Healthy Eating and Physical Activity Standards in Early Care and Education

Young girl looking at an apple
Priority Policy

Healthy Eating and Physical Activity Standards in Early Care and Education

Helping children in early care and education settings get a healthy start to life

Early childhood is a critical period for helping children develop healthy habits. Yet, 13.9% of children ages 2 to 5 have obesity. Children who are overweight or have obesity as preschoolers are 5 times more likely to be overweight or have obesity as adults. With millions of children across the country spending time in early care and education (ECE) settings like Head Start, Early Head Start, and pre-kindergarten programs, these settings are optimal environments for encouraging healthy eating and physical activity. These programs are primarily regulated through federal and state laws – with many states having minimum standards for early care and education providers to follow.

State child-care regulations and quality requirements are beginning to address healthy eating, screen time, and physical activity in ECE settings. The evidence is strongest for city and state policies and regulations related to beverages, screen time, and physical activity, which appear to have the greatest potential to improve young children’s health behaviors, decrease BMI, and provide healthcare cost savings.

Through years of research, organizations such as YMCA of the USA, Nemours’ Healthy Kids Healthy Future, ChangeLab Solutions and others have developed Healthy Eating Physical Activity guidelines to help early care and education providers institute standards. Effective HEPA standards are composed of role modeling, family engagement, physical activity, screen time, food, beverages, and infant feeding guidelines.


States should include healthy eating and physical activity guidelines in ratings and/or credentialing for early care and education centers.

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Licensing Laws State By State

While every state regulates early care and education settings, regulations differ state-by-state. The Public Health Law Center has developed a 50-state analysis of licensing laws for early care and education settings.

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Model Licensing Statues For States and Local Jurisdictions

States and local jurisdictions looking to include obesity prevention in their licensing often do not know where to start. ChangeLab Solutions has developed model statutes that provide guidance on physical activity, healthy eating and screen time.

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Efforts To Prevent Obesity in ECE Settings Taking Hold

Efforts to strengthen policies, systems, and environments to promote health and prevent obesity in early care and education settings have become more robust and widespread. Healthy Eating Research provides a comprehensive overview of changes that have occurred in recent years and reviews the impact that these policy, systems, and environmental interventions have had in the ECE setting on promoting a healthy diet, adequate physical activity, and reduced screen time.

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Beverage Recommendations For Young Children

Research shows that what children drink from birth through age five has a big impact on their health – both now and for years to come. The nation’s leading health organizations agree that for most kids, the recommendations can help to set children on a path for healthy growth and development.

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Fast Facts


An estimated 73% of children under age 5 participate in an early child care program.

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Each day in the U.S. about 13 million infants and young children (under age 5) spend time in an ECE setting (Head Start, Pre-K, child care centers, family child care homes).

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Twenty-nine states have quality rating systems for child care that include obesity prevention in their state standards.

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Data to Share

42 states include obesity prevention topics in online professional development courses for early care and education providers.
Allowing infants and toddlers to become familiar with healthy eating habits is key to developing healthy food preferences. Evidence shows that young children are more likely to try new foods when they observe caregivers eating them enthusiastically.
Healthy Eating Research and leading health organizations recommend that children under the age of 5 avoid drinking flavored milks and any drinks with added sugars, artificial sweeteners, or caffeine.