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Flip flops, mulch and no coat

May 05, 2008

First phase of NHLBI-sponsored study on children's physical activity in child care

CINCINNATI -- At a time when over half of US children (aged 3-6) are in child care centers, and growing concern over childhood obesity has led physicians to focus on whether children are getting enough physical activity, a new study of outdoor physical activity at child care centers, conducted by researchers at Cincinnati Children's Hospital Medical Center, has identified some surprising reasons why the kids may be staying inside. The study, will be presented May 5 at the annual meeting of the Pediatric Academic Societies in Honolulu, Hawaii.

"It's things we never expected, from flip flops, mulch near the playground, children who come to child care without a coat on chilly days, to teachers talking or texting on cell phones while they were supposed to be supervising the children," according to Kristen Copeland, M.D., lead author of the study which was funded by the National Heart, Lung and Blood Institute. She noted that because there are so many benefits of physical activity for children - from prevention of obesity, to better concentration and development of gross motor skills - it's important to know what barriers to physical activity may exist at child-care centers.

"With so many American preschool-aged children in child care centers, and previous reports that the amount of physical activity children get varies widely across different centers, we wanted to explore what some of the barriers to physical activity at these centers might be," said Dr. Copeland, a physician scientist and Assistant Professor of Pediatrics in the Division of General and Community Pediatrics at Cincinnati Children's. According to the most recent statistics 74% of US children aged 3-6 years are in some form of non-parental child care. 56% percent of 3-6 year old children spend time in centers, including child care centers and preschools. Her team began by exploring child-care center staff members' perceptions of barriers to children's physical activity. They 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) as the first of several studies on this subject.

"We found several previously unreported barriers that meant kids had to stay inside, including inappropriate footwear such as flip flops and inappropriate clothing for the weather," said Dr. Copeland. In some child care centers, if one child in the group shows up without a coat on a chilly day, she noted, that means the whole group has to stay inside. Even more surprising to the researchers was the fact that the child-care staff members said some parents appear to intentionally keep their children's coats (or send children without coats) so they'd have to stay inside, which staff attributed to parents' concerns about the child getting injured or dirty, or a having a cold that may be exacerbated by cold weather.

Teachers said they also felt pressure from some parents who were more concerned with children spending time on cognitive skills, such as reading and writing, than on the gross motor and socio-emotional skills (such as kicking a ball or negotiating with another child for a turn on the slide) that are best learned on the playground.

Then there was the mulch factor. "The staff members who participated in the groups were really concerned about mulch in the play area," said Dr. Copeland. "Many said that the kids eat the mulch, or use it as weapons, or it gets caught in their shoes. It also requires constant upkeep. It's certainly not something that we had anticipated as an issue, but judging by the amount of and intensity of the discussions among child care teachers, it really is."

Dr. Copeland said the child-care center staff recognized that they themselves could sometimes serve as a barrier to children's physical activity. "We heard reports of teachers talking or texting on cell phones instead of interacting with the children while on the playground," said Dr. Copeland. She continued, "We found that a staff member who doesn't like going outside-maybe she's not a cold-weather person, or she thinks it's too much work to bundle up and unbundle the children on a cold day - could act as a gatekeeper to the playground." In some cases, staff reported that their own issues with being overweight prevented them from encouraging children's physical activity.

"This initial qualitative research has identified a number of issues that we will be exploring in subsequent studies," noted Dr. Copeland. "Clearly this is a complex issue -But finding out what the barriers are is the first step in addressing the problem and getting more kids involved in more much-needed physical activity."

Cincinnati Children's Hospital Medical Center