Childcare Center-Based Programs
Childcare centers, such as daycares and preschools, can provide a safe and supportive environment for young
children to grow and learn about positive health behaviors. Childcare centers can implement early childhood education programs that include a
focus on children’s health and family well-being. Early childhood education programs incorporate health
promotion efforts through instruction and health-related screenings and services. The curriculum-based structure
of education used widely in the U.S., including in early childhood, provides existing infrastructure to carry
out health-related lesson plans or health-promoting activities. Curricula can address:
- Physical activity
- Mental wellness and resilience
- Oral health
- Positive habit development
- Healthy living behaviors
Head Start, a federally-funded early childhood school preparedness
program for children under five from low-income families, is a critical component of child care in rural
communities. Head Start is present in nearly 86% of rural
counties across the country. However, rural areas continue to experience a lack
of childcare options. Fifty-nine percent of rural communities are considered to be childcare
deserts, meaning there is an insufficient supply of licensed childcare providers in the area. Factors
that impact the availability of center-based child care in rural areas include:
Demand for childcare services may be insufficient, or unreliable over time
Costs of opening and operating a childcare center, including staffing, training, infrastructure, and
Additional expenses such as transportation
Providers may not be ready or willing to operate center-based care in rural areas given the unique
Examples of Childcare Center-Based Models
Color Me Healthy is a preschool program for
children ages four and five that uses a highly visual and interactive curriculum to teach children about healthy
eating and physical activity. The curriculum includes 12 circle time lessons, picture cards, posters, seven
original songs, and parent newsletters. The program is highly adaptable to each individual childcare center,
allowing for flexibility of implementation. Many states have implemented the curriculum using the
train-the-trainer model with childcare providers receiving in-depth training on how to use the curriculum. The
English-language kit and the Spanish-language supplement are both available for a fee. Color Me Healthy reaches
all 50 U.S. states, Canada, Mexico, the Virgin Islands, and Israel.
Go NAPSACC is an evidence-based program designed to assist
childcare providers to improve children's health using program, policy, and environmental changes. Childcare
providers learn how to assess, plan, and take action to implement changes related to topics like child
nutrition, breastfeeding, child physical activity, outdoor play, screen time, and oral health. The program
currently operates in 19 states, providing technical assistance in addition to access to online tools.
seeks to help children recover from
trauma and improve their well-being by delivering clinician-led group interventions in an elementary school
setting. A close adaptation of the Cognitive Behavioral Intervention for Trauma in Schools for middle- and
high-school students, the elementary group activities include coping skills, feelings identification, relaxation
exercises, positive activities, social support, and problem solving. Clinicians also hold sessions with parents
to review their child's progress and with individual students to address their specific traumas.
Schools Healthy Communities is an initiative through the Missouri Foundation of Health that
helps school districts become hubs to create healthy communities. From 2013 to 2015, the initiative provided
outreach to nearly 30,000 students. School wellness committees address school food options, physical
activity, health education, and family engagement. School districts create partnerships with community
organizations, including early childcare centers, to develop action plans and align efforts to address barriers
to healthy eating and active living for children. In 2020, more than 30 childcare centers participated in the
The Coordinated Approach to Child Health (CATCH) is a
health program that focuses on the education of children at school and at home. The CATCH Early Childhood
program is designed to encourage physical activity,
introduce classroom-based gardening and nutrition,
and encourage healthy eating in children ages 3-5. The program includes games and activities, flexible lesson
plans, music to sing and dance along to, curriculum connectors to connect the lessons into other learning areas,
and more. The Sun Safety curriculum called Ray and the
Sunbeatables®educates children, parents, and teachers about sun protection, specifically for children in
pre-K, K, and first grade. The Early
Childhood Coordination Guide is a toolkit that helps administrators, managers, directors, teachers and
teacher assistants, and parents and families implement the CATCH Early Childhood Program.
The I Am Moving, I Am Learning program
championed by the federal Office of Head Start connects physical activity and learning. This program uses a
train-the-trainer model that involves a 2.5-day interactive workshop. The educator-taught curriculum integrates
physical activity and nutrition into daily routines of early care and education programs.
Choosy Kids provides resources to promote health for
children and their families. The curricula feature the character Choosy, the Health Hero and Role Model, and
music to engage children in lessons about nutrition, physical activity, and oral health, and encourage children
to choose health-promoting behaviors. Choosy Kids also offers staff development resources, which pair current
child development content with adult learning models, to help educators more effectively implement the Choosy
Kids curricula. The Choosy Kids online store provides resources for educators and families. The Choosy Kids
program is in partnership with the I Am Moving, I Am Learning program as well.
Hip Hop to Health Jr.,
part of the SNAP-Ed Strategies and Interventions Toolkit, is a healthy
eating and exercise curriculum for children aged 3-7. The literacy-based curriculum includes two curriculum
books, parent newsletters, food group puppets, and a CD with songs and two 20-minute exercise routines.
Early/Healthy Bites are partner guides that help early care and education professionals
improve positive health behaviors in the forms of physical activity and nutrition. The Active Early program
emphasizes physical activity, and the Healthy Bites program focuses on nutrition and healthy eating.
Program Clearinghouse Examples
Considerations for Implementation
shows that physical
activity and nutrition interventions in childcare settings improve nutrition, increase
physical activity, and improve weight status. However, preschool and daycare teachers may not have the time or
resources for training on how to integrate programs that address healthy behaviors. Early
childhood teachers often experience stress related to low salaries, lack of access to healthcare, and
stressful work environments. Challenges related to time and resources are important to address when choosing to
implement a childcare center-based program. It may be helpful if a program can offer an incentive (for example,
continuing education credits for teachers), or if the program can demonstrate how it will help the school meet
local or state standards or requirements.
Funding. Many of the programs in this toolkit are free to implement, but there are also
programs that require upfront costs to train teachers, purchase the curriculum, or acquire equipment. For more
information on the costs and benefits of funding childcare health programs, see Module 4.
Child care availability. More than half of rural areas qualify as childcare deserts. Areas
considered childcare deserts often have larger Hispanic/Latino and American Indian populations. Even when child
care is available, not everyone has access to this resource.
Families may face barriers to enrolling in child care, including high costs, low wages, and transportation
challenges. Limited availability of child care means that children not enrolled would not receive the beneficial
interventions taking place in center-based programs.
Resources to Learn More
Healthy Kids, Healthy Future
Offers childhood obesity prevention resources for child care and early education providers in a variety of
settings including preschool, tribal, military, faith-based, and Early Head Start and Head Start programs.
Resources focus on nurturing healthy eating, increasing physical activity, reducing screen time, and supporting
Organization(s): Healthy Kids, Healthy Future, CDC, Nemours
Wellness in Alaska Child
Care: Best Practices
Describes the Wellness in Alaska Child Care (WIACC) project, a grant program designed to offer childcare staff
training that will encourage children to adopt positive behaviors related to healthy eating and physical
activity. Highlights several WIACC supported programs encouraging childhood wellness throughout rural and urban
Organization(s): Alaska Department of Education & Early Development, U.S. Department of Agriculture
Early Care and Education (ECE)
Discusses early childcare and education centers, and their impact on obesity prevention. Highlights the
efforts of the CDC to support national obesity prevention initiatives targeting ECE settings, and includes
resources and best practices.
Organization(s): Centers for Disease Control and Prevention
Childhood Care Obesity Prevention Recommendations: Complete List
Offers recommendations for early childcare providers supporting childhood obesity prevention. Topics
covered include early childcare nutrition, infant feeding and mealtime habits, physical activity, screen time,
and sleep routines.
Organization(s): Harvard T.H. Chan School of Public Health