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ABCs And No Skinned Knees: Study Reveals Various Barriers to Physical Activity in Child Care

NIH and Robert Wood Johnson Foundation-Sponsored Study Focuses on Childcare Providers Perspectives


Monday, May 04, 2009

Nearly 75 percent of children ages 3-6 are in child care centers, and many may not be getting enough exercise. A focus group study of child care providers by Cincinnati Children’s Hospital Medical Center shows several reasons children are not getting as much physical activity as they should: some providers said they feel pressured by parents to prioritize classroom time for learning over outdoor time for motor development; some providers cited a fear of injury and the cost of playground design and upkeep as other barriers to children’s physical activity in child care. 

The study, sponsored by the National Institutes of Health and the Robert Wood Johnson Foundation, will be presented May 2 at the annual meeting of the Pediatric Academic Societies in Baltimore. 

“Child care providers told us that many parents were more focused on their children learning cognitive skills such as reading, writing and preparing for kindergarten than their participation in recess,” says Kristen Copeland, MD, a pediatrician at Cincinnati Children’s Hospital Medical Center and the study’s main author. “And yet childcare providers realized that some of the most valuable lessons in science, nature, cause and effect, and even important social skills such as problem-solving and peer negotiation, all come from playing outdoors on the playground.”

The child care providers said that during playtime, children learn gross motor skills, such as learning how to skip and throw a ball. They noted that children who master gross motor skills at an early age tend to become more self-confident than other children, win more friendships, and develop their social skills.

Other barriers to physical activity cited include licensing standards and that made outdoor playgrounds unchallenging and uninteresting to children, and a lack of indoor play space and equipment that would foster activity when children had to stay inside on rainy, cold or extremely hot days. Tight center operating margins and the expense of equipment and upkeep severely limited the indoor and outdoor opportunities that many centers could offer children.

According to the most recent statistics 74 percent of US children aged 3-6 years are in some form of non-parental child care. Fifty-six percent of 3-6 year old children spend time in centers, including child-care centers and preschools. Dr. Copeland’s team conducted focus groups with 49 staff members from 34 child-care centers in the Cincinnati area including Montessori, Head Start and centers in the inner city and suburban areas to get a better idea of why children weren’t involved in physical activity during the school day.

Center staff had several creative suggestions for increasing physical activity, including  partnering with a landscaping architect to put more shrubs and hills on the center’s property to encourage children’s climbing; placing a wooden dance floor in the school playroom to encourage dancing;  offering workshops that teach child care providers fun games to play with children outside; and encouraging sporadic movement during the day, such as small music breaks when children can get up and move along to songs.

“Many children spend long hours in child-care, and some do not have safe places to play outdoors at home, so for many children, the child care center is their only opportunity to be active, Dr. Copeland says. “But the typical things we think should be on a playground -- such as climbers and jungle gyms -- can be very expensive and essentially cost-prohibitive for many child care centers. Those centers that could afford climbers found that their children quickly mastered them and became bored with them. If the goal is to increase physical activity, creative solutions are needed to overcome all of these barriers” she said.

The PAS meeting is the largest international meeting focused on research in child health. It is sponsored by the American Academy of Pediatrics, the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

About Cincinnati Children’s

Cincinnati Children's Hospital Medical Center is one of America’s top three children’s hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children’s hospitals in the U.S., Cincinnati Children’s is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health.

For its achievements in transforming healthcare, Cincinnati Children's is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize ® for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes.  Additional information can be found at www.cincinnatichildrens.org.

Contact Information

Danielle Lewis, 513-636-9473, danielle.lewis1@cchmc.org