a) Children’s typical growth related to healthy height and weight (BMI), and healthy brain, muscle, and vision development

b) Reduction in the risk of chronic diseases related to poor nutrition

1.  Resources:Iron-deficiency Anemia and Spanish version (Nemours): Article on childhood iron deficiency anemia including causes, symptoms, diagnosing, treatment and prevention. Page includes a recording of the article.

    

   Iron in Foods: Does My Child Get Enough? (USDA): Two page handout for families; discusses why you and your child need iron and lists good sources of iron.

    

   Childhood Nutrition (American Academy of Pediatrics): Web information on child nutrition importance for physical and mental development. Includes what children need at any age.

a) Serving fruit

• Suggestions for serving seasonal fruits
• Serve fresh or frozen fruit (no sugar added).
• Serve canned fruit (without added sugar, in water, or 100% fruit juice).
• Serve unsweetened dried fruit with care for choking concerns.  This kind of fruit may need to be chopped finely.
• Serve fruit by itself and as part of other foods, such as in soups and salads.

b) Serving vegetables

• Suggestions for serving seasonal vegetables
• Serve fresh, frozen, or canned low sodium vegetables.
• Serve dark green and orange vegetables.
• Serve vegetables without added salts, oils, and sauces. Do not use added salts, oils, or sauces excessively when serving vegetables.

c) Serving meat and meat alternatives

• Serve poultry: chicken and turkey.
• Serve lean meats: beef, pork, lamb.
• Serve fish: fresh, frozen, or canned.
• Serve shellfish with care for allergy concerns.
• Serve legumes, such as lentils, beans and peas, either cooked, canned or frozen (includes tofu, legume-based vegetable patties, and hummus).
• Serve nuts, seeds, and nut butters with care for allergies and choking concerns.
• Serve meats grilled, roasted, poached, or boiled, rather than fried.
• Trim away visible fat on meats.
• Serve eggs hard-boiled, deviled, or scrambled (cook eggs thoroughly to avoid salmonella). Limit processed meats such as hot dogs, (hot dogs are choking hazards, and must be prepared with guidance), chicken nuggets and fish sticks.

d) Serving whole grains

• All of a child’s grains should be whole grains.
• Serve whole-grain wheat flour products.
• Serve whole-grain brown rice, wild rice, and quinoa.
• Serve whole-grain oatmeal—old-fashioned rolled oats or steel-cut oats without added sugar.
• Serve whole-grain barley.
• Serve whole-grain cornmeal.
• Serve whole-grain cereal.
• Serve 100% whole-grain bread (stay away from white bread or wheat bread that isn’t 100% whole wheat.).
• Serve whole-grain wheat pasta or whole-grain noodles.
• Serve whole-grain tortillas and whole-corn tortillas (stay away from white flour tortillas).
• Serve whole-grain crackers.

e) Serving Healthy Beverages

• Children must have easy access to water throughout the day, including at meals and snacks, indoors and outdoors.
• It is a good practice to serve water at the table with meals and snacks, even if another beverage is served.
• Serve one-percent or non-fat cow’s milk (non-flavored) to children age 2 and older with attention to allergies and lactose intolerance.
• Serve whole milk to one-year-olds.
• Health Beverage discussion shall also reference current US Dietary Guidelines for Americans
• All milk should contain vitamins A and D (at levels specified by the Food and Drug Administration).
• Milks and juices must be pasteurized.
• Juices are not needed or recommended.  Avoid serving juices because whole fruit is more beneficial than juice and provides dietary fiber and other nutrients.  If you choose to serve fruit juice, make sure to serve an age-appropriate portion of 100% juice not more than once daily.
• Do not serve sweetened beverages (with added sugar or artificial sweetener).

f) Serving milk

• Store milk in the refrigerator below 40 degrees.
• A child who is lactose intolerant may still be able to enjoy milk-based foods.  Discuss this issue with the child’s family so they may discuss this with the child’s medical provider to learn how this can be done.
• For children who are lactose-intolerant or vegan, a parent may choose alternative milks (almond, soy, coconut) that are enriched with calcium, iron, and vitamins A and D.  Be sure to discuss these choices with a child’s parent with regard to whether a child is allergic to such alternatives for milk.

Resources:

MyPlate California For Children Ages 2-12 (California Department of Public Health): This handout, available in English and Spanish promotes children to include a variety of fruits, vegetables, whole grains, lean proteins and dairy on their plates every day and to be physically active.

Dietary Guidelines for Americans 2015-2020, Eighth Edition: The Dietary Guidelines is designed for professionals to help all individuals ages 2 years and older and their families consume a healthy, nutritionally adequate diet.

Growing Minds Farm to School Program (Appalachian Sustainable Agriculture Project): This web-based toolkit contains information about getting started with Farm to Preschool, rules and regulations, recommendations for local procurement, and monthly resources (sample recipe card and sticker, This Week in the Garden and Farm to School Goes Home resources, as well as food and farm based lesson plans).

Eat Fresh Recipes (EatFresh): San Francisco Human Services Agency provides recipes and meal plans in English, Spanish and Chinese.

Kids…Get Cookin’! Fast and Fun Recipes (Champions for Change Community, California Department of Public Health, Nutrition Education and Obesity Prevention Branch): In Spanish and English; Spanish starts on page 25. Contains healthy recipes for all types of snacks, meals, and beverages in English and Spanish. Geared towards cooking with kids.

Eat Fruits & Vegetables Every Day, Stay Healthy All The Way! (California Department of Public Health, Nutrition Education and Obesity Prevention Branch): Chinese only. Cookbook provides recipes for healthy Chinese cuisine.

Procuring Local Foods for Child Nutrition (USDA): Learn best practices about procuring local foods.

a) Promotion of breastfeeding in the child care setting. Serve all babies iron-fortified baby foods beginning at around 6 months of age in consultation with parents, not independently.

b) How to phase-in solid foods, advancing texture as appropriate and in consultation with parents, not independently.
c) How to safely feed human milk in the child care setting.
d) Creating a place for breastfeeding moms to nurse their children in your child care home or center.
e) How you can make your child care setting a supportive setting for breastfeeding moms.
f) The importance of feeding babies on cue, rather than by a schedule.
g) Breast- or bottle fed babies can be weaned to a cup.
h) Appropriate portion sizes for feeding babies.
i) Safe storage of breast milk and formula.
j) Formula preparation – the importance of adhering to instructions. (The importance of not adding ingredients to a baby’s formula.)

k) How to introduce other beverages to babies besides breast milk and formula.

1.   Resources:

   California Infant Feeding Guide (California Department of Public Health): This Guide, in English, Spanish and Chinese, promotes “normal” infant feeding, which is defined as breastfeeding for at least the first year of life and introduction of iron-rich complementary foods around six months of life.

    

   CA Breastfeeding Web Page (California Department of Public Health): This CDPH breastfeeding website shares information for families, health providers, and advocates.

    

   10 Steps to Breastfeeding Friendly Childcare Centers (Wisconsin Department of Health Services): This guide describes steps and resources to help childcare centers better support breastfeeding families.

    

   Proper Handling and Storage of Human Milk (CDC): Links to the latest information for the public, including parents and providers, about handling and storing human milk from the Centers of Disease Control and Prevention.

    

   Feeding My Baby (California WIC Program): Links to materials so parents can understand infants’ cues and meet the infant’s feeding needs, such as related to breastfeeding and starting solid foods. Includes Getting to Know Your Baby (understanding baby cues), guide to feeding your 6 to 12 month old baby, A Guide to Breastfeeding, Formula Compared to Breastmilk, When You Feed Me Formula, Feed Me! Birth to 6 Months, Let Your Baby Set the Pace, Feed Me! 6 to 12 Months, and Sample Menu for Older Babies-8 to 19 Months.

    

   Feeding My Child (California WIC Program): Includes handouts on Fast and Healthy Breakfast Ideas, Tips for Picky Eaters, Tips for Mealtimes, Healthy Choices for Kids.

    

   The Healthy Children Show: Safe Storage and Preparation of Breast Milk and Formula (American Academy of Pediatrics): Video explains how to safely store and properly prepare breast milk and formula for babies.

    

   Caring for Our Children, Guidelines for Early Care and Education Programs (National Resource Center for Health and Safety): Search for “Preparing, Feeding, and Storing Human Milk,” “Preparing, Feeding, and Storing Infant Formula,” “Techniques for Bottle Feeding,” “Feeding Infants on Cue,” “Feeding Age-Appropriate Solid Foods to Infants,” “Serving Size for Toddlers and Preschoolers,” and “Encouraging Self-Feeding by Older Infants and Toddlers.”

    

   Child and Adult Care Food Program Meal Patterns (USDA): Required changes by 2017 based on scientific recommendations from the National Academy of Medicine, the American Academy of Pediatrics and stakeholder input. Meal patterns recommend amounts of foods and fluids during breakfast, lunch, supper, and snack time.

    

   Child Care: Frequently Asked Questions (Arizona Department of Health Services): Questions and answers on providing a breastfeeding-friendly environment, even if you don’t have infants directly in your care.

a) Watch for the word, “hydrogenated” in the ingredient list.

b) Choose products made with vegetable oils that are not hydrogenated and do not contain trans fats.

c) Instead of butter, lard, margarine, and shortening, cook with oils that are not hydrogenated, such as olive oil, and coconut oil.

d) Cut back on foods with added sugar

Minimize or exclude trans fats, sugars used as sweeteners, and refined starches.

Read food labels to see how many sugar grams are in each.

1. • Stay away from products with added sugar, honey, or any ingredient ending in the letters “ose.”  That means they contain sugar.
   • If sugars are in the ingredients, make sure they are not one of the first three ingredients on the ingredient list. If they are, that means that sugar makes up most of the product.

e) Reducing Sugar

1. • The SugarScience Initiative, found at SugarScience.org, is the result of 11 researchers, mostly from UCSF, spending a year poring over thousands of published scientific articles on sugar and its health effects. The group removed articles that didn’t hold up to certain scientific standards, including industry-funded papers.

f) Serving Foods that are Low in Fat

1. • Limit use of butter, margarine, gravy, and regular cheeses on vegetables, grains, and other foods.
   • Limit serving fried foods.
   • Use of herbs and no-salt spices to flavor vegetables and other foods.

g) Serving Foods that are Low in Salt

1. • Choose low-sodium soy sauce and catsup
   • Avoid using flavor packets that come with processed foods. Use lemon juice, lemon or orange zest, fresh or dried herbs, and 100% fruit juice to add flavor to foods, without adding salt.
   • Drain and rinse canned and pre-cooked beans and vegetables.
   • Avoid packaged or canned foods as these products almost always contain added salt.
   • Limit adding salt when cooking and at the table.
   • Purchase foods labeled “low salt,” “no salt added,” “reduced sodium,” or “no sodium.”
   • Do not serve processed foods, as they contain added salt.

    

   Resources:

   The Hidden costs of Sugar (UCSF): A national initiative to educate the public about the health impacts and costs of sugar. Includes link to Sugarscience, another UCSF web page that explores the latest evidence-based research on the health effects of sugar overconsumption.

    

   Cut back on your kid’s sweet treats and Spanish Version (USDA): Ten tips to decrease added sugars in foods and beverages.

    

   Choose Foods Low in Sodium (National Institutes of Health): One page handout providing advice on how to choose and prepare foods that are lower in salt and sodium.

a) The CACFP is a federal program administered by the California Department of Education (CDE) that provides reimbursement for serving healthy meals to children and adults in care. The CACFP has resources for recipes, menu planning, food preparation, nutrition education, and farm to preschool activities.

b) The application process is different depending on whether you are a family child care provider or a child care center.

1. • Family child care providers apply directly with a day care home sponsor. To find a day care home sponsor, access the CDE Web page at http://www.cde.ca.gov/ds/sh/sn/cacfpsponsormap.asp. Select the county you live in and then contact one of the day care home sponsors listed. They will provide you with training, and help you with planning menus and filling out reimbursement forms. The average family child care provider receives approximately $6,000 per year to help offset the cost of serving nutritious meals.
   • Child care centers apply directly with the CDE. Instructions are located on the California CACFP’s How to Apply Web page at http://www.cde.ca.gov/ls/nu/cc/howtoapply.asp.

c) The California CACFP offers a child care recognition program. Preschools SHINE showcases child care programs that excel in implementing nutrition and physical activity practices that support children’s health and readiness to learn.

1.  Resources:United States Child and Adult Care Food Program (CACFP): Provides aid to child and adult care institutions and family and group day care homes for the delivery of nutritious foods. Search “CACFP Training Tools” for handouts, infographics and other resources that help trainers teach providers about the new CACFP guidelines in English and Spanish.

    

   California Child and Adult Care Food Program (CACFP): Web links to Information about meal programs offered at public and private child care centers, day care homes, adult day care centers, and homeless shelters under the CACFP.

    

   CACFP Meal Patterns (California Department of Education): Eight meal pattern videos: 1&2) The New Infant Meal Pattern in the CACFP, 3) The New Adult Meal Pattern in the CACFP, 4) Family style Meal Service in the CACFP, 5) Offer Versus Serve in the CACFP, 6) Milk Requirements in the CACFP: A Webinar for Child Care Centers, 7) Milk Requirements in the CACFP: A Webinar for Child Care Providers, and 8) Requisitos de La Leche En El Programa de Alimentación en Centros de Cuidado Infantil y de Adultos (CACFP) Seminario virtual para proveedores de cuidado infantil en casas familiares (Milk Requirements in the CACFP for Providers—Spanish)

a) Providing a variety of foods and setting patterns for eating a variety of foods builds healthy habits among children.

b) How to explain to children that healthy nutrition makes children’s bodies strong and healthy.

c) How preparing healthy foods with children can be done in the child care setting.

d) The topic may include:

1. • How children can help grow a garden in the child care setting.
   • Comment: Child care providers do not usually take children grocery shopping
   • How children can be included in visits to farmer’s markets.
   • Division of Responsibility in Feeding Children: Children’s role in their own nutrition

   Resources:

   Food and Drink to Grow On from Sesame Workshop (Sesame Street Organization): This guide for providers includes information about why children need to learn about nutrition side-by-side with ideas and worksheets for nutrition related activities.

    

   Nutrition Tips for Kids (Academy of Family Physicians): Blog about the importance of teaching children about nutrition and specific steps that parents (and providers) can take to improve children’s nutrition.

    

   Nutrition & Wellness Tips for Young Children: Provider Handbook for the Child and Adult Care Food Program (USDA): This handbook was developed by USDA’s Food and Nutrition Service and the Department of Health and Human Services (HHS) Administration for Children and Families, Centers for Disease Control and Prevention, and Health Resources and Services Administration to help CACFP child care providers create healthier environments for the children in their care. It includes a series of tip sheets.

a) The benefits of family-style meal service are: it helps children self-regulate the amount eaten, provides more opportunity for provider to talk about food, allows for more trying of new foods, allows for more modeling of positive eating, and provides for socialization and development of fine motor development.

b) Examples of how to implement family style meal service in the child care setting.

c) Ideas for implementing Family Style Meal Service in the child care setting.

d) Using child-size serving utensils facilitates family-style meal service.

e) How to measure portions into communal serving bowls according to the CACFP meal pattern, while still allowing children to serve themselves (this would require reviewing the CACFP meal pattern to assist in planning the meal portions that go into the communal serving dish or bowl.)

1.  Resources:Best Practices for Serving Foods to Groups of Children (University of Idaho): Handout describes an environment that provides the best space for serving foods to groups of children with examples of child-sized utensils, and helping children assess and prepare foods.

    

   Starting Family-Style Dining – Part 1 (EnvironmentsChild): This is the first of two videos on Starting Family-Style Dining.

    

   Starting Family-Style Dining – Part 2 (EnvironmentsChild): This is the second of two videos on Starting Family-Style Dining.

a) Include sample policies and information on how to develop such policies.

b) How written nutrition policies can help child care staff provide healthier meals and snacks to the children in their care.

c) Writing policies can help child care providers understand what will be served and how it will be served in the child care program.

d) Written policies should be shared with all staff that provide care to children.

e) Written policies should be shared with the children’s families; families need to understand what will be followed in their child’s care setting, including what types of foods can be brought into the child care environment for meals, snacks, and celebrations. This is especially important to keep children with food allergies and special dietary needs safe in the child care setting. Policies can also help families learn new information.

f) Written policies help new staff learn about the responsibilities in the child care setting and what they are expected to do regarding feeding the children in their care.

1. Resources:Early Care and Education Physical Activity and Nutrition Policy and Templates (Nutrition Education and Obesity Prevention Branch, California Department of Public Health): Customizable Early Care Nutrition and Physical Activity policy and templates. Child care providers can use the templates in their entirety or can adapt, and/or adopt portions of the templates as desired.

    

   Child Care Wellness Policy Workbook (Nemours): This 60 page workbook helps child care providers, families and communities work together to raise fit, happy children. Child care providers and other early childhood professionals can use this workbook to develop their own individualized wellness policies.

    

   Healthy Apple Resources (Children’s Council of San Francisco): Provides materials in English, Spanish, and Chinese including resources to develop nutrition and physical activity policies. There are sample policies so you can start today.

    

   Child Care Nutrition and Physical Activity Policies (NAP SACC): Check off policies to provide the best possible nutrition and physical activity environment in child care sites.

    

   Best Practices Recommendations for Child Care Facilities (NAP SACC): Nutrition and physical activity best practices for Child Care Facilities.

a) Some children in your care may be allergic to certain foods. Commonly allergenic foods include nuts, wheat, soy, seeds, seafood, shellfish, milk, and milk substitutes. Some children are allergic to sourdough.

b) Food allergies can be serious and potentially deadly.

c) Discuss food allergies and their dangers with a child’s family.

d) Work with the child’s family to prepare a food safety plan.

e) Alert all child care staff who provide care to a child or prepare a child’s food as to the food allergy.

f) Teach the staff how they are to care for the child regarding the food allergy.

g) Write policies for caring for children with food allergies. These policies should cover how children with food allergies will be fed safely, and what kinds of checks and balances will be carried out in order to make sure children’s foods in the child care setting are safe. The policies should be shared with all children’s care providers and food preparation staff.

h) Have a written plan for what to do if a child has an allergic reaction to a food while in your care. This plan should be in the child’s medical information, but should also be available to cooking, feeding, and child care staff.

i) List precautions to be taken to prevent cross-contamination in the preparation of food for the child with food allergies.

j) In addition to a food safety plan for an individual child with food allergies, a child’s food allergies should be listed in the child’s medical records, and these records should be regularly referred to by child care staff that provide care and food, so they may provide the best-informed care.

k) Actively supervise children while they eat. In the case of a child with a food allergy, time is essential, and the quicker the emergency response, the better the chance a child will survive an allergic reaction.

1. Resources:Food Allergies (California Childcare Health Program): A one page fact sheet describing allergies of all kinds and what information a parent should share with their child care provider.

    

   Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs In 2011, Congress passed the FDA Food Safety Modernization Act to improve food safety in the United States which lead to developing voluntary guidelines for schools and early childhood education programs to help them manage the risk of food allergies and severe allergic reactions in children.

    

   Resources for Child Care Facilities (Food Allergy Research & Education): Web page with information and other web links on how to care for children with food allergies.

a) The information for this topic may include:

1. • Keep all foods that can spoil in the refrigerator or freezer until you’re ready to cook them.
   • Return all leftovers to the refrigerator immediately after cooling.
   • Keep fresh fruits and vegetables away from raw meat, poultry, or seafood while shopping, washing, preparing, or storing them.
   • Cook foods to the proper temperatures. See website for further information on the proper cooked food temperatures.
   • Use a food thermometer to check the temperature of foods to determine when a meat, poultry, fish, or egg dish is fully cooked.
   • Never defrost foods on the kitchen counter.
   • Don’t rinse raw fish, seafood, meat, or poultry, as this can spread germs to sinks, kitchen surfaces, cooking utensils, and other foods.
   • Rinse all fresh vegetables and fruits under running water.
   • Use a clean produce brush to scrub melons and firm fruits.
   • Don’t use soap to clean fruit and vegetables.
   • Dry fruits with a paper towel after you have rinsed them.  Cut rotten or bruised parts of fresh fruit and vegetables away before preparing or eating.
   • Quickly store fresh vegetables and fruits that can rot—put them in the refrigerator at 40 degrees or below.  (Be aware that there are some fruits, such as bananas, and vegetables, such as tomatoes, that may rot more quickly if placed in the refrigerator.)
   • Before opening canned food, rinse and dry the top of the can.
   • When using foods with past expirations dates, know which foods to safely use, and when not to use foods that are past their expiration dates.

b) Preventing Choking

The information for this topic:

• At mealtimes, children may talk while they eat, but actively supervise the meal by sitting with the children. You can be a role model for safety during meals by socializing with them during meal and snack times.
• Children should be seated for meals and snacks, and not doing other activities while they eat.
• Serve foods that are safe and age and developmentally-appropriate for children up to 4 years of age.
• For very young children (approximately age 6 months to 2 years) who are just beginning to eat a variety of foods, serve thoroughly cooked, mashed, or pureed vegetables, fruits, beans, and peas.  As they develop, you can offer young children foods in a form that will require them to do more chewing.

The information for this topic may include:

• String cheeses, larger chunks of meat and cheeses, large beans, raw vegetables, hard fruits, and nut and seed butters pose choking hazards to young children.
• If serving hot dogs, sausages, cheese sticks, and other round foods, slice them in strips or half-moon shapes.

• Popcorn, chips, hard pretzels, and rice cakes pose choking hazards

Resources:

First Aid and CPR Instructors  (EMS Authority): A list of First Aid and CPR Child Care Training Program Providers.

Reducing Choking Risks: Tips for Early Education and Child Care Setting (American Academy of Otolaryngology—Head and Neck Surgery): Lists foods and food characteristics of common items that children choke on. Provides guidance on reducing food choking risks.

Food Safety Coloring Book and Spanish Version (USDA): A coloring book on food safety (clean, separate, cook and chill) for children. Coloring pages may be duplicated for educational purposes.

Fight Bac! ®Partnership for Food Safety Education Curricula and Programs (Partnership for Food Safety Programs): Award winning curriculum for grades K- 3 consisting of an animated video; teacher guides; activity booklets that reinforce food safety through math, language arts, art and science.

Food Detectives Fight Bac Game (New Mexico State University): An online game for kids to learn how to fight bacteria that lives on food that isn’t cooked properly.

Keeping Kids Safe (USDA): A 25 page guide for safe food handling and sanitation.

Food Safety Tips for Preschoolers (USDA): One page handout with 10 tips to keep food safe and clean.