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Healthy lifestyle attitudes begin early. You can help school-age children develop lifelong healthy habits. Understanding what to eat and how much to eat are important skills for children and youth to learn and develop. At the same time, understanding the importance of physical activity and how to achieve it is equally significant for children. Establishing and maintaining healthy lifestyle attitudes ultimately affects children's learning and reinforces the significance of the mind-body connection.

Childhood obesity is an issue that is becoming more prevalent than ever in today’s society. The number of children who are considered obese has nearly tripled since 1980. Data from 2015-2016 show the number of children who were considered obese was nearly 20 percent—or a staggering 1 in 5 children and youth aged 6 to 19 years old. The root causes of the sharp increase in obesity rates are complex and include a variety of factors. However, when we compare this number to the mere 7 percent recorded in 1980 (CDC), it is clear that unhealthy decisions and lifestyles are serious problems. 

Choosing What to Eat

The U.S. government has developed a tool, known as MyPlate, to guide everyone toward healthier food choices. You can find more information at www.choosemyplate.gov. You can find information about helping children and youth make healthy choices at http://www.choosemyplate.gov/kids.

All of us need a variety of foods each day. A healthy diet includes a mix of grains, fruits, vegetables, dairy, and protein. The MyPlate guide helps you visualize the relative amounts of food you--and children--need each day. Half of your plate should be covered with fruits and vegetables. The other half is split between grains and protein. Filling the plate with this balance of food will help children develop healthy habits.

Watch an introductory video about the MyPlate initiative on the White House's YouTube channel: http://www.youtube.com/watch?v=SEFmSk08LIE

Choosing How Much to Eat

In addition to thinking about what types of food to eat, it's also important to think about how much to eat. With obesity on the rise, portion control is an essential skill to teach children and youth. Each person has specific dietary needs, and we need a certain balance of calories each day to stay healthy. Depending on their level of physical activity children need approximately 1,200 to 1,600 calories per day, split between the five food groups on MyPlate. The example below from the MyPlan guidelines (see https://www.choosemyplate.gov/MyPlatePlan) shows a daily food plan for an eight-year-old child who has at least 60 minutes of daily activity. This example shows how much of each kind of food this child needs. You can find other examples online.

This food plan provides suggestions for a full day's supply. School-age programs can also look to the U.S. Department of Agriculture's (USDA) Child and Adult Care Food Program for nutritional information related to each meal. You can find the recommended daily servings of each food group for breakfast, snack, and lunch in the Child Care Meal Pattern resource located below in the Learn Activities section.

Tips to Encourage Portion Control

Encouraging portion control in school-age programs can be challenging. In open-snack environments, children make choices; they collect their own snack and eat when they are hungry - snack is an option available for them, along with other activities. There are bound to be times during meals or snacks when children take too much or too little, spill, or refuse a particular food. This is part of the process towards healthy eating. You can help the process along by responding patiently. To prevent many of these problems:

• Use small, child-sized pitchers and serving dishes. These can be especially helpful for the younger school-age children in your program.
• Use child-size plates, bowls, and cups; this will help children limit themselves to healthy portions.
• Remember that children's appetites and tastes change over time; growth spurts happen throughout the school-age years.
• Encourage children to put a small serving of each available food on their plates or napkins, but do not require children to eat a certain food or a certain amount of food.
• Model adventurous eating; try each food yourself even if you know you don't like it.
• For children who need strict portion control for health reasons, teach them how much of each item to take and monitor their eating.
• In an open-snack environment, you can also provide a picture and/or words about what one serving of today's snack looks like (e.g., one apple, 1 large gram cracker square, and 1 cup of milk), so children know the appropriate amount to take. You can check back in with those who may need more.
• Allow second helpings of nutritious foods and make sure water is always available.

Diverse Eating Habits and Beliefs

Some individuals, cultures, and religion follow eating habits that differ from the USDA recommendations. It is important to find out if any children in your care cannot follow the USDA guidelines. Families should notify program staff of any dietary restrictions and note any substitutions or accommodations that need to be made. Staff must ensure that dietary restrictions are posted in food preparation areas and in areas where children eat. Staff should monitor dietary restrictions daily. When working with school-age children with dietary restrictions because of their religion, it is best to get written instructions from families detailing what they can or cannot eat or drink.

Some families follow vegetarian or vegan diets, avoiding eating animals (meat) or animal products (milk, cheese, etc.). They may request that their children be served vegetarian or vegan food. Again, it is best to check with the family and obtain written instructions as to what and what not to allow their children to eat while in your care.

It may be challenging at times to provide children with a balanced and nutritional diet when dietary restrictions rule out many of the foods usually served in your program. Work with families to come up with options to best fit their needs.

Eating Disorders

The increased focus on childhood obesity should not lead us to overlook children who may be suffering from an eating disorder. According to the U.S Census Bureau (2000), nearly 1 million U.S. youths are using extreme and unhealthy behaviors in attempts to control their weight. As a school-age staff member, it is your job to watch for any signs that a child in your care may be using unsafe methods to control his or her weight. You should do your best to promote self-esteem and positive body image for all children.

Below are some signs of possible eating disorders (PBS, 2012). The school-age child:

• Has lost a great deal of weight in a relatively short period of time
• Wears big or baggy clothes, or dresses in layers to hide his or her body
• Obsesses over weight and complains of being fat (even if the school-ager is of average weight or thin)
• Obsesses over the calorie and fat content of foods
• Exercises obsessively
• Starves himself or herself, or limits food
• Eats a lot of food at once, then makes himself or herself vomit
• Often makes trips to the bathroom right after meals (sometimes you will hear water running; this hides the sound of vomiting)
• Uses or hides the use of diet pills, laxatives, ipecac syrup, or enemas
• Avoids eating with or near others

These are the most common symptoms seen in older school-age children with eating disorders. However, it is important to remember not to jump to conclusions if you see any of these symptoms. If you observe behaviors that seem alarming or cause for concern, bring them to the attention of your administrator.

What Does a Program That Promotes Healthy Eating Look Like?

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Healthy eating should be a requirement of your program and menus should be clearly posted. Snacks, meals and beverages should all be planned to fit within the federal recommendations.

Watch this video to learn more about healthy eating in school age programs. Notice that some of the programs engage in family style dining. Family style dining is a great way to model healthy eating habits with school-age children. It involves sitting at the same table with school-age children, in groups, with the children serving themselves and eating together with adults. People pass food to one another from serving dishes. Along with healthy eating, it can promote social skills as children ask one another for food, use “please” and “thank you,” and language development, as children and adults share pleasant conversation.

Physical Activity

According to the Centers for Disease Control and Prevention (CDC), children and adolescents should have 60 minutes or more of physical activity each day. Children's weekly activity should include a combination of aerobic activity, muscle- and bone-strengthening, and stretching. In school-age programs, the National After-School Association suggests that school-age children be offered the choice to engage in at least 30 minutes of active play for every three-hour block in the program.

As a school-age program staff, you must help the children in your care meet these goals by planning daily physical activities. Encourage school-age children to be active so you can increase the likelihood of them leading a healthy lifestyle into their teen and adult years. Remember that the information you share with parents and guardians is valuable. When parents make an effort to improve or maintain their good health, those benefits are strongly related to their children's good health. (Murphey, Cook, Beckwith, & Belford, 2018).

Unfortunately, in 2011, only 18 percent of teen girls and 38 percent of teen boys were physically active for 60 minutes each day (CDC, 2011). Teaching children the importance of physical activity by modeling good behaviors and creating a fun and safe environment will only help those numbers increase in coming years. In the Physical Development course, you will learn more about physical fitness, ways to engage and motivate school-age children, how to encourage motor development, and how to incorporate physical activities into your daily plans. Examples of appropriate physical activities for school-age children include:

Watch this video of ways school-age programs promote children's physical health.

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Encourage Physical Activity

You can ensure children stay healthy outdoors when you:

• Make sure each child is dressed for the weather. Encourage families to send children in layers that can be easily removed if needed.
• Have extra clean mittens, jackets, and hats available if a child does not have appropriate gear.
• Make sure all the clothing a child wears is dry.
• Offer shaded and sheltered areas outdoors.
• Use sun protection on sunny days. Make sure children wear protective clothing and sunscreen with SPF 15 or greater.
• Make sure water is available.

The best way to encourage physical activity in children is to be physically active yourself. At recess, sitting down on the playground or at a picnic table outside sets a poor example for the children (and it limits your ability to supervise effectively). Instead of sitting or standing still while children play, take an active role. Your first priority is to ensure safety and adequate supervision, but when you can do so safely, join in. Here are some ideas:

• Suggest a game of kickball, create an obstacle course, or take a walk around the playground or outdoor space.
• Bring music outside and dance.
• Offer toys like jump ropes, balance beams, and balls. The wide span of children's ages in most school-age programs means you'll want to offer a variety of balls, bats, hoops, rackets, etc. for different developmental levels.
• Make sure you are dressed for the occasion (dress in layers); wear sensible shoes and clothing.
• Encourage children's activities by recognizing their efforts. Try noticing and commenting positively when children run, throw, jump, dance, or participate in other vigorous physical activities, for example, ‘that was a challenge to catch!’ If you need a refresher on the difference between praise vs. encouragement, see the Michigan State University Extension website at http://msue.anr.msu.edu/news/praise_vs_encouragement.

Be a Model and Encourage Healthy Eating

Children learn the most from what they see. Help them to make healthy choices by doing so yourself. You can do your part by modeling healthy eating habits.

• Join school-age children during meals and snacks. Eat with the children and eat the same food that is served to them.
• Make sure the size of your portions are appropriate and remember your fruits and veggies!
• Do not consume any outside foods or drinks while participating in the program.

Helping school-age children create healthy eating habits can be a fun and interactive process that goes beyond snack and meal times. Here are a few ideas to encourage healthy eating habits in school-age children:

Cooking Clubs

Teach basic cooking skills, such as following recipes, measuring, mixing, whisking, etc. Give children the opportunity to work together to create healthy meals. Younger school-age children might enjoy learning some "No-Bake" or microwave recipes that do not require an oven or stove top. Older school-age children who are allowed to use an oven or stove top should also be reminded of kitchen safety rules.

Eating Around the World

Use cooking to learn about other cultures by making multicultural-inspired meals. Share information about a specific culture or country and then ask the school-age children to work together to create a traditional meal that is reflective of the culture. This is a fun way to work on cooking skills, try new foods, and experience various cultures.

Portion Facts

In healthy eating, portion control is huge. Teach school-age children about proper portion control by sharing information on serving sizes and appropriate portions. Use the MyPlate system as a guide and create actual size maps or place mats to help determine how much food is the right amount.

Menu Planning

When possible, allow school-age children to help plan their menu. Work together to brainstorm healthy snack and meal options for your program. You can even encourage children to develop their own healthy recipes.

Check out some of these recipes and resources on the Kids in the Kitchen topic on the USDA website: https://www.nutrition.gov/topics/nutrition-age/children/kids-kitchen. You can also find a number of kid-friendly recipes at the Academy of Nutrition and Dietetics website https://healthychildcare.unc.edu/ (select the "recipes" tab). As you select recipes to make with the children, remember to consider any food allergies. You can read more on food allergies in Lesson Seven in this course. Lesson Seven of the Focused Topics course, Essentials in Child Care Food Service also includes information about this topic.

Special Programs

When possible, plan special programs for school-age children to help reinforce their healthy eating habits. Invite local physicians, nutritionists, or chefs to visit your program to discuss the importance of healthy eating. Another idea is to work with athletes from local high school, college, university or even professional teams to discuss how healthy eating is important for their performance.