Building a Healthy Eating Environment

Building a Healthy Eating Environment Webinar

April Powell: Welcome, everyone. Thank you for standing by. My name is April Powell, and I am the Program Manager for the National Center on Early Childhood Health and Wellness. And I'm pleased to welcome you to today's webinar, Building a Healthy Eating Environment. 

Before we begin, I have just a couple housekeeping announcements. So, first off, all participants will be muted throughout the entire presentation portion of the webinar, and there's a slide deck that's being shown in the webinar system that only the presenters will have access to. If you have a technical or content question, please type it in the chat box. I see a couple people have introduced themselves. So, feel free to use that chat box to ask any content or technical questions. Some of the questions that you ask we'll get to right away, and some we'll save for the end.

Before the end of the webinar, you'll be able to access your certificate in the files for download box. And you can just type your name in and save that for your own records. Below the files for download box, you'll see a couple of links that we'll be referencing during the webinar. And at the very end of the webinar, we'll leave the platform open for just a few minutes for you to take your evaluation. Please take a minute to take the survey at the very end of the webinar.

Finally, this webinar is being recorded, and an archive version will be emailed to you shortly after the webinar, and it will also live long term on ECLKC, E-C-L-K-C website. So, now, I'll turn it over to our expert speakers.

Florence Rivera: Thanks, April. This is Florence Rivera, with the National Center on Early Childhood Health and Wellness. I'm hoping you all can hear just fine. If not, of course, use the chat box to let us know. As April mentioned, you will be muted. But please feel free to type your questions, or if you have particular ideas or comments as we're going through some of the content today. I do try to keep my eye on the chat box, so I'll answer as many questions as I can as we move through the presentations. So, I can answer your related questions in real time. If not, I'll try to get to them at the end of the presentation. And very worst case scenario if we don't get to your question, we'll make sure to follow up and get you the answer that you need.

So, let's go ahead and get started today. We're talking about building a healthy eating environment. There we are. And I want to start before we really talk about what that means or what's entailed, I want to just bring up the point that mealtimes are more than food. Healthy foods are important to a healthy eating environment and important to healthy child development, but that's not all that mealtimes entail. We think about the social emotional aspect to allow our young children to bond with us as early care and education providers, or also with their family members. It's also an opportunity to support fine motor skill development.

We don't have time to talk a lot today about the different learning domains and how mealtime can be used as a learning tool, but hopefully I'll be able to offer small snippets as we move forward to think about it beyond simply the menu development, what sort of foods are you serving in your mealtime. And a good way to think about this that I like to use as I get started to think about your own experiences, particularly around celebrating a particular milestone with  family or friends, or offering comfort in a time of need. Very often, those experiences will center around food. Just to demonstrate the social emotional aspect, that relationship that we have for food.

Another question that I like to start off with when talking with staff is, what were mealtimes like when you were growing up? Many of us can think through our own childhood and the common routines that we had. So, where did you commonly sit? Did you have meals together? Did you spend time together and interact, or did you often have the TV on? What sort of foods did you eat? And what's important about this question as you self-reflect on your own habits from your childhood, is that these are really indicative of how we feel, or these routines are indicative of how we implement eating environments, not just at our own homes, but in our program environment.

So, if you ... Had a very positive approach and interaction with family and caregivers regularly during mealtimes, it might feel much easier for you to engage young children in the program setting in positive interactions. If that hasn't been your experience, you might struggle a little bit with implementing these well. So, hopefully, today we're able to talk through a little bit of that and provide some suggestions of some ways to make changes or improve your eating environment.

Some of you may have grown up as a member of the "clean your plate club," kind of this mentality that we need to finish all the food on our plate or we're being wasteful. And I know I myself actually grew up with the same mentality and really struggled as an adult understanding, kinda reprogramming myself to look at those external cues, or internal cues of hunger and satiety or fullness.

So, am I actually eating until my body is telling me I'm full? Or am I looking for external cues, such as my plate is empty, I'm out of time, which happens often enough when you're running in between meetings, and so forth. And it can be really difficult to break this way of thinking about mealtime, that I'm not finished until we clean our plate.

And so, a good first step when we're talking with staff about how we're implementing our meal environment, or we're talking to families, is to acknowledge that some of those experiences might be affecting how we're implementing this in the program or at home. So, thinking about, "How do you think this affects how you eat now?" It's a great follow-up question to that.

Specifically, I'm thinking of an example would be, have you ever eaten at a time when you were stressed beyond what you needed, or chose a higher fatty sweet or even salty kind of treat as a reward or a mechanism for dealing with that stress, would speak a little bit to that that relationship that's been affected around your eating environment. And then this follow-up question is, "How do you want children to think about food?" Do you want them to have that same relationship? Do you want them to relate broccoli with the thing you have to suffer through before you get to chocolate? Or cleaning your plate before you're actually full? Those sorts of things.

If you're able to answer this question, it's really helpful to move forward in what sort of skills do we want our young children to have when they think about food and how they approach eating, healthy eating. And that's essentially how you're designing your eating environment.

So, really, our end point here is much about who we are and where we come from, and what we share with our children is centered around food. And I don't have a lot of time today to talk about how mealtime ... Sorry, Gloria. I'm just laughing at your comment. Yes, and I cook for an army instead of just what I need, which is a really good point. And many of us are actually kind of programmed to do that, especially if we came from big families. And then ... Trying to adjust cooking for smaller families or something as well. So, thanks for bringing that up. 

So, how do we use mealtime as a way to support child development and learning is a question I like to bring back to our teaching staff. It really should not be, when you're setting up your eating environment, something extra you're doing or a time out of your lesson plan or how to reach your learning goals. It should be part of your lesson plan, because you are able to reach your learning goals by using mealtime.

So, for example, I talked about fine motor development just a minute ago or social emotional, you know kind of building relationships. Are we learning how to share? Are we learning how to pass foods? Are we learning how to use our manners -- please and thank you? All of that negotiation, relationship negotiation is really important around mealtime. Especially for our 0 to 3, so much of what we do is really about feeding them, cleaning up, and getting ready to feed them again, that's a crux of how we're building some of that relationship. 

But in addition, there are other learning domains that we touch at mealtime. So, cognition. Our older children are learning spatial awareness when we're asking them to serve food to themselves or pour their own, you know, milk or water into a glass and so forth. And even in our younger kids, actually, spatial awareness in terms of am I practicing self feeding? I'm able to pick up a fork and judge how far or how to put it into my mouth and so forth.

Other learning domains around language and literacy. So, we're teaching them new words, we're teaching them new colors. We're allowing them the opportunity to explore foods in a safe environment. And then math, of course. Counting, sorting our shapes and so forth. So, I don't have a lot of time unfortunately today, because we really do want to showcase two new tools for you, which I don't think we mentioned earlier.

In the links that are provided, in addition to the feedback survey, you'll have the direct links for two tools that we'll be highlighting here at the end around, how do you do this? How do you evaluate whether or not your program is implementing a positive eating environment? So, this is a fact that I like to bring up. The literature tells us that our young children have assumed the eating habits of their family by the age of 2. This is really important for a couple of things.

Hopefully we can take a couple of takeaways. One being that we're probably very aware of the eating habits of the families that we serve, and we're very aware that those eating habits may not be as healthy as they can be or should be. So, to think that our 2 year olds are eating in the same way that some of the families that we serve are could be alarming, especially when we start talking about the specific nutrients that are needed in early childhood to support brain development and healthy growth.

We know that if your diet is consisting of sugar sweetened beverages and junk or processed foods, that you're not having a consistent source of specific nutrients that we're looking for, like for example, iron or your B vitamins such as folic acid and so forth. If we don't have healthy foods regularly in our diet, our young children aren't getting enough in order to develop their brain and bodies the way that they need to. The second thing I'm hoping that you'll take away from this statement is that it's never too early to build healthy habits. That we shouldn't wait until kindergarten or school age to really be talking to young children about this. We need to be talking actually about this for -- if I have Early Head Start folks on the  phone, when you're enrolling those pregnant moms, we need to be talking about it then. That the foods that they're eating actually affect the food preferences of their baby later on.

And what's really interesting in talking about starting this early is we actually see adult or family meal patterns emerge around 9 months of age. And if I have any teachers on the phone here, hopefully you're able to articulate that developmental milestone we're looking for around 9 months of age, which is the development of the pincher grasp, that ability to pick up something with your forefinger and thumb, small objects. It tends to be things like Cheerios or those puffer snack items. So, what we see are those healthy habits starting at 6 months of age when we introduce solid foods. We see a lot of fruit and vegetable consumption.

And then, however, at 9 months of age, we see the development of this pincher grasp, and all of a sudden these fruits and vegetables plummet. The consumption plummets, and they start eating a lot more simple carbohydrates and then assuming the eating habits of their families. So, they're actually picking up the same foods that are on their family's plates or sharing foods as well. So, all in summation that it's never too early to build these healthy habits, that we really need to talk about this as early as possible, as early as they're coming into your program. 

And then the third and last thing I hope you take away from this one statement is that we've got to build family habits together.

We cannot treat the child's eating habits as a solo activity. And so when you're thinking about the eating environment in your program, which is mostly what we're focusing on today, it's really helpful to also think about how this needs to happen at home and not just for that individual child but for the family together, that this is a group effort and we can't increase fruit and vegetable consumption for young children without increasing fruit  and vegetable consumption for their families. Those who are buying and making the foods and so forth, that it's not a siloed activity by any means. OK, so that's sort of just laying the foundation of why we're here and why we are going to talk about the eating environment, some of these other
factors that go into the eating environment. 

So, what is an eating environment? So, hopefully it's entailing that, avoiding your clean your plate mentality. And that it's encouraging children to listen to their own hunger and satiety or fullness cues. So, children are actually cued up. They're actually given the opportunity to determine whether or not ...Sorry, I'm just reading, Gloria's also saying, "You have a happy plate. That grinds my gears.

So, encouraging children to listen to their own hunger cues and satiety cues or cues of fullness. So, what I like to refer to this, and we'll talk about this in a minute. It's really around responsive feeding, which can be summed up called, "Parent provides, or you provide, and the child decides." So, children are responsible for deciding if they're going to eat, whether or not they're going to eat, and how much they're going to eat and so forth. Like I said, I'll talk about that in just a minute.

But this third bullet point, that we're creating this positive effect on a child's food preferences, that we actually see when we create this positive eating environment where children were given the opportunity to flex their independence muscles, to make choices of their own, to decide whether or not they're hungry or full, that they actually have better outcomes. That they're more likely to try new foods, that they associate that positive eating environment with eating the healthy foods that we're offering. Yeah, Charlie. We will talk here just a little bit about the thank you bite. Thanks. I'll make sure we talk about that, because we have, of course, the concern around CACFP regulations and responsive feeding. So, hold tight, but I'll make sure to talk about that. 

So, anyway, so we see science shows us that when we create that really positive environment, it gives children a developmentally appropriate avenue for trying new foods and exploring foods. On the opposite side, when we have an environment that's very restrictive or directive, where we're telling them they have to eat, they have to clean the plate, they have to try this, etc. We find those children essentially rebelling against them. And they start associating that experience with that food. So, a vegetable very often becomes that experience that they've had that that's been very unpleasant.

So, I'd be remiss if I didn't talk just a minute about ... Family style meal, because that is certainly a component of your eating environment that you are providing meals in a family style. I will, of course, acknowledge that for my Head Start programs you're no longer required to do this but encouraged. However, you've always been encouraged if you're child care or family child care Head Start programs through the Caring for Our Children standards and through your CACFP meal patterns, if you are reimbursed through those requirements, they've always encouraged family style meals as well. Though, they have not been required. So, if you're doing this, these are general logistics that I just want to make sure we cover here. And then we'll talk a little bit about what it means, because I find that most programs do these things on this slide. They're able to check these boxes. They feel very manageable and implementable.

It's the environment and organizing an environment that's very positive that acknowledges our own kind of experiences that is the tricky part, of course. So, we have to make sure that kids are involved, that hopefully our preschoolers for sure are washing and setting the table, bringing food to the table, passing or sharing food and able to clean up. Our toddlers, of course, it gets a little bit hairier. And your teachers or other staff will be able to determine the level of involvement based on developmental achievement for our toddlers.

And adult modeling, and this is really a hard one, too. I find that most programs struggle with some aspect of adult modeling. Hopefully you have at least one adult, and I want to be careful that I'm not saying teacher here, because if you are hopefully offering your classroom staff a break during the day, often it is during mealtime so you could have any other staff doing this. 

And sitting, preferably eating the same foods with the children. So, no outside drinks, leaving our phones, and we're modeling some of those behaviors. So, we're trying the food that staff may or may not like, which can be really challenging, asking adults to do this.

And I know it ended up being a common problem that surfaced when we had the meal pattern changes a couple of years ago. A lot of it surfaced around adult modeling, some of these changes as well, and there were feelings about these healthier menus. And we've already talked about this one, children choose whether to eat, what to eat, how much to eat. And hopefully, you're using child sized serving bowls, plates, and utensils, one other mechanism for children to visualize an appropriate serving size for them. I'm sorry. One second. Sorry. Just had a little technical issue. But I'm back now, so hopefully ...

We're talking about child- sized serving bowls, plates, and utensils so children can visualize an appropriate serving for them, and staff as well. That if we're using plates that are too big or bowls that are too big, that it's very hard for adults to cue up an appropriate serving size. And along with that, we're using measuring cups that would also be indicative of a serving for toddlers and preschoolers, so quarter cup or a half a cup. So, Sheryl has shared a comment here. "When I know a child is a picky eater, I only put one to three pieces of food on their plate so they can have the success of eating." And I think it's a great idea, Sheryl. Thank you for sharing. It's always easier to have manageable amounts for a young child, that we're not
pressuring them to try something that seems insurmountable. So, that's a wonderful suggestion, so keep them coming. Thanks for sharing. I have a question here, "How does that affect CACFP practices." If you're talking about the small amounts. So, we'll just go ahead and talk about it here.

So, programs have often had the question around, "How do I let a child choose whether or not they're going to eat and which foods they're going to eat and still get reimbursed on meal pattern?" And that's why I think someone here, I'd have to scroll up, but someone had mentioned the, "Thank you bite." There's also the two bite club, where every child is encouraged to put the food on their plate, but they're not forced to eat. And that's how often programs are able to balance those two concerns. That we're not forcing young children to try something but recognizing the reimbursement need for food that you've already prepared. 

And then, we have small groups of five to seven, which hopefully you're already doing. If you're looking for a logistical change, I would certainly make sure that you have one staff member to five to seven in small groups, trying to implement mealtimes. Anything bigger than that would be quite a challenge, especially for our young children. And Patricia would like to hear more about picky eaters during this webinar. So, I'll do my very best, but please let me know if I don't answer any specific questions. I'll be happy to answer them. OK, so some benefits for children. 

So, we're providing some structure and expectations that actually set them up for success in kindergarten. They will be expected to eat in larger groups in kindergarten depending on your school system in your community, and they will need the successes and these clear routines and expectations to make them successful. They're building independence, which is something that's really important to remember here, that this is developmentally appropriate, something that we should be expecting in our young children in this age group and to remind families of this as well. That that picky eating is often -- for those of you who have questions on picky eating is -- it's often tied to this developmental milestone.

So, that we should be expecting this. Food [Inaudible], so they want to eat the same thing over and over again, or when they've accepted a food one day and they reject it the next day, it's all part of normal development. It's our job to provide that environment where they're allowed to explore and reject it, and then later on accept it. So, we're not creating this atmosphere that teaches them one food is better than the other. We're enhancing the development of motor skills, language, and social skills, and I think we've talked about here in just a little, or talked about earlier. And builds their self-esteem, which is linked to their confidence and further on linked to their intrinsic motivation.

For my educators on the phone, we know that intrinsic motivation is so important to our early learners in terms of having the confidence to try that activity in the classroom that's a little bit harder that they haven't quite mastered. And later on in school age, it's that child who's more confident to raise their hand to answer the question, and so forth. Hopefully, you're finding some benefits for staff and families that it's an atmosphere that is not to be dreaded for either one of you as staff or at home.

That you're creating this atmosphere that gives you the permission to be OK with whether or not that child has eaten everything on their plate or not. And I will say from a parent perspective, this is one of the very few opportunities I have as a parent where I can say, "No," and feel really good about it that I've done the right thing, that I've offered my child -- my children -- a healthy meal, and when they've refused it which is developmentally expected, I'm very comfortable with saying, "Well, that's what I'm offering for dinner. I'm not making anything else. And if you decide you're hungry, this is the food that you'll be offered."

And in so many instances as a parent, that's really not the case. You always kind of second guess your choices, and this is one of those few instances where you're like, no, I've actually done the right thing. And for staff, it allows some of that pressure to be removed as well. So, there is a comment here I just want to stop. I've heard it said that children won't let themselves starve. They won't go on a hunger strike is what I like to say often as well. But I've been told by specialists that some children will indeed refuse food to the point of losing weight and becoming underweight. So, that's a really good comment, because there's a lot of anxiety about it. I will say I have seen children who will go on long hunger strikes in terms of eating in the program setting if the food is so very different from what they're being served.

And from my opinion, it is less to do with the foods that are being served and more to do with the social emotional development of that child. You'll actually have that often with children who might be experiencing trauma or communities of violence. And so, they might struggle a little bit with finding a locus of control, and where can they ... Show independence and be safe? 

And so, that might be something if you have a mental health or a family service worker to bring in for that. That is a special case that kind of transcends perhaps what I'll call a typical experience. But it certainly is not out of the realm of possibility.

OK, so other benefits. It's your opportunity to talk with kids. Again, as a parent, it's usually my very first time in my day to talk with my children. It's my opportunity to be a parent. And as for staff, it's your opportunity to learn a little bit about them as well. As staff, you spend most of your day being directive, telling children what to do, and kind of guiding the lesson plan. And this is your opportunity to hear from them and support them from behind. And I do want to go back to my second bullet point here quickly. Sorry. It is a strategy to discourage the picky eater. 

So, if you have the picky eater, not only is your eating environment which we talked about just a minute ago around, more conducive for letting children try and explore new foods so they're more willing to when you have a positive eating environment, but you have also other strategies.

So, my other question around picky eating in terms of, you know sitting that child who is a picky eater next to the child who will eat, will try more foods or eat more foods is another strategy for you as well. And I think we've talked about this, but it will improve. I'll go to my last bullet point, because I want to make sure I give Stephanie enough time to highlight the resources -- is it improves your mealtime behavior. When children have clear expectations of what they ... Of how they're supposed to act, what is coming next, you will see these improvements in mealtime behavior.

And so hopefully, if there's another small tidbit you can take away from today, it's do I have strong routines before the mealtime and after the mealtime is extremely important to the success of your eating environment. OK, so I feel like I've kind of spilled the beans on this, because we've been circling around it for a while. But responsive feeding. Hopefully you've heard of this before. But you are responsible for offering healthy meals and snacks to the kids, and that's why hopefully you have a registered dietitian or someone, another nutritionist who's reviewing your menus and providing the healthiest foods possible within your budget. And then children are responsible for deciding whether or not they're going to eat, which of those foods they're going to eat, and how much of those healthy foods they would like to eat. And so we kind of summed this up as you provide, child decides. And, here we go. 

So, this is really important, and it starts in infancy. And so, you'll see here, these graphics are around infancy. I'll just highlight them here now. There we go. So, the child is providing a signal of hunger and fullness, and their parent is recognizing and responding to these cues. And that means caregiver as well. So, those of you who serve infants and young toddlers, you're feeding them on demand, so you're responding to those cues of hunger and satiety. And you're building that relationship. The child knows that their needs are going to be met consistently. 

OK. So, some of the benefits of this responsive feeding -- I think we've talked a lot about already. It supports self-regulation, and that is that the child is looking and being supported and to look at those internal cues of hunger and fullness, that they're being encouraged to do that. And I want to make sure I do go into actual, some suggested things to say to be able to do this here in just a couple of slides. And so, it builds attachment, we've discussed. It supports the ability to regulate their food intake into adulthood.

You know, as we started the conversation today on ... Some self-reflective questions, many of us might be able to recognize in ourselves the inability to regulate our food intake into adulthood. That when we eat a little bit more than we need or we stress eat, emotional eat, those things are indicative of our lost skill of self-regulating and looking at those internal cues. So, I'll just briefly go through this, is that hopefully for infants, especially 0 to 6 months they're only being fed breast milk or formula. So, we're not giving them cow's milk or other things in supplement of that. They're being held while they're being fed and fed on demand. What's interesting is that we spend most of our time, especially in our early infancy, only feeding our young children and then putting them back down to sleep.

So, propping the bottle really takes away our ability to bond with them and build the relationship. And I just include this bullet here around no water for the first four months. I read anywhere between four to six months, but I want to be very clear, because this seems to be a common misconception for families. I will not read all of the hunger and fullness cues to you, but I wanted to make sure that you have them here. What I find really interesting for families, though I hope your staff are able to do this, is that often when I work with a family and I say, "Tell me how your baby tells you that they are hungry?" They can list most of these things here in early infancy. When I say, "Tell me how your baby tells me, tells you they are full," they struggle a little bit more with doing that. And so, that's a good question. If you are conducting a nutrition assessment with families during enrollment or periodically through program services, having those two questions as separate questions is always really helpful.

And again, I'm not going to read all of these, but we start getting a little bit more advanced in 3 to 6 months, and then we want to talk a little bit about a child is developmentally ready for solids. We recommend around 6 months of age that a child should be introduced to solid foods. 

Usually, those pureed foods that you either make at home or are store bought. And there are specific developmental milestones that we're looking for, for when a baby is ready for solids. So, how are they telling you that they are ready? And I ... Offer you some different ways to talk about them with families. The tongue thrusting reflex is fading, so I wouldn't probably ask that to a family, but I might say something or even sometimes with staff. But if we're putting the food in the front of the mouth, are they pushing it back out with their tongue? Are they able to take the food in so they're not pushing it out with their tongue, and they're able to move it to the back of their mouth and swallow it without choking?

They can sit with some support and have good head and neck control. Those are the milestones that we're really looking for. Andrea, I just want to answer your question here, "For infant feeding, what if the parent requests to mix breast milk with formula in the same bottle?" I don't recommend doing that, because you have a lot of -- and neither does CACFP which you note here, because you have a lot of food safety concerns there.

And it also could be challenging to understand how much they're getting of each and so forth. So, I wouldn't recommend doing it, and I'd want to know why the parent feels that that's important, versus having separate bottles. So, signs of hunger and fullness in middle infancy get a little bit more advanced. And remember, at 9 months is when we're seeing that developmental milestone of the pincher grasp, and so we're seeing those eating habits change at this age.

So, I'm just trying to be mindful of my time so I don't rush Stephanie later on when she's showing the resources. But I want to just speak about our toddlers and preschoolers. What does it mean to have a positive eating environment for a toddler or preschooler? Hopefully you're sitting at the table, you're having eye-to-eye contact with them. You have clear expectations and established routines.

Something I highly recommend if you don't already do in the program setting – and if you do in the program setting, making sure families can do it at home -- is have pictures of your mealtime routine around the meal environment or even in the classroom depending on how you all are set up in terms of, we wash our hands, we set the table, then we eat. We clean up, we have a song, etc. We have pictures of that so we're able to visually cue children to what's coming next.

And then the staff person is able to walk them through some of this as well. And the same thing  here. We're still encouraging our child to listen to hunger and fullness cues, and engaging in a positive give and take conversation style. So, let me move forward, I think my next slide right here. What's really interesting is we often think we're doing this. We think we're checking all these boxes. That I'm sitting down at the same table, I have a very clear routine, I'm very vocal about my expectations. ... And I talk to the children, and we have a nice conversation. But we often say -- and I'm not simply making this up. We pull this from literature and observations of staff. We often use these words: "Eat more of that." "Can you please try one more bite?" And then at home, ... We tend to use food as a reward or punishment. "You have to eat all your spinach before you can have dessert."

So, instead, make sure staff are using words like this. So, your observations should include words like, "Are you full? Have you had enough to eat?" And then my favorite, "What does your tummy feel like? Does it have enough food, or would you like more?" Same thing here for parents. Hopefully, you're not doing this in the program setting, but parents often do this. And it's not an intentional thing. We all do it to ourselves. If I work out, I can have that pop I want or something, or that glass of wine, whatever it may be.

So, we all do this to ourselves, but we need to be very thoughtful of what that is teaching our young children, how it's teaching them to think about food. So, we often say things like, "If you take a bite of that vegetable, I'll let you have dessert," or "If you don't pick up your toys, then you can't have the snack pack you want." Trying to equip parents with things to say -- this is where we need to equip staff with things to say.

Remember in those first few slides, we're all, might be programmed a little bit differently to think about food, and this might be a paradigm shift for us of how we approach foods and how we support young children to approach foods. And again, I won't read all of these to you either, but you will need some patience. I'm probably preaching to the choir here, and I will say early care education staff, wherever you are, you already have a plethora of patience. We've talked about minimizing distractions. Reminding parents that when they're doing this at home, that they are teachers, too. Empowering them to engage their child in some of the learning opportunities we've talked about earlier.

But my last bullet point is probably my most important or my main point, because this is where I get push back from programs. That you're giving children enough time, but not forcing them to sit of course. Thirty minutes for snacks, Forty-five minutes for meals. That can be, or appears to be, a bit burdensome for some programs, but I highly encourage you, especially if you're using your mealtime as part of your lesson plan, that you should have ample time to give children time to eat. So, 30 minutes for snack, 45 minutes for meals. I don't have unfortunately a long time. Yeah, that's way more than we offer. And I feel like a lot of programs have said that, too. And I've even had some say it's just not possible.

But our young children need that much time -- excuse me, I'm a little congested today – need that much time to explore their foods, be willing to try new foods, and have that environment. 

So, if you take nothing away, really go back to your program staff and think about, are there options for adding more time? And it may not initially be 45 minutes for mealtimes, but say you offer 20 or 25, can you offer 30? So, thank you for bringing that up.

So, I don't have a ton of time to talk about food insecurity today, but it does affect the eating environment. And how you organize your eating environment is pivotal to supporting the child with food insecurity. And Jessica, no, I don't encourage young children grazing throughout the day ...For a couple of reasons. One, I want them to come to the table hungry so that positive eating environment I've established they're actually going to eat during. And traditionally, our snacking options when they are grazing tend to be simple carbohydrates. That tends to be more about our cheese puffs and animal crackers and so forth, and that's not just at the program setting, which I don't know if you would have the opportunity to let young children graze, but at home, they carry around the sippy cup of juice or milk all day, and so they are not as hungry when it comes to the table time. So, no, I don't usually recommend grazing. 

So, questions about food insecurity. Is your family able to afford balanced meals? Do they reduce the size of the meals, and they reduce the quality and variety of their diet can be indicative of food insecurity. What's interesting here and why I like to put it in is because I get a lot of questions around, what about the child with a very high BMI, we're talking about two to five, who wants to keep serving themselves more and more food? The portions are out of control, and it's four or five or six servings.

And I usually push back a little bit and say, you might be dealing with a child with food insecurity, and it might really be about anxiety about having enough food. Because even our children with high BMIs can very often suffer from food insecurity. And the eating environment is a great way to support the child with food insecurity with those strong routines, helping them understand there's going to be enough food, and that consistently they're going to get enough food in the program.

So, these are just some sample assessment questions if you do a nutrition -- a nutrition assessment during the program. And even if you don't, it's helpful to identify families who  might be struggling with food insecurity so you can link them to community resources. Of course, of course, don't ask the question unless you've got resources prepared to share with them. And if there aren't any in your community, it still might be helpful to know in case there is some way to support the families. OK. I'm going to turn it over to Stephanie here in just a little bit, but really the best way to understand whether or not your program is establishing the eating environment is to assess the program.

Go in and actually observe what's happening during mealtime environment. ... And there are several validated tools to do that. And Stephanie, my colleague is going to present a self assessment here that will also help you. But make sure you're asking these questions. How do teachers engage children during mealtime? Is it being used as a learning tool? Are they role modeling? And do staff know appropriate serving sizes for the 2 year old or the 4 year old? OK, I want to turn this over to my colleague Stephanie Womack, who will share resources with you. 

Stephanie Womack: Great. Thanks, Florence. All right, so yeah, we just want to be able to go through a couple of resources that we have available today. So, we're just working through some technical stuff there. Thank you. So, hopefully, this is something that you've seen or heard of before. We have the link to it in the links box, and I've already seen a couple of people that have downloaded it or are looking at it.

So, this is the PDF version of the Positive Eating Environment Self-assessment tool that we have. And it's really meant to inform the interactive version that we'll demonstrate a little bit later. But this can be used for simple staff discussions, for policy planning, and really focus on those baseline behaviors at mealtime. So, I thought that someone asked about what's the difference between this tool and the Knapsack. So, the Knapsack really is a really formal assessment tool, and this is really meant to look at basic practices. Obviously, you're welcome to use some of those other tools. But we just want to walk through this version of the tool and also walk through the interactive version so you can see how they complement each other. 

So, in the PDF version, you can see it's very brief. It's meant to be user friendly. Really designed to help you evaluate the availability of healthy and nutritious foods and the mealtime environment itself. So, there are five sections to the tool, and we're looking at fruits, vegetables, beverages, menu selection, and the ECE provider's role during this meal and snack time. And you can see under each statement there, there are three options for you to assess the level of frequency of activity in those areas or behavior.

So, you have the option for frequently, sometimes, or never. And then you can also see that last box for ready to get started, which can really help you determine your area of focus when you're having staff discussions or you're thinking about changing some policies to help support you in these areas. And that'll become really important when we get to the interactive version of the tool to help guide you through it. There's also a planning worksheet for this PDF version of the action plan, where you can see there's some sample language about objectives you might want to consider, some action steps, how does the program environment need to be set up to support this and additional policies, and also who's responsible.

So, all of those are important steps when thinking about taking a plan or working through a plan with your staff and other folks who might be involved to really outline what you're going to do and assigning who's going to be responsible and making it tangible with some data. So, you can find these resources on ECLKC, and also we've linked to these resources as we've mentioned in the links box here in the webinar platform. But you just go there, enter the positive eating tool in the search box, and then you'll get a list of resources including the PDF.

And it will take you to the interactive version of the tool as well.

So, that's what we want to spend the rest of our time kind of highlighting and going through. 

And I know we're getting close to time, and I want at least some time for questions as well. So, we're just going to do a brief demonstration. And again, this is reflective of the PDF version of the tool. But this tool really allows you to actually go into detail to learn about some of those best practices related to the topic that we've already talked about, related to fruits, vegetables, beverages, etc. And really think about and plan some important next steps towards creating a more positive eating environment.

So, when you get to the tool, you'll also see when you enter you have the ability to link back to the PDF assessment right there in the interactive tool. And we really do encourage you to complete that PDF version first, because it really will help you focus on what you think is the best area for your program at that time and be able to move through the tool a little bit quicker. But it doesn't ... Mean that you have to rush through the tool, because you can always go back to the interactive action plan.

On the next page, you'll just see some basic introductory information and how the tool works. 

And we also encourage you to choose one section at a time to work through and work on, and that's really for two reasons. One, because change takes time, and two, because you can continue to revisit the tool. We really encourage you to ... Use the PDF to take a basic assessment and then use the interactive action plan to see where you are, actually make that plan, and then maybe revisit it. If you have some goals around one month, six months, revisit the action plan to see how you're doing and where you are. So, it's really meant for you to continue to go back and use over and over.

You'll be asked to select what type of program most accurately represents how you see your program, because the tool does tailor slightly based on program type. So, that's an important step to take as well. And just for the sake of moving through, we're going to choose center based care here. You click continue. And also for the sake of moving through, we are just going to select fruits here. Let's just say ... And what will drive what you work on is if you are looking at the PDF version of the tool, the areas where you marked never and ready to get started, those are the areas that you want to focus on when you go to your action plan. 

So, we'll choose fruits here. And you'll see that once you make a selection for what you want to work on, you'll get some additional information about the value of fruits there and some instructions on how to start creating your plan.

So, then the next section is where you get a little bit more background information on the standards that inform this particular section, and the recommended practices are from Caring for Our Children, Head Start Program Performance Standards, and Child and Adult Care Food Program -- CACFP. And if you click on this little hyperlink here, "about these standards," you'll get a pop up box that just gives some high level information about those standards. Sorry, I went to fast there.

So, if you go back to that page where the standards are, what you'll notice is there is a little triangle to the left of all of the content. And what that allows you to do is there's a dropdown list of content, and that's really throughout the tool that you'll notice those little triangles. And if you click on those, it will expand the content. So, then you'll be able to click on the different recommendations and recommended practices within those  resources we've listed related to the topic that you've chosen.

So, for fruits, those are the standards that we've pulled out. And the other thing that we want to just note is that when you click on a link within the tool, it will open in a separate window and give you the ability to toggle between the new window and the tool, so you won't lose your place in the tool.

So, again, going back, you can toggle back to the tool, and you're here on the standards page.

And then here is where you'll start to build your action plan based on the areas that you want to work through. And there are three categories of recommended practice, looking at program policies, menu selection, and the program environment. 

So, again, you'll see the triangles to the left of each header expand to give you more content. 

And when you expand the content, you're provided with both some education and information, as well as example policies that you might consider for your action plan. Also note the plus sign  to the right of the content. This is what allows you to add that content to your final action plan and also will give you the ability to add notes. So, if there's something specific that you want to make sure you note for a particular section, this is where you have the ability to add notes. And this will pop up on the screen. You can add comments, specific questions you might have or things that you want to bring up with SAP. So, this is just the place for you to put all of the notes that you have, and make sure you click the save, and then exit out of that.

So, now you'll see that the icon has changed. So, now you have the ability to edit the note that you added or delete this content from the final action plan. So, the little pencil is the edit, and the red circle there is to delete that from your action plan. So, I also want to point out that throughout the tool and in several sections, you'll notice live links that provide additional information or resources on that particular subject.

So, these links will work in the same way as the standards. The resources will open in a different window, but you'll be able to keep your same spot in the tool. And this is just, again, throughout the tool, several areas for additional learning, additional resources. So, be sure to click down on those expanded content so you can see the additional learning and content in those.

Again, just making sure to show you that there are all sorts of example objectives and policies throughout the tool that you can simply add to your final action plan. So, that you don't have to start from scratch. That's the main thing. This is an opportunity for you to think through, you know, what are really the areas that you want to work on and what are some things that are manageable for you and your program staff to work on to be able to improve these areas when it comes to the mealtime environment. And lastly, here's where you will be able to print or save your action plan. So, you can just print it right out if you want. Or if you want to save it and come back to it, you have the ability to do that. You have ... The ability to save the PDF, but when you exit the tool, you do have to start over.

So, you can't save your place, per se, but you can either print it here or save it as a PDF here.

And here is just a quick look at what your final action plan could look like with all of your notes and everything. So, they will all be there. You will have all of the information related to the section that you have decided to work on with your notes as well. So, with that, I think we have about five minutes left for questions, comments, or anything in the chat box. For additional resources for folks who are ... I'm seeing some questions, so we'll just open it up. Thank you. 

Florence: Well, Stephanie, if you don't mind taking this question, Loray asks, "So the actual plan must be completed in one seating, or do you have to recreate it?" Stephanie: Yes, so ... It is designed to be completed in one sitting. You can't save your place, so if you leave off of the tool, you can't go back to the exact same place that you were at unless you opened another window. You can toggle between it, but once you exit out of the window that the tool is in, you won't be taken back to your exact place. So, if you can't complete it in one sitting, it would probably be best to save it where you are, and then you can easily click back through it and go back to where you were.

Florence: And I'll just add, we're hoping that ... Or we encourage you, anyway, to only do one section at a time just to make it more manageable. So, hopefully it's helpful in that regard, and  you're able to save the PDF so you can remember what you had said and so forth. And then I think I had seen earlier from Sheryl a question about local foods, incorporating local foods. 

So, in the self-assessment, you won't see a specific question on whether or not you use local foods, but you'll have some links in the action plan tool to consider around encouraging local foods when applicable. If that helps answer your question, Sheryl. OK, so I've got a couple minutes. ... I'm just reading some of these questions here. OK. ... One question here is, "My program struggles with family-style meal service in the school system. I'm assuming it's a lack of or inability to implement classes where family style is looked down or unavailable." 

So, the school system is a sticky question to answer. Every school system does it a little bit differently. Our schools and our classrooms tend to be much, much bigger than what we can offer in early childhood. And so, it is a lot harder to do family-style meals. And then the staff supervision is completely different. So, if that's something you're really interested in working with your public school system to implement more of, kudos to you. Absolutely get involved and help them. I will say, it would be probably more very small implementable things in terms of can they offer more time? There was a lot of chat box conversation around school systems don't offer nearly enough time for young children to eat and so forth, or the menu 
development and some of those healthy foods that they offer. Oh, OK. I'm sorry. Your program is housed there. We vend the food from them.

So, it's very difficult, especially from the service perspective, that they don't provide the food in the same way, and even how they probably do some reimbursement. So, I actually just got this question last week. And I would highly suggest that you work with your CACFP provider at the state level. And I even think we have someone here on the line. I saw a brief mention. They had a really good point, I'm sorry I wasn't able to read it yet, around breast milk and formula sharing. But I would suggest that you work with them, because that has to do with how your funding is linked within the school system and then how you all are using the same food service provider.

So, it's kind of a nuanced approach that I'd encourage you to try to work with them. OK, and then it is right at the hour, so if I didn't answer your question, I apologize. We'll try to get all the questions here, and I'll make sure that you get some answers as we move forward. April, do you want me to turn this back to you? 

April: Not much to say, but thank you both. Thank you, Stephanie, and thank you Florence for this wealth of information. I'm sure everyone learned so much. I learned a little even though I've heard this before. So, thank you again. And we will keep the platform open for just a few minutes. If you can go down to the little box that says, "links" and take that feedback survey, we'd appreciate getting everyone's feedback on how things went. And if you go to, "files for download," that's where you'll get your webinar certificate. 

So, we'll leave the platform open for just a few minutes so that everyone can have access to those two things. If you have any trouble with either of those and we've already closed the platform, just send us an email at health at ecetta dot info, and that is the conclusion of our presentation. Thank you, everyone.