Association of the Quality Rating and Improvement System, Texas Rising Star, on Physical Activity and Screen Time Policies and Practices in Texas Child Care Centers

Supporting Healthy Weight in Statewide Quality Rating and Improvement Systems: A Review of 2020 Standards and Comparison to 2015 Standards

Background: Quality Rating and Improvement Systems (QRISs) are used to assess, improve, and communicate quality in early care and education (ECE) programs. One strategy for supporting healthy growth in early childhood is embedding nutrition, physical activity, infant feeding, and screen time content into state QRIS standards, using the Caring for Our Children high-impact obesity prevention standards (HIOPS) and the CDC Spectrum of Opportunities framework (CDC Spectrum). We assessed the number of obesity prevention standards in QRISs in 2020 and compared results to an analysis published in 2015. Methods: We collected state QRIS standards for ECE centers from March to April 2020. Two analysts coded documents for standards related to 47 HIOPS and 6 Spectrum areas. Results: Thirty-nine states and the District of Columbia had statewide QRISs in early 2020. Of these, 21 QRISs (53%) embedded 1 or more HIOPS, and 26 (65%) embedded 1 or more Spectrum components. On average, 6.9% of HIOPS were embedded in QRIS standards in 2020, an increase from 4.6% in 2015. Nine QRISs included more HIOPS in 2020 than in 2015. Five QRISs added 10% or more of the 47 HIOPS between 2015 and 2020. Physical activity and screen time standards continued to be most often included; infant feeding standards were least included. Conclusion: Obesity prevention components were embedded in three-quarters of state QRISs, and more were embedded in 2020 than in 2015, suggesting that QRISs can be levers for supporting healthy weight in ECE settings.

Improving child care through healthy eating and physical activity

PURPOSE OF REVIEW

Most young children in the United States spend a significant portion of their time in early care and education (ECE) settings, commonly known as child care. This review highlights recent literature to support a continued focus and increased investment in embedding nutrition and physical activity standards within ECE settings and systems as a critical strategy for child obesity prevention. Pediatricians can support the promotion of these standards by understanding their local child care settings and sharing information with families about the importance of healthy eating and physical activity in early childhood.

RECENT FINDINGS

The child care sector is fragile and complex, but quality improvement efforts have been successful in improving healthy eating and physical activity. Diverse child care providers, including family child care homes, can effectively embed nutrition and physical activity standards in their environments to promote healthy eating and active play, limit screen time, and support breastfeeding families. A small but growing body of evidence also demonstrates how these standards can be embedded in broader state systems to stimulate change across a state.

SUMMARY

The literature demonstrates progress supporting diverse child care settings to embed high-impact standards into their environments. There is a small but growing body of evidence around systems-change efforts as well. Greater attention is needed on embedding physical activity standards in facilities, especially family child care homes, and state systems.