Optimizing health services for young children in poverty: enhanced collaboration between Early Head Start and pediatric health care.

Given the importance of health to educational outcomes, and education to concurrent and future health, cross-systems approaches, such as the Whole School, Whole Community, Whole Child (WSCC) framework, seek to enhance services typically in K-12 settings. A major gap exists in cross-systems links with early care and education serving children birth to age 5. Both pediatric health systems and early family and child support programs, such as Early Head Start (EHS) and Head Start (HS), seek to promote and optimize the health and wellbeing of infants, toddlers, preschoolers, and their families. Despite shared goals, both EHS/HS and pediatric health providers often experience challenges in reaching and serving the children most in need, and in addressing existing disparities and inequities in services. This paper focuses on infant/toddler services because high-quality services in the earliest years yield large and lasting developmental impacts. Stronger partnerships among pedicatric health systems and EHS programs serving infants and toddlers could better facilitate the health and wellbeing of young children and enhance family strengths and resilience through increased, more intentional collaboration. Specific strategies recommended include strengthening training and professional development across service platforms to increase shared knowledge and terminology, increasing access to screening and services, strengthening infrastructure and shared information, enhancing integration of services, acknowledging and disrupting racism, and accessing available funding and resources. Recommendations, including research-based examples, are offered to prompt innovations best fitting community needs and resources.

Resilience: supporting children's self-regulation in infant and toddler classrooms.

Introduction: Resilience is a process that develops as a complex transaction as children experience and shape their social-ecological contexts. The dynamic development of self-regulation is an aspect of resilience that has received increased attention as a key mechanism predicting a variety of important short- and long-term outcomes. The current study examined how the self-regulation skills of infants and toddlers in a classroom could potentially shape classroom interactions and quality which, in turn, could potentially shape the development of self-regulation skills of the individual infants and toddlers enrolled in the classroom across an early childhood program year. The unique contribution of this study is the focus on a critical component of resilience, self-regulation, in an understudied age group, infants and toddlers, in an important and understudied context, the infant-toddler early childhood classroom. Methods: Data are from a statewide evaluation of early childhood programs serving children birth to age 3 growing up in low-income contexts. Multi-level mediation models were employed to examine the mediation effect of classroom quality between classroom-level self-regulation and individual children's gain in self-regulation over a year. Results: We found a significant indirect path. The results showed that classroom-level self-regulation skills demonstrated by infants and toddlers in the fall predicted higher levels of teachers' implementation of three important aspects of classroom quality - support for social-emotional, cognitive, and language development - in the winter. We also found that higher levels of teachers' support for social-emotional, cognitive, and language development associated with children's increased growth in self-regulation skills from fall to spring. The direct path from classroom-level self-regulation demonstrated in the fall to individual children's gain in self-regulation was not significant. Discussion: These findings, unique due to the focus on infants and toddlers in a classroom context, are discussed within the larger body of existing self-regulation research conducted with older children and prevalent theories outlining developmental mechanisms. Implications for both infant-toddler classroom practices and future research are addressed. Relative to practice, our findings have implications for informing how the development of self-regulation, an important component of resilience, can be supported in the youngest children, infants and toddlers, specifically those enrolled in center-based classrooms serving young children growing up in families with low incomes. We focus on the need to improve the support and professional development of infant-toddler teachers which, in turn, can improve classroom quality and foster resilience in infants and toddlers. Relative to research, our use of a relatively new measure of infant-toddler classroom quality, the Quality of Care for Infants and Toddlers (QCIT), shows how this tool can expand infant-toddler research, a need in the current literature. Future research using different measures, designs, analytical strategies, and diverse samples and contexts is needed to further explain very young children's development of self-regulation, a critical component of resilience.

Relationships between proximity to grocery stores and Oklahoma Early Care and Education classroom nutrition practices.

The study purpose was to determine associations between proximity to grocery stores and Early Care and Education programs' (i.e., ECEs) classroom nutrition practices and barriers, by ECE context (Head Start, community-based childcare [CBC], and family child care homes [FCCHs]). A statewide cross-sectional survey was implemented in Oklahoma ECEs. Directors reported classroom nutrition practices with the Nutrition and Physical Activity Self-Assessment tool, and barriers to implementation. Locations of 457 grocery stores statewide were determined by in-person audit. Geocoded ECEs were considered within a "low proximity" area if no grocery stores were available within a 0.25-mile radius for urban, or 10-mile radius for rural, ECEs. From November 2019 to February 2020, 54 Head Starts, 159 CBCs, and 160 FCCHs participated. 31.0 % were considered as low proximity. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. While proximity to grocery stores was not related to classroom nutrition practices for any ECE context (p > 0.05), FCCHs located within a low proximity area reported barriers to implementing those practices more often compared to FCCHs in an area within accessible proximity of grocery store. Thus, proximity to grocery stores was related to barriers in FCCHs only; those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. ECEs may serve as protective micro-environments supporting health for children residing in nearby low-access communities.

Macronutrient and micronutrient intakes of children in Oklahoma child-care centres, USA.

OBJECTIVE: To determine macronutrients and micronutrients in foods served to and consumed by children at child-care centres in Oklahoma, USA and compare them with Dietary Reference Intakes (DRI). DESIGN: Observed lunch nutrients compared with one-third of the age-based DRI (for 1-3 years-olds and 4-8-year-olds). Settings Oklahoma child-care centres (n 25), USA. SUBJECTS: Children aged 3-5 years (n 415). RESULTS: Regarding macronutrients, children were served 1782 (sd 686) kJ (426 (sd 164) kcal), 22·0 (sd 9·0) g protein, 51·5 (sd 20·4) g carbohydrate and 30·7 (sd 8·7) % total fat; they consumed 1305 (sd 669) kJ (312 (sd 160 kcal), 16·0 (sd 9·1) g protein, 37·6 (sd 18·5) g carbohydrate and 28·9 (sd 10·6) % total fat. For both age-based DRI: served energy (22-33 % of children), protein and carbohydrate exceeded; consumed energy (7-13 % of children) and protein exceeded, while carbohydrate was inadequate. Regarding micronutrients, for both age-based DRI: served Mg (65·9 (sd 24·7) mg), Zn (3·8 (sd 11·8) mg), vitamin A (249·9 (sd 228·3) µg) and folate (71·9 (sd 40·1) µg) exceeded; vitamin E (1·4 (sd 2·1) mg) was inadequate; served Fe (2·8 (sd 1·8) mg) exceeded only in 1-3-year-olds. Consumed folate (48·3 (sd 38·4) µg) met; Ca (259·4 (sd 146·2) mg) and Zn (2·3 (sd 3·0) mg) exceeded for 1-3-year-olds, but were inadequate for 4-8-year-olds. For both age-based DRI: consumed Fe (1·9 (sd 1·2) mg) and vitamin E (1·0 (sd 1·7) mg) were inadequate; Mg (47·2 (sd 21·8) mg) and vitamin A (155·0 (sd 126·5) µg) exceeded. CONCLUSIONS: Lunch at child-care centres was twice the age-based DRI for consumed protein, while energy and carbohydrate were inadequate. Areas of improvement for micronutrients pertain to Fe and vitamin E for all children; Ca, Zn, vitamin E and folate for older pre-schoolers. Adequate nutrients are essential for development and the study reveals where public health nutrition experts, policy makers and care providers should focus to improve the nutrient density of foods.