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Among people aged 12 or older who were past year users of heroin, Because of the creation of a new section in the interview for methamphetamine see the "Introduction" , SUDs for prescription stimulants in do not include methamphetamine. For the to year-old age group, tests of differences were done assuming independent samples between years an odd number of years apart because two distinct cohorts a year apart were monitored longitudinally at 2-year intervals. As shown in this report, however, estimates are still reported for past year initiation for the individual prescription drug categories i. Among people aged 12 or older who were past year users of methamphetamine, Winter safety tips from the American Academy of Pediatrics.

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In response to an increased demand for data all over the world, UNICEF has been providing assistance to countries at more frequent intervals since - every three years instead of every five years. This is providing the opportunity for countries to capture rapid changes in key indicators, particularly the MDGs. As key data sources generating data on equity, MICS will play a key role in tracking progress towards elimination of disparities and inequities.

While UNICEF and partners work with national governments to accelerate improvements in the lives of the most vulnerable, MICS will produce the data to validate the results of these focused interventions. Survey tools The MICS global team, based at UNICEF headquarters, develops a standard set of survey tools in consultation with government representatives and other experts — from tabulation plans and sample weights guidelines to manuals and questionnaires.

National ownership Government institutions typically carry out the surveys with technical and financial assistance from UNICEF and its partners. Technical support UNICEF provides technical support and training through a series of regional workshops covering questionnaire content, sampling and survey implementation, data processing, data analysis, report writing, data archiving and dissemination.

Face-to-face interviews Data are collected during face-to-face interviews in carefully selected nationally or subnationally representative samples of households. Field testing High-quality data can be obtained thanks to thorough and tested field procedures, combined with rigorous data verification. Focus on equity By , more than surveys will have been implemented in more than low- and middle-income countries.

Any food brought from home should not be served to other children. This will prevent cross contamination and reinforce the policy that food sent to the facility is for the designated child only. Unused portions in opened factory-sealed baby food containers or food brought in containers prepared at home should be stored in the refrigerator and discarded if not consumed after 24 hours of storage.

Feeding of age-appropriate solid foods in a bottle to a child is often associated with premature feeding ie, when the infant is not developmentally ready for solid foods 5,6. Published February 22, US Department of Agriculture. Food Safety and Inspection Service Web site.

Baby food and infant formula. Effects of early nutritional interventions on the development of atopic disease in infants and children: WIC Works Web site. Modified October 31, Flavored milks contain higher amounts of added sugars and should not be served. Water should not be offered to children during mealtimes; instead, offer water throughout the day.

Early care and education settings should check with state regulators about the timing between meals. State agencies may require any institution or facility to allow a specific amount of time to elapse between meal services or require that meal services not exceed a specified duration 2. Following CACFP guidelines ensures that all children enrolled receive a greater variety of vegetables and fruits and more whole grains and less added sugar and saturated fat during their meals while in care 3.

Even during periods of slower growth, children must continue to eat nutritious foods. Picky or selective eating is common among toddlers. Over time, with consistent exposure, toddlers are more likely to accept new foods 4. Independent Child Care Centers: The facility should serve toddlers and preschoolers small, age-appropriate portions. The facility should permit children to have one or more additional servings of nutritious foods that are low in fat, sugar, and sodium as required to meet the caloric needs of the individual child.

Young children should learn what appropriate portion size is by being served plates, bowls, and cups that are developmentally and age appropriate. Usually a reasonable amount of additional food is prepared to respond to any spills or to children requesting a second serving.

Children should continue to be exposed to new foods, textures, and tastes throughout infancy, toddlerhood, and preschool. Children should not be required or forced to eat any specific food items. A child will not eat the same amount each day because appetites vary and food jags are common 2. Eating habits established in infancy and early childhood may contribute to optimal eating patterns later in life.

The quality of snacks for young and school-aged children is especially important, and small, frequent feedings are recommended to achieve the total desired daily intake. Strong evidence supports that larger plates, bowls, and cups, when paired with sustained long-term exposure of oversized portions, promote overeating 3.

Allowing children to decide how much to eat, through family-style dining, may also help promote self-regulation in children 3. Preschool children's sensitivity to teacher-served portion size is linked to age related differences in leftovers. How to improve eating behavior during early childhood. Pediatric Gastroenterol Hepatol Nutr. An explanatory framework of teachers' perceptions of a positive mealtime environment in a preschool setting.

All of which are developmentally appropriate for young children to feed themselves. Children can also use their fingers for self-feeding. Children in group care should be provided with opportunities to serve and eat a variety of food for themselves. As children enter the second year after birth, they are interested in doing things for themselves. Self-feeding appropriately separates the responsibilities of adults and children. To allow for the proper development of motor skills and eating habits, children need to be allowed to practice feeding themselves as early as 9 months of age 3,4.

Children will continue to self-feed using their fingers even after mastering the use of a utensil. J Pediatr Gastroenterol Nutr. Williamson C, Beatty C. Weaning and childhood nutrition. American Academy of Pediatrics Committee on Nutrition. Elk Grove Village, IL: American Academy of Pediatrics; Children between 12 and 24 months of age can be served whole pasteurized milk 1.

Milk provides many nutrients that are essential for the growth and development of young children. The fat content in whole milk is critical for brain development as well as satiety in children 12 to 24 months of age 3. For those children whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or early cardiovascular disease, the primary health care provider may request low-fat or nonfat milk 2. Some early care and education programs have children between the ages of 18 months and 3 years in one classroom.

To avoid errors in serving inappropriate milk, programs can use individual milk pitchers clearly labeled for each type of milk being served. Prevention of cardiovascular disease in pediatric populations.

Demos Medical Publishing; Children attending facilities for 2 or more hours after school need at least 1 snack. Breakfast, or a morning snack, is recommended for all children enrolled in an early care and education facility or in school. Depending on age and length of time in care, snacks should occur 2 hours after a scheduled meal.

State agencies may require any institution or facility to allow a specific amount of time to elapse between meal services or require that meal services not exceed a specified duration 1,2. Early childhood is a time of rapid growth that increases the need for energy and essential nutrients to support optimal growth 2. Food intake may vary considerably because this is a time when children express strong food likes and dislikes.

The CACFP requirements ensure that children in child care centers for longer than 8 hours common in military child development centers, for example are given the appropriate number of meals and snacks to meet individual caloric and nutrient needs 1. Programs serving children during the summer months can find the recommendations of the Summer Food Service Program at https: Family style meal service, with the serving platters, bowls, and pitchers on the table so all present can serve themselves, should be encouraged, except for infants and very young children who require an adult to feed them.

A separate utensil should be used for serving. Children should not handle foods that they will not be consuming. The adults should encourage, but not force, the children to help themselves to all food components offered at the meal.

When eating meals with children, the adult s should eat items that meet nutrition standards. The adult s should encourage social interaction and conversation, using vocabulary related to the concepts of color, shape, size, quantity, number, temperature of food, and events of the day.

Extra assistance and time should be provided for slow eaters. Eating should be an enjoyable experience at the facility and at home. Special accommodations should be made for children who cannot have the food that is being served.

Children who need limited portion sizes should be taught and monitored. One adult should not feed more than one infant or three children who need adult assistance with feeding at the same time.

When eating, children should be within sight of an adult at all times. Both older children and staff should be actively involved in serving food and other mealtime activities, such as setting and cleaning the table.

Staff should supervise and assist children with appropriate handwashing procedures before and after meals and sanitizing of eating surfaces and utensils to prevent cross contamination. Experiences with new foods can include tasting and swallowing but also include engagement of all senses seeing, smelling, speaking, etc. Children should be seated when eating. Children should not be allowed to continue to feed themselves or continue to be assisted with feeding themselves if they begin to fall asleep while eating.

The nutrition plan encompasses:. Potentially hazardous and perishable foods should be refrigerated and all foods should be protected against contamination. The facility should have a nutrition plan that integrates the introduction of food and feeding experiences with facility activities and home feeding.

The plan should include opportunities for children to develop the knowledge and skills necessary to make appropriate food choices. The children should have the opportunity to feel the textures and learn the different colors, sizes, and shapes of foods and the nutritional benefits of eating healthy foods.

Children should also be taught about appropriate portion sizes. The teaching should be evident at mealtimes and during curricular activities, and emphasize the pleasure of eating. The key to identifying a qualified nutrition professional is seeking a record of training in pediatric nutrition normal nutrition, nutrition for children with special health care needs, dietary modifications and experience and competency in basic food service systems.

Early care and education programs should create and implement written program plans addressing the physical, oral, mental, nutritional, and social and emotional health, physical activity, and safety aspects of each formally structured activity documented in the written curriculum. These plans should include daily opportunities to learn health habits that prevent infection and significant injuries and health habits that support healthful eating, nutrition education, physical activity, and sleep.

Awareness of healthy and safe behaviors, including good nutrition, physical activity, and sleep habits, should be an integral part of the overall program.

Young children learn better through experiencing an activity and observing behavior than through didactic methods 1. There may be a reciprocal relationship between learning and play so that play experiences are closely related to learning 2. Children can accept and follow rules, routines, and guidelines about health and safety when their personal experience helps them to understand why these rules were created.

National guidelines for children birth to age 5 years encourage their engagement in daily physical activity that promotes movement, motor skills, and the foundations of health-related fitness 3.

Physical activity is important to overall health and to overweight and obesity prevention 4. Healthy sleep habits e. Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years. Bedtime in preschool-aged children and risk for adolescent obesity.

Sleep duration and obesity in children: J Paediatr Child Health. Longitudinal impact of sleep on overweight and obesity in children and adolescents: J Epidemiol Community Health. Later emotional and behavioral problems associated with sleep problems in toddlers: US Government Printing Office; Effects of a physical activity intervention in preschool children.

Med Sci Sports Exerc. Curr Dir Psychol Sci. Int J Early Years Educ. Early Childhood Obesity Prevention Policies: Goals, Recommendations, and Potential Actions. Institute of Medicine; The importance of healthy sleep habits should be incorporated into obesity prevention programming.

Informal programs should be implemented during teachable moments throughout the year. One goal of a facility is to provide a positive environment for the entire family. Periodically providing families records of the food eaten and progress in physical activities by their children will help families coordinate home food preparation, nutrition, and physical activity with what is provided at the early care and education facility.

Education should be helpful and culturally relevant and incorporate the use of locally produced food. Subchapter B—the administration for children and families, Head Start program. Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey. Sleep health literacy in Head Start families and staff: The facility should have food handling, feeding, and nutrition policies and plans under the direction of the administration that address the following items and assigns responsibility for each:.

For sample policies see the Nemours Health and Prevention Services guide on best practices for healthy eating at http: Children should have ample opportunity to do moderate to vigorous activities, such as running, climbing, dancing, skipping, and jumping, to the extent of their abilities.

All children, birth to 6 years of age, should participate daily in:. Two to 3 occasions of active play outdoors, weather permitting see Standard 3. Playing Outdoors for appropriate weather conditions. Continuous opportunities to develop and practice age-appropriate gross motor and movement skills. The total time allotted for outdoor play and moderate to vigorous indoor or outdoor physical activity can be adjusted for the age group and weather conditions.

Infants birth—12 months of age should be taken outside 2 to 3 times per day, as tolerated. Toddlers 12 — 35 months and preschoolers 3—6 years should be allowed 60 to 90 total minutes of outdoor play 1. These outdoor times can be curtailed somewhat during adverse weather conditions in which children may still play safely outdoors for shorter periods, but the time of indoor activity should increase so the total amount of exercise remains the same.

Toddlers should be allowed 60 to 90 minutes per 8-hour day for moderate to vigorous physical activity, including running. Preschoolers should be allowed 90 to minutes per 8-hour day for moderate to vigorous physical activity, including running 1,2. Infants should have supervised tummy time every day when they are awake. Place toys in a circle around the infant. Lie on your back and place the infant on your chest.

Opportunities to actively enjoy physical activity should be incorporated into part-time programs by prorating these recommendations accordingly eg, 20 minutes of outdoor play for every 3 hours in the facility. However, children with out-of-control behavior may need 5 minutes or fewer to calm themselves or settle down before resuming cooperative play or activities. Infants should not be seated for more than 15 minutes at a time, except during meals or naps 5.

Infant equipment, such as swings, stationary activity centers, infant seats eg, bouncers , and molded seats, should only be used for short periods, if used at all. A least-restrictive environment should be encouraged at all times 7. Children can accumulate opportunities for activity over the course of several shorter segments of at least 10 minutes each 9.

Children learn through play, developing gross motor, socioemotional, and cognitive skills. During outdoor play, children learn about their environment, science, and nature Toddlers and preschoolers generally accumulate moderate to vigorous physical activity over the course of the day in very short bursts 15—30 seconds 5. Children may be able to learn better during or immediately after these types of short bursts of physical activity, due to improved attention and focus Tummy time prepares infants to be able to slide on their bellies and crawl.

As infants grow older and stronger they will need more time on their tummies to build their own strength 3. Childhood obesity prevalence, for children 2 to 5 years old, has steadily decreased from Incorporating government food programs, physical activities, and wellness education into child care centers has been associated with these decreases Physical activity habits learned early in life may track into adolescence and adulthood, supporting the importance for children to learn lifelong healthy physical activity habits while in the early care and education program Predicting adult obesity from childhood obesity: Trends in obesity prevalence among children and adolescents in the United States, through Prevalence of childhood obesity in the United States, Updated April 10, Physical activity, fitness, cognitive function, and academic achievement in children: Systematic review of physical activity and health in the early years aged years.

Appl Physiol Nutr Metab. Bento G, Dias G. Environmental factors associated with physical activity in childcare centers. Physical and sedentary activity levels among preschoolers in home-based childcare: J Phys Act Health. Back to sleep, tummy to play. Updated January 20, American Academy of Pediatrics HealthyChildren. Provide opportunities for active play every day. Nutrition and wellness tips for young children: Physical activity during school: Providing recess to all students.

Society of Health and Physical Educators. Am J Prev Med. Early intervention to encourage physical activity in infants and toddlers: Children should play outdoors when the conditions do not pose any concerns health and safety such as a significant risk of frostbite or heat-related illness. Please reference Standard 3. Play areas should be fully enclosed and away from heavy traffic areas.

In addition, outdoor play for infants may include riding in a carriage or stroller. Infants should be offered opportunities for gross motor play outdoors. Outdoor play is not only an opportunity for learning in a different environment; it also provides many health benefits. Outdoor play allows for physical activity that supports maintenance of a healthy weight 3 and better nighttime sleep 4. Short exposure of the skin to sunlight promotes the production of vitamin D that growing children require.

Open spaces in outdoor areas, even those located on screened rooftops in urban play spaces, encourage children to develop gross motor skills and fine motor play in ways that are difficult to duplicate indoors. Nevertheless, some weather conditions make outdoor play hazardous. Children need protection from adverse weather and its effects. Heat-induced illness and cold injury are preventable. Weather alert services are beneficial to child care centers because they send out weather warnings, watches, and hurricane information.

Alerts are sent to subscribers in the warned areas via text messages and e-mail. It is best practice to use these services but do not rely solely on this system.

Weather radio or local news affiliates should also be monitored for weather warnings and advisories. Heat and humidity can pose a significant risk of heat-related illnesses, as defined by the NWS 5.

Children have a greater surface area to body mass ratio than adults. Therefore, children do not adapt to extremes of temperature as effectively as adults when exposed to a high climatic heat stress or to cold. Children produce more metabolic heat per mass unit than adults when walking or running. They also have a lower sweating capacity and cannot dissipate body heat by evaporation as effectively 6. Wind chill conditions can pose a risk of frostbite.

Frostbite is an injury to the body caused by freezing body tissue. The most susceptible parts of the body are the extremities such as fingers, toes, earlobes, and the tip of the nose. Symptoms include a loss of feeling in the extremity and a white or pale appearance. Medical attention is needed immediately for frostbite. If warm water is not available, wrap gently in warm blankets 7. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature.

An infant with hypothermia may have bright red, cold skin and very low energy. Call or your local emergency number if a child has these symptoms. Both hypothermia and frostbite can be prevented by properly dressing a child.

Dressing in several layers will trap air between layers and provide better insulation than a single thick layer of clothing. Generally, infectious disease organisms are less concentrated in outdoor air than indoor air. The thought is often expressed that children are more likely to become sick if exposed to cold air; however, upper respiratory infections and flu are caused by viruses, and not exposure to cold air.

These viruses spread easily during the winter when children are kept indoors in close proximity. Int J Obes Lond. Winter safety tips from the American Academy of Pediatrics. Supervising adults should check the air quality index AQI each day and use the information to determine whether it is safe for children to play outdoors.

The AQI available at http: The AQI is divided into six categories; each category corresponds to a different level of health concern.

The six levels of health concern and what they mean are:. Limit screen time and other digital media as outlined in Standard 2. Children learn from the adult modeling of healthy and safe behavior. Continuing education activities are useful in disseminating knowledge about effective games to promote physical activity in early care and education while keeping children safe 4.

Media and young minds. A comparison of parent and childcare provider's attitudes and perceptions about preschoolers' physical activity and outdoor time. Child Care Health Dev. Physical activity practices, policies and environments in Washington state child care settings: Matern Child Health J. The facility should have written policies for the promotion of indoor and outdoor physical activity and the removal of potential barriers to physical activity participation.

Policies should cover the following areas:. Children will spend 60 to minutes each day outdoors depending on their age, weather permitting. Policies will describe what will be done to ensure physical activity. Hats and sunglasses should be worn to protect children from sun exposure. Lightweight, breathable clothing, without any hood and neck strings, should be worn when temperatures are hot to protect children from sun. Clothing that can catch on playground equipment eg, those with drawstrings or loops.

If appropriately dressed, children can safely play outdoors in most weather conditions. Children can learn math, science, and language concepts through games involving movement 3,4. The policy can make clear that outdoor activity may require special clothing in colder weather or arrangements for cooling off when it is warm.

The inappropriate dress of a child is often a barrier in reaching recommended amounts of physical activity in child care centers. Sometimes, children cannot participate in physical activity because of their inappropriate clothes. Children can play in the rain and snow and in low temperatures when wearing clothing that keeps them dry and warm.

When it is very warm, children can play outdoors, if they play in shady areas, and wear sunscreen, sun-protective clothing, and insect repellent, if necessary 6. For assistance in creating and writing physical activity policies, Nemours provides several resources and best practice advice on program implementation. Information is available at https: Looking inside and out: Early Child Development and Care. Choosing an insect repellent for your child.

Updated March 1, Chapter 2 Program Activities Standard 2. This standard states that children two years and older in early care and education settings should not be exposed to more than thirty minutes per week of screen time and that computer use should be limited to no more than fifteen minute increments.

Is the fifteen minute increment for computer use included in the total screen time of thirty minutes per week? It does not include video-chatting with family. Children ages 5 and older may need to use digital media in early care and education to complete homework.

Devices should be turned off at least one hour before bedtime. When offered, digital media should be free of advertising and brand placement, violence, and sounds that tempt children to overuse the product. Programs should prioritize physical activity and increased personal social interactions and engagement during the program day.

It is important for young children to have active social interactions with adults and children. Media use can distract children and adults , limit conversations and play, and reduce healthy physical activity, increasing the risk for overweight and obesity. Media should be turned off when not in use since background media can be distracting, and reduce social engagement and learning.

The guidance above should not limit digital media use for children with special health care needs who require and consistently use assistive and adaptive computer technology 2. However, the same guidelines apply for entertainment media use. Consultation with an expert in assistive communication may be necessary.

Digital media is not without benefits, including learning from high-quality content, creative engagement, and social interactions. However, especially in young children, real-life social interactions promote greater learning and retention of knowledge and skills.

When limited digital media are used, co-viewing and co-teaching with an engaged adult promotes more effective learning and development. Because children may use digital media before and after attending early care and education settings, limiting digital media use in early care and education settings and substituting developmentally appropriate play and other hands-on activities can better promote learning and skills development.

Such an activity is reading. In addition, if adults view media such as news in the presence of children, children may be exposed to inappropriate language or violent or frightening images that can cause emotional upset or increase aggressive thoughts and behavior. Instead, opportunities for collaborative activities are preferred.

It is important to safeguard privacy for children on the internet and digital media. Special Collection Preventing Childhood Obesity in Early Care and Education Programs The second edition of Preventing Childhood Obesity in Early Care and Education Programs is the new set of national standards describing evidence-based best practices in nutrition, physical activity, and screen time for early care and education programs.

Table of Contents I. Requirements for Infants 4. Requirements for Toddlers and Preschoolers 4. Requirements for School-Age Children 4.

Meal Service and Supervision 4. Food Brought From Home 4. Physical Activity Standards 3. Screen Time Standard 2. How Much Is Needed? General Requirements Standard 4. Accessed September 7, Content in this standard was modified on November 10, Updated July 25,

2011/13 Australian Health Survey