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Table 1 Best practices from NAP SACC and algorithm for meeting best practices based on survey responses and/or EPAO data

From: Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the ‘Healthy Start/Comienzos Sanos’ cluster randomized trial

Domain Best practice Requirement to meet best practice N = Newsletter
V = Video
Water Make drinking water available for children at all times. Staff observer indicates that children have self-service access to water in the FCCH (including from filled cups that are always accessible) Water Drink Water!
Water Prompt children to drink water during each indoor and outdoor play time. Staff observer indicates that provider reminds children to drink water at least once during every outdoor play time and every active indoor play time.
Juice Limit 100% fruit juice to no more than two, 4-6 oz. servings per week. Staff observer indicates that the total amount of 100% fruit juice served to a single child across the 2 days of observation does not exceed 12 oz; AND the amount of 100% fruit juice that the provider reports serving the children does not exceed 12 oz per week. Juice Juice
Juice Only serve 100% fruit juice that has no sugar added. Staff observer indicates that provider does not serve juice that is less than 100% fruit juice at any meal or snack time.
Milk Children ages 2 and older should only be served skim or 1% milk. Staff observer does NOT indicate that provider serves 2% or whole milk at any meal or snack time. Milk Milk
Milk Never serve flavored milk (milk with chocolate or strawberry syrup, or with added sugar). Staff observer does NOT indicate that provider serves flavored milk at any meal or snack time.
Sugary Drinks Never serve sugary drinks. Staff observer does NOT indicate that provider serves sugary drinks (e.g. fruit flavored drink, lemonade, sports drink, soda, sweetened tea, or homemade drink with added sugar) at any meal or snack time. Sugary Drinks Sugary Drinks
Vegetables Offer children vegetables two or more times a day. Staff observer indicates that provider offers vegetables at more than one meal or snack time on each observation day. Vegetables Vegetables! How you can serve more
Vegetables Don’t prepare vegetables with added fat. Small amounts of vegetable oil is the healthiest option. Staff observer does NOT indicate that vegetables are fried or prepared with lard, butter, margarine, or cheese sauce at any meal or snack time.
Fruit Offer children fruit two or more times a day. Staff observer indicates that provider offers fruit at more than one meal or snack time on each observation day. Fruit Fruit!
Fruit Never serve fruit in syrup or with added sugar. Staff observer does NOT indicate that fruit served at any meal or snack time was canned in syrup or sweetened with added sugar.
Whole Grains Offer children high fiber, whole grain foods two or more times a day. Staff observer indicates that FCCP offered a whole grain food (including whole grain breads, pastas, cereals, crackers, and granola bars) two or more times daily on both observation days (at any combination of morning meal, morning snack, lunch, and afternoon snack) Whole Grains Whole Grains
Snack Foods Limit offering children sugary, salty, or fatty foods to less than 1 time per week or never. Staff observer indicates that the provider does NOT serve crackers, pretzels, chips, dessert items, sugary cereal, granola bars, pastries, or Poptarts at any meal or snack time; AND the provider reports serving such items less than once per week. Healthy Snacking What are Healthy Snacks for Children
More Healthy Snack Ideas
High-fat meats Limit serving high-fat meats to less than 1 time per week or never. Staff observer indicates that the provider does NOT serve bacon, ham, hot dogs, bologna, salami, regular sausage, or other high-fat meat at any meal or snack time; AND the provider reports serving such items less than once per week. High Fat Meat Healthy Meat Options
Fried and Pre-Fried Foods Limit offering children fried or pre-fried foods to less than 1 time per week or never. Staff observer indicates that the provider does NOT serve fried meat, fried potatoes, or other fried foods at any meal or snack time; AND the provider reports serving such items less than once per week. Fried Foods How to Avoid Fried Foods
Mealtime Environment Always sit at the table and eat with the children. Staff observer indicates that FCCP sat with the children “a lot” at every observed meal on both days (morning meal, morning snack, lunch, and afternoon snack) Mealtime Environment Mealtime Environment
Mealtime Environment Teach children how to serve themselves or, in the case of older children, allow them to serve themselves. Staff observer selected EPAO option that “children served themselves most or all foods, and decided what size portions to take” at every observed meal and snack time. This best practice could still be met if a staff observer indicated for a given meal that “food was brought from home” or that “children served themselves most or all foods, and decided what size portions to take. Provider served fruits and/or vegetables”.
Self-Regulation Always ask children if they are full before removing an unfinished meal or snack plate. Staff observer indicates that provider never removes an unfinished plate without asking a child if they are full at any observed meal and snack time. Self-Regulation Hungry or Full: Paying attention to Our Bodies
Self-Regulation Always ask children if they are hungry before serving more food. Staff observer indicates that provider serves seconds only after a child requests them and after asking if child is still hungry “a lot” at every observed meal and snack time where seconds are served.
Self-Regulation Never pressure children to eat more food than they want. Staff observer indicates that provider never required a child who ate less than half of a meal or snack to sit at the table until they cleaned their plate at any observed meal or snack time.
Self-Regulation Do not use food or sweets as a reward or reward children for finishing their plate. Staff observer indicates that provider never uses food or sweets as a reward or rewards children for finishing their plate at any meal or snack time.
Role Modeling Enthusiastically role model eating and drinking healthy foods Staff observer indicates that provider enthusiastically role models eating and drinking healthy foods a little, sometimes, or a lot at 75% or more of observed meal and snack times. Role Modeling Be a Role Model
Role Modeling Always participate in indoor physical activity with the children. Staff observer indicates that provider plays actively with children an average of “a lot” during morning and afternoon observed indoor playtime across both observation days.
Role Modeling Always participate in outdoor physical activity with the children. Staff observer indicates that provider a) joins children in a game, b) plays with children, and c) joins a chasing/running game with children an average of “a lot” during morning and afternoon observed outside time across both observation days.
Role Modeling Do not model sedentary behavior. Staff observer indicates that provider does not watch any TV or use other screen time during observation period.
Encouragement Always prompt and praise children for trying new or less preferred foods. Staff observer indicates that provider prompts and praises children for trying new, less preferred, or healthy foods a little, sometimes, or a lot at 50% or more of observed meal and snack times. Encouragement Encouragement
Encouragement Always prompt and praise children for being physically active. Staff observer indicates that provider a) praises a child for being physically active at least “a little” and b) prompts children to increase their physical activity at least “a little” each observed morning and afternoon.
Nutrition Education Lead a planned nutrition education lesson one or more times per week. Provider reports leading a planned nutrition education lesson at least once per week. Nutrition Education Activities Nutrition Education: Teach Explore Eat!
Nutrition Education Talk with children informally about nutrition and healthy eating as often as possible. Staff observer indicates that provider talks with children informally about nutrition a little, sometimes, or a lot at every observed meal and snack time.
Parent Communication Provide families with information on child nutrition to help them continue healthy practices at home. Provider reports sharing information with families about child nutrition topics, including 1) types of foods and drinks children should eat, 2) recommended serving sizes, 3) the importance of serving a variety of foods, and 4) a healthy mealtime environment. Parent Communication Parent Communication
Parent Communication Provide families with information on children’s physical activity to help them continue healthy practices at home. Provider reports sharing information with families about child physical activity topics, including 1) the amount of time children should spend being physically active, 2) encouraging children to be physically active, 3) limiting long periods of seated time, 4) the amount of time children should spend playing outdoors, and 5) using the outdoors to encourage children’s active play.
Parent Communication Provide families with information on children’s screen time to help them continue healthy practices at home. Provider reports sharing information with families about child screen time topics, including 1) the amount of screen time children should have, 2) why it’s important to limit screen time, and 3) activities children can do instead of screen time.
Physical Activity Provide children with 90 min or more of indoor or outdoor play PA each day. Staff observer records 90 min or more each day during which time children engage in activities at least as intense as walking or marching. Physical Activity Physical Activity for All Seasons
Physical Activity Provide children with 60 min or more of outdoor play each day. Staff observer records 60 min or more each day during which time children spend outdoors.
Adult Led Physical Activity Provide children with 45 min or more of adult-led physical activity each day. Staff observer records 45 min or more each day during which time an adult leads children in physical activity. Adult Led Physical Activity Adult-Led Play
Sedentary Time Limit the time children are asked to remain seated on any occasion to less than 15 min at a time. Staff observer does not indicate any occasion when children are required to sit for more than 15 min at a time during the 2 days of observation. Sedentary Time No Video
Screen Time Limit children’s screen time to less than 30 min per week. Staff observer records less than 30 min of children’s screen time across both observation days; AND the amount of children’s screen time that the provider reports allowing is less than 30 min per week. Screen Time Screen Time
TV at Meal Time TV is never on during mealtime or snack time. Staff observer indicates that children do not use the TV or other screen device during any observed meal or snack time.
Physical Activity Education Lead planned physical activity class one or more times per week. Provider reports leading a planned physical activity lesson at least once per week. Physical Activity Education Physical Activity Education: Teach Explore Move!
Physical Activity Education Talk with children informally about the importance of physical activity. Staff observer indicates that provider talks with children about the importance of physical activity at least “a little” at any time during the observation days.
Policies Establish a set of nutrition and physical activity policies in place for your child care. Share these policies with parents so they understand the practices in your child care. Staff observer indicates that provider has written policies about nutrition, physical activity, and screen time in place for their FCCH. Policies Policies for Your Childcare