In this first systematic study of child-care centers’ physical activity facilities and outdoor play policies, we found considerable variability in facilities--even within a single county of Ohio--and that per center policies children’s active opportunities can often be curtailed due to inclement weather. This is problematic because only half of the centers had indoor gross-motor rooms where children could be active during inclement weather. Most centers had an accessible playground on-site, but only half had a large space, shade, and a variety of portable play equipment. Less than a third had a hard surface to permit all types of portable play. Compared to other studies of playground environments, a similar proportion of centers had playgrounds,24
and the playgrounds were of comparable size,21
had less fixed equipment21, 25
and more portable play equipment21, 25
and special needs access.24
Insufficient playground and indoor facilities may help explain why preschool-aged children are not getting sufficient amounts of physical activity.10–12
Weather policies permitting playground use also varied considerably, with multiple weather conditions potentially curtailing children’s active opportunities. No center reported allowing children outside in wind chills ≤15°F, the minimum safe temperature per recent guidelines.20, 37, 38
Specifically, only 20% of centers were permitted children to go outside in subfreezing temperatures (<32°F). This would mean roughly 1.5 months that children in this area could not go outside (National Weather Service). Only 43% of centers reported allowing children outdoors during light rain, adding an additional 132 days in which children would not be allowed outdoors (National Weather Service). In sum, the typical weather-related policies at child-care centers in Cincinnati would restrict outdoor play for approximately 179 days (46%) of the year. The 32°F minimum temperature is much higher than the minimum safe temperature for play according to newly released physical activity guidelines for child-care (minus 15°F windchill),20
but is congruent with the local elementary school system’s outdoor play policy. It is not known how these outdoor play policies were developed. To our knowledge, this is the first study of weather-related outdoor policies of child care centers. More research is needed to understand how these policies were developed and how parents’ and teachers’ attitudes about weather (including concerns about children getting dirty or sick when exposed to cold air)31
may influence decisions about outdoor play. This highlights the interaction among policy, provider and parent attitudes. Reducing the minimum safe temperature for outdoor play and providing training about safe conditions for outdoor play could substantially increase active opportunities. Given that we have previously reported that parents do not dress children appropriately for weather and active play,31
pediatric clinicians should consider discussing with parents during well-child checks the importance of: 1) outdoor play for healthy growth and development, 2) dressing children appropriately for play, and 3) working with child care center staff to ensure that children are given adequate opportunities for physical activity.
Centers having more low-income children (receiving subsidized child-care) also reported having poorer quality facilities and more stringent outdoor play policies. Centers with primarily non-white enrollment reported poorer quality facilities. This is concerning because non-white and low-income children may not have safe opportunities for outdoor play near or around their homes,39–42
so the child care center may be their only opportunity for outdoor play. The tuition rate for full-paying attendees was not found to be significantly associated with quality of physical activity facilities or practices, yet most children (65%) were receiving some form of subsidized child care. A potential way to increase children’s physical activity and reduce income and race disparities in physical activity opportunities may be to provide small grants to centers that serve minority and/or low-income children that would enable these centers to establish or enrich safe places for children to be active. Many of the improvements are not costly: e.g., re-configuring an indoor space to allow gross-motor play during inclement weather, addition of shade trees, more portable play materials, or a hard surface to the playground. The grants should be directive, though, because the most common change that respondents wanted to make to the playground was to add more fixed play equipment, which is both very costly and inversely
related to children’s physical activity levels. 21, 23
Such grants could offer educational opportunities about cost-effective strategies to increase children’s physical activity. The reason for the relation between lower income child centers and more stringent outdoor policies is unclear, but perhaps better training or subsidies to provide warm or waterproof clothing to children could help centers have a less strict weather-related policy regarding outdoor play.
Centers that were NAEYC-accredited reported more practices associated with physical activity promotion, which may be related to NAEYC requirements that directors be trained in early childhood development. Centers that were not-for-profit also reported a greater number of weather conditions under which children were permitted to play outdoors. These associations may be helpful in identifying which types of centers may benefit from policy training about safe outdoor weather conditions for play.
Our results may not be generalizable to other regions and were based on self-report rather than observation of actual practices. However, study strengths are it was a census of all licensed full-time child care centers within this region, not centers of a particular type (e.g., Head Start), and it achieved a high response rate. This allowed us to examine demographic predictors of physical activity policies and facilities within the sample. We focused on facilities and outdoor play policies because directors may not reliably report their staff’s behavior. Our survey was designed to use open-ended questions and volunteer responses to minimize social desirability bias. Lastly, as there have been few previous studies of the quality of child-care physical activity facilities or weather-related policies for playground use, we developed summary scores for these two domains de novo. The individual items in the scores were selected from predictors identified in the literature and our formative research. Further research is needed to identify the factors associated with higher levels of physical activity.
This study contributes to the sparse but growing literature of child-care center physical activity environments by reporting on the prevalence of “typical” child care policies and environments, and the extent to which they vary even within a single county. Additionally, it highlights the potential large impact of weather, outdoor-play policies, and caregiver behaviors related to weather in influencing children’s active play opportunities.