Early Childhood Care and Education

More than 60% of Hawaii’s young children under the age of 6 have both parents in the workforce, meaning that a majority of Hawaii’s children spend a large amount of time in care outside of their home. Thus no other setting outside of the home rivals the reach early childhood care and education (ECE) settings have for young children with respect to food and drink intake and opportunities for, and encouragement of, physical activity, screen time limitations, and the development of healthy habits.

Childhood obesity is a national epidemic that disproportionately burdens low income and ethnic minority communities. By preschool, nearly one-third of low income children are already overweight or obese, setting the stage for a myriad of adverse health conditions in adolescence and adulthood. As a Healthy Kids, Healthy Future State, the Department of Health, guided by the CDC’s Spectrum of Opportunities Framework for State-Level Obesity Prevention Efforts Targeting the Early Care and Education Settings, partners with national organizations, state agencies, county and community partners, and ECE programs and administrators to embed physical activity and nutrition best practices (including screen time and breastfeeding) into Hawaii’s ECE system and settings.

The Spectrum of Opportunities Framework

Circular diagram illustrating the framework of Early Childhood Care.The Spectrum of Opportunities Framework outlines how both standards and support for ECE providers to achieve these physical activity and nutrition standards can be embedded into a state’s ECE system. The focus is on system-level changes, as these have the potential for statewide impact by reaching either all legally-operating providers or a subset(s) of providers statewide who are specifically served by an opportunity area (e.g. all licensed providers; all providers accepting subsidy funds; all providers required to complete pre-service/professional development training).

Successful state efforts require strong partnerships among stakeholders from both the state’s early childhood and public health arenas, as well as careful consideration of factors that impact the viability of any opportunity at a given point in time. Such factors include, but are not limited to: costs (resource, personnel), stakeholder support and political will, available resources, reach, timing, and ECE provider needs. A state’s equity goals for ECE and public health should both be considered for all efforts, not just those focused on the opportunities that target providers serving low-income children (e.g. the Child and Adult Care Food Program, child care subsidy, Head Start). Not all opportunities, nor sub-options, need to be pursued successfully to achieve impact. However, it is likely that multiple opportunities pursued as part of a coordinated approach that takes advantage of their interconnectedness will be most effective.

ECE Licensing Scorecard

Graph showing the evolution of licensing regulations for child care centers in Hawaii.

The CDC’s State Licensing Scorecards offer one way for public health practitioners, ECE advocates, and parents to understand how well their state’s child care licensing regulations support science-based, healthy eating and physical activity standards.

Licensing regulations for ECE programs can encourage widespread adoption of policies and practices that support healthy eating and physical activity. This scorecard measures state support of 47 high-impact obesity prevention standards across four ECE licensing subdomains: 1) healthy infant feeding, 2) nutrition, 3) physical activity, and 4) screen time limits. It can be used to understand how Hawaii compares nationally and to other states.

View Hawaii’s 2019 scorecard.

Hawaii ECE Wellness Guidelines

Cover of a wellness guidelines manual.The need for stronger efforts to support physical activity and nutrition with young children has become increasingly urgent. Childhood obesity is now a global epidemic and almost one in three kindergartners in Hawaii are considered overweight or obese. Children with obesity are at higher risk for having other health problems such as asthma, sleep apnea, bone and joint
problems, and type 2 diabetes.

Early childhood care and education (ECE) providers play an integral role in helping children learn skills that support lifelong healthy behaviors and directly influence what they eat, how active they are, and how much screen time they consume. ECE providers also serve as resources for families who are breastfeeding their little ones, looking for ways to introduce new foods, trying to be more active, and building a foundation for their child’s success in life.

The Wellness Guidelines provide opportunities to incorporate nutrition and physical activity into daily routines and learning experiences. Each wellness guideline summarizes the overall strategy to enhance health and includes a detailed list of best practices. In addition to addressing concerns around obesity, the purpose of the Wellness Guidelines is to promote quality care environments and interactions between ECE providers, children, and families. We hope that ECE providers and administrators will find these materials useful when developing their own plans and policies to support the health and wellness of young children within their program(s).

The foundation for the Wellness Guidelines is Caring for Our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs. The Wellness Guidelines has also been thoroughly vetted with local and national content experts. Additional resources were cross-walked and referenced, including but not limited to: Head Start Program Performance Standards, Child and Adult Care Food Program, Hawaii Administrative Rules, National Association for the Education of Young Children Accreditation Standards, and Nemours Child Care Wellness Policy Workbook.

View the Hawaii ECE Wellness Guidelines here.

Farm to ECE

Illustrative diagram with interconnected circles showing the core elements of Farm to Early CareFarm to Early Care and Education (farm to ECE) is a policy, systems, and environment (PSE) change intervention designed to increase access to healthy, local foods in ECE settings through local food purchasing and gardening; increase the quality of the ECE setting through food, nutrition, and agriculture
related experiential education; increase children’s acceptance and preference for healthy foods; increase children and family knowledge about healthy foods and local food systems; and positively influence child, family, and provider health behaviors.

Farm to ECE involves implementing one or more of three key elements: 1) procurement of local food, 2) education with activities related to agriculture and foods, and 3) contact with growing food, such as through community or on-site/pre-school gardens and/or local farm visits. As farm to ECE is not a “one size fits all” strategy, the core elements adapt readily to different settings, geographic locations, enrollment numbers, and diverse ages and abilities of children. Farm to ECE aims to advance racial and social equity by increasing access to healthy, local foods and high quality education opportunities for all children.

View the Hawaii Farm to ECE Coalition website here.