Early Care and Education (ECE)

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Why is This Setting Important?

Most young children spend time in care outside of their home, making the ECE setting one of the best places to reach young children with obesity prevention efforts.

• An estimated 73% of children 3-5 years old not yet in kindergarten are in a non-parental care arrangement on a weekly basis. ¹
• ECE centers are the primary weekly care arrangement for more than 7.5 million children birth through age 5 not yet in kindergarten.¹
• Children birth to 3 years old attending ECE centers spend an average of 32 hours a week at the center.²

State ECE systems can promote standards that address nutrition, infant feeding, physical activity, and screen time. ECE facilities can implement practices and programs that support healthy eating and physical activity among young children. These improvements can directly affect what children eat and drink, how active they are, reduce their screen time, support moms who breastfeed, and build a foundation for healthy living.

Join Us!

The Obesity Prevention in ECE Listserv and News Blasts share expertise and resources around improved nutrition, physical activity, and obesity prevention in the ECE setting.
Email eceobesity@cdc.gov for more information.

What is CDC’s Role?

CDC provides funding, training, and technical assistance to a variety of organizations to carry out obesity prevention efforts for the ECE setting based on our Spectrum of Opportunities pdf icon[PDF-655KB] framework. The Spectrum outlines how a state’s ECE system can embed recommended standards and support for obesity prevention. The Quick Start Action Guide (April 2018) pdf icon[PDF-512KB] guides users through the Spectrum and provides action steps to plan or strengthen state-level efforts in obesity prevention.  CDC’s current funded programs that include obesity prevention efforts for the ECE setting are bulleted below.  Read more about prior funded projects.

• The State Physical Activity and Nutrition Program (SPAN; 1807) cooperative agreement award funds 16 states for statewide initiatives to implement evidence-based strategies at state and local levels to improve nutrition and physical activity.  All grantees are required to implement and integrate nutrition and physical activity standards into statewide early care and education (ECE) systems.
• The Healthy Kids, Healthy Future Technical Assistance Program (TAPS), a partnership with the Nemours Foundation, funds 10 states to improve and expand nutrition and physical activity through existing states ECE systems based on the CDC’s ECE Spectrum of Opportunities and, where appropriate, at the ECE facility level.
• The 2019 Obesity Mini-Collaborative Improvement and Innovation Network (Mini CoIIN), a partnership with the Association of State and Public Health Nutritionists, funds 5 states to improve ECE nutrition environments, policies and /or practices statewide utilizing a comprehensive farm to ECE approach. Read more about all 5 states pdf icon[PDF-1.38MB]
• The Physical Activity Learning Session (PALS) Project, a partnership with the Nemours Foundation, is building the capacity of three states to better integrate physical activity (PA) into statewide ECE technical assistance and training networks so that they can equip ECE providers with the knowledge, skills, and resources to engage and lead infants, toddlers, and preschoolers in PA.
• The High Obesity Program (HOP; 1809) cooperative agreement funds land grant universities to work with community extension services in states with counties that have more than 40% of adults with obesity.  HOP grantees can choose to fund activities targeting the ECE setting.
• The Racial and Ethnic Approaches to Community Health (REACH) cooperative agreement is a national program to reduce racial and ethnic health disparities. Recipients plan and carry out local, culturally appropriate programs to address a wide range of health issues among persons who are Black or African American, Hispanic or Latino, Asian, American Indian, and natives of Hawaii, other Pacific Islands, and Alaska. REACH grantees can choose to fund activities targeting the ECE setting.
• Through a partnership with theAssociation of State Public Health Nutritionistsexternal icon, CDC awarded $90,900 each to 10 states and the District of Columbia to strengthen their state-level farm to ECE initiatives for one year, with work beginning in late 2020. The Farm to Early Care and Education Implementation Grants were competitively selected and include Colorado, District of Columbia, Iowa, Michigan, Minnesota, Mississippi, New Mexico, North Carolina, Ohio, Vermont, and Washington. Equity across all farm to ECE activities was a common theme among the selected proposals.

In addition, CDC tracks states’ obesity prevention efforts targeting the ECE setting. See ECE State Licensing Scorecards, released in 2020 with 2019 data.

Download factsheet pdf icon[PDF-501KB]

Key Resources

This section provides tools and resources to help states, ECE systems, and public health practitioners promote good nutrition and physical activity in the ECE setting.

• Healthy Kids, Healthy Future on-demand modules in Englishexternal icon and Spanishexternal icon
• Spectrum of Opportunities pdf icon[PDF-665KB] 1-pager
• Quick Start Action Guide for State Efforts (April 2018) pdf icon[PDF-512KB]
• Breastfeeding and Early Care and Education (ECE) Cdc-pdfpdf icon[PDF-259KB]
• Increasing Access to Drinking Water and Other Healthier Beverages in ECE Settings pdf icon[PDF-3.68MB]
• Caring for Our Children National Guidelines for Obesity Prevention Standards in ECEexternal icon
• Institute of Medicine reports:
  • Early Childhood Obesity Prevention Policiesexternal icon
  • Child and Adult Care Food Program: Aligning Dietary Guidance for Allexternal icon
• Achieving a State of Healthy Weight Report: National Assessment of Child Care Regulations (2018)external icon
• Go NAP SACCexternal icon – Nutrition and Physical Activity Self-Assessment for Child Care
• National Farm to Early Care and Education Websiteexternal icon

Stories from the Field

This section highlights successes from grantees at the state and local level to promote good nutrition and physical activity in the ECE setting.

State-level

• ECE Highlights from State Health Departments pdf icon[PDF-283KB].
• Hawai’i Gathers Information About Early Child Care by Using a Carbon-Copy Survey pdf icon[PDF-109KB]
• Michigan Early Child Care: Improving Nutrition and Physical Activity Standards pdf icon[PDF-636KB]
• New Mexico Early Care and Education Centers Create Lasting Wellness Changes pdf icon[PDF-638KB]
• North Dakota Department of Health Makes Healthy Living Easier for Young Children pdf icon[PDF-460KB]
• Ohio Health Department Makes Healthy Food Choices Easier for Ohio Children pdf icon[PDF-410KB]
• Alaska Child Care Workgroup Addresses Childhood Obesity pdf icon[PDF-126KB]
• Lessons Learned from the Arizona Empower Program pdf icon[PDF-3.55MB]
• Healthy Kids Healthy Future: State Examples and Success Storiesexternal icon.

Local-level

• Wood County, Wisconsin, Childcare Providers Remove Breastfeeding Barriers [PDF-281KB]
• Child Care Sites in York County, Maine, Move Toward Better Health [PDF-367KB]
• Making Health Easier: Healthy Changes Start in Preschool – Los Angeles, CA (English)
• Making Health Easier: Healthy Changes Start in Preschool – Los Angeles, CA (Spanish)