Regulations varied considerably from state to state, and within each state, regulations often varied for different types of child care settings (). Overall, CCCs were the most heavily regulated, followed by LFGHs. SFHs had the fewest regulations. CCCs had the most specific and strongest regulations. Many states exempted SFHs from licensing requirements, opting instead to allow voluntary registration.
State Licensing Regulations Related to Nutrition, Physical Activity, and Media Use for Preschool-Aged Children in Child Care Facilities, 50 US States and the District of Columbia, January-April, 2006a
Nutrition regulations varied among states. The most common regulation was for child care providers to follow the federal Child and Adult Care Food Program (CACFP) (17
) or similar meal pattern requirements. Twenty-nine states require this regulation for CCCs, 24 states require it for LFGHs, and 20 states require it for SFHs.
Just 2 states, Michigan and West Virginia, specify that CCC menus should be consistent with the Dietary Guidelines for Americans. Nineteen states' CCC licensing regulations specify the number of meals and snacks to be offered by defined, comprehensive increments of time in care, up to a full day. Eleven states outline such requirements for LFGHs, and 9 do so for SFHs. An alternative approach adopted by some states is to require a specific proportion of daily nutrition needs per meal or by length of time in care (14 states required this for CCCs, 8 for LFGHs, and 6 for SFHs).
Twelve states had regulations prohibiting or limiting specified foods of low nutritional value in CCCs, as did 7 states for LFGHs and 4 states for SFHs. No states provided specific nutrition standards or criteria, such as limits on total or saturated fat or maximum number of calories. Four states, all located in the southeastern United States, regulate vending machines in at least 1 of the 3 child care settings. Alabama, Georgia, and Louisiana prohibit vending machines in areas used by children, and Mississippi requires foods sold in vending machines to meet overall nutrition standards. Georgia and Mississippi apply these same regulations, respectively, to the LFGH setting. The only other state to regulate vending machines is Arkansas, whose regulation applies only to school-aged children.
For physical activity, states were most likely to require large muscle or gross motor and daily outdoor activity time for children in care. Thirty-nine states required that the program of activities in CCCs engage children in large muscle or gross motor activities or provide activities or equipment that focus on large muscle or gross motor development. Half (n = 25) of the states required this for LFGHs, and 19 states required this for SFHs.
Roughly three-fourths of the states (n = 36) required that children have daily outdoor activity time in CCCs, as did approximately half of the states for LFGHs (n = 27) and SFHs (n = 24). However, only 9 states set specific minimum lengths of time that children should be outdoors each day. Of these states, most required at least 1 hour each day. CCC regulations were most likely to include a quantified minimum amount of time. DC and Mississippi require the greatest amount of outdoor time for children, specifying that children in a full-day program shall have at least 2 hours of outdoor activity per day and that children in a part-day program shall have at least 30 minutes per day.
Licensing regulations in 10 states specify that children shall be engaged in vigorous play or physical activity (we coded for any inclusion of the term vigorous). Eight states require vigorous play or physical activity for CCCs, 4 require it for LFGHs, and 2 require it for SFHs. Alaska and Hawaii apply this regulation to all 3 child care settings. No states used the term moderate to describe the appropriate level of physical activity.
Two states, Alaska and Massachusetts, quantify the amount of time that children should be engaged in physical activity. Alaska's regulations mandate that "opportunities be provided for a minimum of 20 minutes of vigorous physical activity for every 3 hours the facility is open between the hours of 7:00 am and 7:00 pm." Massachusetts's regulations call for "thirty minutes of physical activity every day." Alaska's regulation pertains to all types of child care settings; Massachusetts' regulation applies only to SFHs and LFGHs.
States that addressed media use in child care settings included a range of media in their licensing regulations. The most frequently mentioned were television, videos, video games, and computers. Approximately one-fourth (n = 14) of the states address, in a nonquantified manner, the appropriate inclusion of media in the child care program of activities in at least 1 care setting. Examples include specifying that media use shall meet a defined educational objective, be used only as an enhancement to the daily program, not be used as a substitute for planned activity, or be "limited" or "not excessive." Many states with media regulations specify that alternative activities should be available for children who do not wish to participate in media viewing.
Ten states set quantified time limits on screen time per day or per week in at least 1 care setting. Seven states apply this regulation to CCCs, 9 states to LFGHs, and 8 states to SFHs. Most states set limits for screen time at a maximum of 2 hours of use per day, and most applied the same time limit for CCCs, LFGHs, and SFHs. Alaska limits screen time for media exposure to a cumulative sum of 1.5 hours per day but allows an additional 2 hours per day for "computer learning activities." Maine and New Mexico limit screen time to 1 hour per day. Only Vermont sets a maximum number of hours per week in some settings; in CCCs and LFGHs, media use is limited to 5 hours per week. Vermont's SFHs are allowed a maximum of 2 hours per day.