a unique avenue that states or communities have worked successfully to change the ECE environment to improve nutrition, breastfeeding support, physical activity, and reduce screen time in ECE facilities.

What are the standards and best practices for obesity prevention targeting the ECE setting?

• Comprehensive national standards for this setting, including standards for obesity prevention addressing nutrition, infant feeding, physical activity and screen time, are contained in Caring for Our Children: National Health and Safety Performance Standards (CFOC), 3rd ed. [PDF-4.71MB]
• The Institute of Medicine has released two relevant reports on standards and best practices
  • Early Childhood Obesity Prevention Policies
  • Child and Adult Care Food Program: Aligning Dietary Guidance for All

How does CDC help states and communities address obesity prevention in the ECE setting?

CDC provides funding, training, and technical assistance to a variety of state and community agencies and other organizations to carryout obesity prevention efforts targeting this setting. Key activities include:

• State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (1305)
  This 5-year cooperative agreement funds all 50 states and the District of Columbia for chronic disease prevention efforts. All grant recipients are required to promote physical activity in the ECE setting and many are also implementing nutrition standards in this setting.
• Early Childcare and Education Obesity Prevention Program
  This cooperative agreement with Nemours  Children’s Health System (Nemours)  supports partnerships with state public health and ECE leaders to: 1) make state-wide improvements in their early care and education system by  incorporating obesity prevention strategies; and 2) to support a targeted group  of ECE providers to make facility-wide improvements using a learning  collaboratives intervention. These activities help providers support  breastfeeding, healthy eating and physical activity for children in their ECE facilities. Since FY12, we have reached ECE  systems and programs in 10 states – Alabama, Arizona, California,  Florida, Indiana, Kansas, Kentucky, Missouri, New Jersey, and Virginia.
• Childhood Obesity Research Demonstration Project (CORD)
  This 4-year cooperative agreement research demonstration project provides funding to 3 grantees to determine better ways to improve children’s nutrition and physical activity behaviors in the places where they live, learn, and play through a multilevel, multi-sector approach. CORD targets children aged 2–12 years covered by the Children’s Health Insurance Program. CORD project grantees are working with 60 ECEs located in Texas, California, and Massachusetts to provide training, technical assistance, and support to CORD intervention ECE centers.
• Early Care and Education Research and Evaluation Working Group [PDF-278KB]
  The Early Care and Education working group focuses on improving the health of young children through improved research and practice in out-of-home care settings. The working group is a collaborative effort of the Robert Wood Johnson Foundation’s Healthy Eating Research (HER) and Active Living Research (ALR) programs and the CDC’s Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) and Physical Activity Policy Research Network (PAPRN).
• Monthly Obesity Prevention in ECE Networking Call and News blast: This national networking group brings together early care and education professionals from a variety of settings (health departments, universities, non-profits, etc.) to share expertise and resources around improved nutrition, physical activity, and obesity prevention in the ECE setting. To join this networking group and to receive monthly ECE news blasts, please email eceobesity@cdc.gov. Information on accessing archived recordings of calls is available here.

How does CDC support national obesity prevention initiatives targeting the ECE setting?

• CDC co-leads the Healthy Kids, Healthy Future National Steering Committee: a public-private partnership dedicated to advancing research, policies, and practices that promote obesity prevention in the ECE setting.
• CDC collaborates with the National Farm to School Network Farm to Preschool Subcommittee to promote best practices, research and evaluation in farm to preschool programs. Farm to Preschool program activities include purchasing local food for snacks or meals, garden-based education, cooking demonstrations, classroom visits from farmers and more. These activities help to shape early taste preferences and create healthy eating habits to last a lifetime. Resources are available at the Farm to Preschool Website.

Key Resources and Publications

In this area, you will find key resources and publications that may help you and your organization make positive changes to early care and education.

• NEW! Infographic on CDC’s efforts in the ECE setting [PDF-1.64MB]
• Early Care and Education State Indicator Report 2016 [PDF-6.83MB]
  This report provides information about state efforts to address childhood obesity in the ECE setting.
• Addressing Childhood Obesity in the Early Care and Education Setting
  This Web site presents a roadmap—Spectrum of Opportunities—for states and communities to create healthier environments for young children in the ECE setting to prevent obesity. The information and tools provided are designed to inspire and equip states and ECEs to take action to improve nutrition, breastfeeding, physical activity, and screen time practices that can help set our youngest Americans off on a path to healthy living.
• Quick Start Action Guide for Obesity Prevention in ECE [PDF-783KB]
  This guide provides “how to” guidance on bringing together key state-level stakeholders to build consensus on identifying and prioritizing policy and environmental approaches for obesity prevention in the ECE setting.
• Spectrum of Opportunities for Obesity Prevention in the Early Care and Education Setting (ECE) CDC Technical Assistance Briefing Document [PDF-286KB] This document outlines a ‘Spectrum of Opportunities’ by which states and communities can support ECE facilities in their jurisdictions to achieve recommended standards and best practices for obesity prevention.
• Promoting Healthy Eating, Physical Activity, Screen Time Reduction and Breastfeeding Support in the Early Care and Education Setting [PDF-1.54MB]
• Obesity Prevention in the Early Care and Education Setting: Successful Initiatives across a Spectrum of Opportunities Weight of the Nation 2012 Conference Proceedings [PDF-286KB]
  This paper provides background information on why ECE is an important component of any jurisdiction’s obesity prevention efforts, references for the primary national reports offering standards and best practice recommendations, an introduction to the Spectrum of Opportunities, and brief summaries of the Weight of the Nation ECE track presentations.
• National Review of State Licensing Regulations Alignment with National Guidelines for Obesity Prevention
  This is a national assessment of the child care regulations in all 50 states and the District of Columbia relative to newly revised expert consensus-defined and evidence-based best practices encompassed in Preventing Childhood Obesity in Early Care and Education Programs: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition.
• Breastfeeding and Early Care and Education: Increasing Support for Breastfeeding Families [PDF-851KB].
  This document describes best practices for supporting breastfeeding families in the ECE setting and includes relevant state and community success stories.
• Caring for Our Children National Guidelines for Obesity Prevention Standards in ECE [PDF-4.71MB]
  The second edition of Preventing Childhood Obesity (PCO) is a compilation of the final comprehensive set of national standards published in Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs, 3rd edition. The standards describe evidence-based best practices in nutrition, physical activity, and screen time for early care and education programs.
• CDC’s Weight of the Nation Obesity Prevention in ECE Policy Review [PDF-4.96KB]
  This report documents how states are using policy to help early care and education providers prevent obesity.
• Stories from the Field: Michigan [PDF-440KB]
  This report highlights Michigan’s work applying nutrition policies in the early care and education setting.
• Addressing Obesity in the Child Care Setting Program Highlights: New York [PDF-110KB]
  This report highlights New York’s work addressing obesity in the early care and education setting.
• Obesity State Program Highlights [PDF-110KB]
  This report highlights several states’ work addressing obesity in the early care and education setting.
• Vital Signs Progress on Childhood Obesity
  This report released in August 2013 documents a decline in childhood obesity among low-income preschoolers.
• Increasing Access to Drinking Water and Other Healthier Beverages in Early Care and Education Settings[PDF – 3.76MB]
  This document describes the importance of Increasing access to drinking water and other healthier beverages and how to implement standards for drinking water and healthier beverages in your in early care and education facility.