Child care centre adherence to infant physical activity and screen time recommendations in Australia, Canada and the United States: An observational study

Objective: The aim of this study was to compare adherence to physical activity and sedentary behaviour recommendations within the 2011 Institute of Medicine Early Childhood Obesity Prevention Policies as well as screen time recommendations from the 2013 American Academy of Pediatrics for samples of infants in child care centres in Australia, Canada, and the United States (US). Methods: This cross-sectional study used data from: the Australian 2013 Standing Preschools (N = 9) and the 2014-2017 Early Start Baseline (N = 22) studies; the 2011 Canadian Healthy Living Habits in Pre-School Children study (N = 14); and the American 2008 (N = 31) and 2013-2017 (N = 31) Baby Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) trials. Data were compared on the above infant recommendations. Percentages were used to describe compliance to the recommendations and chi-square tests to determine whether compliance differed by country. Results: Child care centres were most compliant (74%-95%) with recommendations to: provide daily indoor opportunities for infants to move freely under adult supervision, daily tummy time for infants less than 6 months of age, indoor and outdoor recreation areas that encourage infants to be physically active, and discourage screen time. Centres were least compliant (38%-41%) with adhering to recommendations to: limit the use of equipment that restricts an infant's movement and provide education about physical activity to families. Compared with Canadian and US centres, Australian centres were less compliant (46%) with the recommendation to engage with infants on the ground each day, to optimize adult-infant interactions and to limit the use of equipment that restricts the infant's movement. Canadian centres were less compliant (39%) with the recommendation to provide training to staff and education to parents about children's physical activity. US centres were less compliant (25%-41%) with the recommendations to provide daily opportunities for infants to explore their outdoor environment, limit the use of equipment that restricts the infant's movement and provide education to families about children's physical activity. Conclusions: Assisting child care centres on limiting the use of equipment that restricts an infant's movement, and providing education about children's physical activity to families may be important targets for future interventions.