Educating early childhood teachers about nutrition: a collaborative venture.

Nourishing the young child can be a challenge. This stage of life is critical to the development of positive attitudes toward maintaining a healthful diet and learning to make reasonable food choices. Educators of young children are often the gatekeepers of child nutrition. This article reports on the current nutrient needs of young children, reviews changes to children's eating patterns, and describes a collaborative nutrition project between early childhood educators in Head Start programs and university nutrition students. Seventy-two Head Start staff attended the programs; the outcomes indicated that a majority of the participants found the presentations new and interesting, and they indicated they would incorporate the nutrition information into their own classrooms. The nutrition students praised the collaboration as being a great experience during which they also were able to enhance their public speaking skills and gain valuable experience in engaging an audience and holding their attention.

THE NUTRIENT NEEDS OF YOUNG CHILDREN

Young children must learn what to eat, when to eat, how much to eat, and how to eat it (Birch, 1998). Growth and development, while slowing considerably after infancy, remain at a rapid rate, with growth spurts being followed by periods of little to no growth. Growth spurts are accompanied by increases in appetite, just as periods of little growth are accompanied by decreased appetite and interest in food. There is no difference in nutrient requirements based on the gender of preschool children.

Although growth proceeds at a steadier, slower pace after infancy, the young child has relatively high nutrient needs, based on size. Requirements for energy, protein, and fluid continue to increase as the child gains weight and becomes more active. Needs are such that there is little room for foods of low nutrient density, meaning foods that are high in calories but low in nutrients. Table I shows the estimated energy requirements for children at varying levels of activity. After nutrient needs are met, only 165 to 170 additional calories remain for discretionary foods. That is the equivalent of half of a small order of French fries or one 12-ounce soda.

Children need protein to support their optimal growth and to cover maintenance needs. Good sources of protein include eggs, dairy products, meat, fish, poultry, or combinations of complementary vegetable proteins. Recommendations for protein vary--younger preschoolers need less protein (13 g/day for 1- to 3-year-olds) than do older preschoolers (19 g/day for 4- to 6-year-olds). The same variation is true for vitamins and minerals. Dietary intakes of calcium, potassium, magnesium, and vitamin E are believed to be low enough among children to be identified as "nutrients of concern" (U.S. Department of Health and Human Services and U.S. Department of Agriculture [USDHHS/USDA], 2005). The latest dietary recommendations for children can be found at the MyPryamid Web site (www. mypyramid.gov/downloads/MyPyramid_Food_Intake_Patterns.pdf).

Variations in activity patterns as well as in growth rate and eating habits make it difficult to determine if a child is eating enough. A steady increase in height and weight is usually indicative of satisfactory growth. Although genetics play a role in determining height and weight, general health and nutrition also are key factors. While the range of "normal" heights and weights for children is quite broad, growth charts are useful to compare a child's growth pattern with normally developing children of the same age and gender, and to detect a possible growth problem. (You can find growth charts at www.cdc.gov/growthcharts/.) Those who fall below the fifth percentile or above the ninety-fifth percentile should be evaluated by a health care practitioner.

DIETARY GUIDELINES FOR AMERICANS

The dietary recommendations for children are drawn from the U.S. Dietary Guidelines for Americans (USDHHS/USDA, 2005). The latest edition was released in January 2005, and provides direction for Americans 2 years of age and older. It addressed nine topic areas and 41 key recommendations. In general, the revised Dietary Guidelines recommend consuming a variety of nutrient-dense foods and beverages, limiting consumption of saturated and trans fats, maintaining a healthy body weight, participating in regular physical activity, and practicing safe food handling. Everyone should consume less than one teaspoon of salt per day and consume potassium-rich foods, such as fruits and vegetables. Specific recommendations for children are found in Figure 1. The full Dietary Guidelines report is available online at www. healthierus.gov/dietaryguidelines/.

Figure 1
Key Recommendations Specific to Children

Overweight children should reduce the rate of weight gain
while allowing for growth and development.

Always consult a health care practitioner before placing a
child on a weight reduction diet.

All children should engage in at least 60 minutes of physical
activity on most--preferably all--days of the week.

Children should consume whole-grain products often--at
least half the grains they eat should be whole grains.

Children 2 to 8 years should consume 2 cups daily of fat-free
or low-fat milk (or equivalent dairy products).

Keep total fat intake to 30-35 percent of calories for children 2
to 3 years old; 25-35 percent for children ages 4 and older.

Young children should not eat or drink raw milk or any
products made from unpasteurized milk; raw or partially
cooked eggs; raw or undercooked meat, poultry, or fish; or
unpasteurized juices.

U.S. Department of Health and Human Services and U.S. Department of
Agriculture. Dietary Guidelines for Americans, 2005 (6th ed.).
Washington, DC: U.S. Government Printing Office.

Research shows that most young children could improve their diets. Based on the Healthy Eating Index (HEI), a summary measure of overall diet quality, less than 20 percent of children ages 2 to 9 had diets that were described as "good" (Lino, Basiotis, Gerrior, & Carlson, 2002). Most (81 percent) had diets that were identified either as poor or having room for improvement. The HEI measures not only compliance with the Food Guide Pyramid but also the degree to which the diet conforms with specific dietary recommendations, including total fat and saturated fat consumption as a percentage of calorie intake, cholesterol and sodium intake, and degree of variety in the diet.

RECENT CHANGES IN CHILDREN'S EATING PATTERNS

The proportion of children dining with their families appears to decline with age. Eating dinner with the family is associated with a healthful diet and psychosocial well-being (Eisenberg, Olson, Neumark-Sztainer, Story, & Bearinger, 2004; Gillman et al., 2000). Children who participate in family-style dining tend to eat more fruits and vegetables and less fried food, drink less soda, take in less saturated and trans fat, and eat more fiber and micronutrients from food versus those who did not dine with their families (Gillman et al., 2000). The "family diners" also show higher intakes of such crucial nutrients as folate, calcium, iron, and vitamins [B.sub.6] and [B.sub.12.]

The consumption of food eaten away from home has increased steadily, however. Preschool children typically eat out 18 percent of the time; middle school children eat out 26 percent of the time (Nutrition Update, 2004). Fast food consumption by children has increased greatly in recent years, with over half the meals away from home eaten at fast-food restaurants. Fast-food meals contribute approximately 10 percent of children's daily calorie intake. On a per-calorie basis, meals and snacks prepared away from home tend to be higher in calories, total fat, and saturated fat than meals eaten at home and tend to be lower in dietary fiber, calcium, and iron (Guthrie, Lin, & Frazno, 2002).

Portion size is an important determinant of energy intake, and large restaurant portions may contribute to the obesity epidemic in the United States. Overweight and obesity affect all segments of the population, including preschoolers; 13.9 percent of 2- to 5-year-olds are overweight (Ogden et al., 2006). The Institute of Medicine has recommended that child obesity prevention become a national priority (Koplan, Catharyn, Liverman, & Kraak, 2004). An association between the intake of sweet drinks and overweight of preschoolers and adolescents also has been identified (Berkey, Rockett, Field, Gillman, & Colditz, 2004; Welsh et al., 2005). Those sweet drinks are not limited to Kool-Aid[R] and soda, but include fruit juice as well.

NUTRITION TRAINING/BACKGROUND/EXPERTISE OF EARLY CHILDHOOD TEACHERS

The training that professionals and paraprofessionals who work with young children in the classroom receive concerning nutrition covers a broad spectrum, from little or no background to workshops/seminar attendance to actual college courses. Everyone who works with young children needs to be updated on nutrition information.

A recent study underscores teachers' and parents' concerns about children's nutritional health (Kubik, Lytle, & Story, 2005). Over two-thirds of the teachers from that study do not believe that schools give adequate attention to nutrition; 90 percent of both parents and teachers would like to see more healthful snacks and beverages in schools.

During the spring of 2004, the authors were searching for a suitable audience on which to focus program development and presentations for our university nutrition education course. We were contacted by a local Head Start program coordinator inquiring as to the availability of university educators to provide nutrition and/or food safety training programs for Head Start staff. Discussions were held about a potential collaboration utilizing our course and nutrition education students to serve as trainers for the Head Start staff. Thus, a collaboration, the Head Start/University of Delaware Collaborative Nutrition Project, was born.

THE HEAD START/UD COLLABORATIVE NUTRITION PROJECT

All students in college nutrition and dietetics majors are required to toaster specific knowledge, skills, and competencies of presenting an educational session for a group (Commission on Accreditation for Dietetics Education, 2002). This is typically accomplished via a course in nutrition education or teaching methods. A usual assignment for such a course is to develop lesson plans and present programs. In our university course, we are continually searching for actual community groups that can serve as an audience with whom the students can practice and demonstrate the teaching skills learned in the classroom. The Head Start group was willing to serve as this audience.

The Collaboration

The county Head Start coordinator indicated that approximately 100 staff members were possibly interested in receiving inservice training on the topics of nutrition or food safety. The types of staff included teachers, teachers' assistants, cooks, cooks' assistants, and program coordinators at nine sites. Nine students were available for teaching. We determined that the students would develop and present, under instructor supervision, a 90-minute workshop on three separate dates. Three students would serve as presenters for each workshop. The workshops would include three 25-minute sessions on the topics of nutrition for young children, nutrition education resources for teachers, and food safety and sanitation. Thirty Head Start staff members were scheduled for each workshop. The participants rotated through each of the 25-minute sessions on their scheduled day of attendance.

Contributions from the Head Start program included a $125 budget for development/purchase of materials for the sessions. In addition, the Head Start staff members agreed to copy handout materials and provide program folders for the participants, as well as host the sessions at one of the Head Start sites. The university program, besides providing the student educators and faculty time, covered the cost of food for program demonstrations. The faculty contacted several local organizations that willingly donated small prizes/gifts for the participants. For example, the state Department of Agriculture donated pencils, erasers, and rulers. Super G, a local grocery retailer, sent nutrition placemats. The National Soybean Board provided soy crayons as well as funds to provide chocolate soy milk for taste testing.

Program Development

The county coordinator surveyed staff members to determine topics of interest for the workshop and registered the staff for specific dates. The programs were held at one of the centers that could provide the three necessary rooms for the presentations; these programs were offered in an after-school time slot, which also coincided with the time of the university course offering.

The specific nutrition topics presented included healthy breakfast, portion sizes, fun food activities for the classroom, preschoolers' nutritional needs, the importance of calcium, hand-washing procedures for food safety, Internet nutrition resources for the classroom, teaching food safety to children via games, the Food Guide Pyramid for children, and common concerns in feeding young children. All lessons were designed to be interactive and provided the participants with information and fun activities they could use with the children in their classrooms.

The university students also developed useful lists of nutrition education resources, many of which could be downloaded for free from the Internet (see Figure 2). Having nutrition faculty oversight of the project ensured that all references were credible.

Figure 2
Nutrition and Food Safety Online Resources

www.keepkidshealthy.com--Pediatrician's guide to child health and
safety

www.mypyramid.gov/kids--USDA nutrition games for children and lesson
plans for teachers

www.nutritionexplorations.org--National Dairy Council site for
educators

www.nal.usda.gov/fnic/pubs/bibs/edu/preschool.html--Food and Nutrition
Information Center of the National Agriculture Library lists nutrition
resources for the classroom

www.5aday.com and www.dole5aday.com--Fruit and vegetable information,
link for educators

www.ext.nodak.edu/food/kidsnutriton--North Dakota Cooperative Extension
provides links to hundreds of nutrition resources

http://navigator.tufts.edu--Tufts University rates nutrition Web sites

www.kidsnutrition.org--Baylor College of Medicine nutrition news,
updates, and tools, such as BMI calculators for children

www.healthychoices.org--Washington State Apple nutrition education
site, also offers materials in Spanish

www.ific.org/nutrition/kids/index.cfm--Variety of basic nutrition
information resources

www.latherupforgoodhealth.com--Colgate-Palmolive provides cute
downloads about proper hand-washing routines

www.fightbac.org--Partnership for Food Safety Education curricula and
games

www.kidshealth.org--Nemours Foundation KidsHealth Project--everything
from recipes to interactive games; type "nutrition" or "hand washing"
in the search box

Program Outcomes

Seventy-two Head Start staff attended the workshops. The student-developed evaluation forms indicated that the majority of participants found the presentations interesting and new (n=69; 96 percent), believed the information would be useful to their jobs (n=72; 100 percent), and were inclined to incorporate the information learned into their own classrooms (n=70; 97 percent). All participants indicated that the students were well-prepared and that they would like to have nutrition students and faculty conduct future training sessions. One enthusiastic participant added, "Let's do this more often!" The programs provided 1.5 hours toward obtaining a Child Development Associate certificate for those who were seeking that credential. Copies of the nutrition student lesson plans also were offered to those interested.

This was a wonderful experience for our students as well. In their evaluations, the students indicated that having a live audience to be the recipients of their course work was a great experience--public speaking skills were polished, ability to time presentations was refined (as there were three repetitions), and they gained confidence in making presentations. The students appreciated the participants' feedback and valued the experience gained in learning how to engage an audience and hold their attention.

CONCLUSION

All parties involved in this collaborative venture believed it to be a great success. Head Start staff members were provided with useful employee training at a very reasonable cost. The nutrition students obtained lesson plan development experience and presentation skills. Although the faculty had additional responsibilities with coordination of all the events outside the classroom, the forging of partnerships made it worthwhile.

Proper nutrition is critical for child growth and development, and it is important that good eating habits be developed at a young age if they are to be carried throughout a lifetime. Along with parents, educators of young children are gatekeepers of child nutrition. Yet the area of nutrition is one that continually changes. Therefore, keeping the staff who work with young children abreast of the latest nutrition information is important. Working with university nutrition programs is a viable way to enhance nutrition knowledge for child educators and is also a winning opportunity for faculty and students.

References

Berkey, C. S., Rockett, H. R., Field, A. E., Gillman, M. W., & Colditz, G.A. (2004). Sugar-added beverages and adolescent weight change. Obesity Research, 12(5), 778-788.

Birch, L. L. (1998). Development of food acceptance patterns in the first years of life. The Proceedings of the Nutrition Society, 57(4), 617-624.

Commission on Accreditation for Dietetics Education. (2002). CADE accreditation handbook. Chicago: American Dietetic Association.

Eisenberg, M. E., Olson, R. E., Neumark-Sztainer, D., Story, M., & Bearinger, L. H. (2004). Correlations between family meals and psychosocial well-being among adolescents. Archives of Pediatrics & Adolescent Medicine, 158(8), 792-796.

Gillman, M. W., Rifas-Shiman, S. L., Frazier, A. L., Rockett, H. R. H., Camargo, C. A., Field, A. E., Berkey, C. S., & Colditz, G. A. (2000). Family dinner and diet quality among older children and adolescents. Archives of Family Medicine, 9(3), 235-240.

Guthrie, J. F., Lin, B. H., & Frazao, E. (2002). Role of food prepared away from home in the American diet, 1977-78 versus 1994-96: Changes and consequences. Journal of Nutrition Education and Behavior, 34(3), 140-150.

Koplan, J. P., Catharyn, T., Liverman, C. T., & Kraak, V. A. (Eds.). (2004). Preventing childhood obesity: Health in the balance. Washington, DC: Institute of Medicine.

Kubik, M. Y., Lytle, L. A., & Story, M. (2005). Soft drinks, candy, and fast food: What parents and teachers think about the middle school food environment. Journal of the American Dietetic Association, 105(2), 233-239.

Lino, M., Basiotis, P. P., Gerrior, S. A., & Carlson, A. (2002). The quality of young children's diets. Family Economics and Nutrition Review, 14(1), 52-60.

Nutrition Update. An overview of child nutrition in the U.S. www.kraftnutrition.com. Fall/holiday 2004; 1-4.

Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association, 295, 1549-1555.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2005). Dietary Guidelines for Americans, 2005 (6th ed.). Washington, DC: U.S. Government Printing Office.

Welsh, J. A., Cogswell, M. E., Rogers, S., Rockett, H., Mei, Z., & Grummer-Strawn, L.M. (2005). Overweight among low-income preschool children associated with the consumption of sweet drinks: Missouri, 1999-2002. Pediatrics, 115(2), 223-229.

Nancy Cotugna and Connie Vickery are Professors, Department of Health, Nutrition, and Exercise Sciences, College of Health Sciences, University of Delaware, Newark.

Table 1
Estimated Daily Calorie Requirements
for Gender and Age Groups

                               moderately
gender/age    sedentary (a)    active (b)    active (c)

Child 2-3             1,000   1,000-1,4004   1,000-1,400
Female 4-8            1,200   1,400-1,600    1,400-1,800
Male 4-8             11,400   1,400-1,600    1,600-2,000

(a) Sedentary means only the light physical activity associated
with typical day-to-day life.

(b) Moderately active means 60 minutes of age-appropriate moderate
activity per day.

(c) Active means 60 minutes of age-appropriate vigorous activity
per day.

(d) Ranges are shown to accommodate needs of different ages
within the group. For children, more calories are needed at older
ages.

Source: U.S. Dietary Guidelines for Americans, 2005.