Health Manager Orientation Guide

Nutrition and Physical Activity

A boy and girl serving themselves food.Nutrition services are a core part of Head Start requirements. The Head Start Program Performance Standards (HSPPS) includes requirements for programs on what and how to feed children. Head Start staff and families identify the nutritional requirements of each child based on their height, weight, cultural preferences, disabilities, allergies, or health conditions. Head Start programs identify what each child needs and supports families to feed and care for their child based on personal data.

Nutrition and physical activity are important parts of a healthy lifestyle. Eating nutritious foods helps everyone get the nutrients their bodies need to avoid illness and stay active. Age-appropriate, moderate-to-vigorous movement and a healthy diet contribute to a child’s physical growth, brain development, and school readiness skills. Health managers and other program staff can use activities and resources to help children learn and keep healthy habits. Staff also help families access and prepare affordable, nutritious foods.

Each Head Start program must have a nutrition program that meets U.S. Department of Agriculture (USDA) requirements and meets the feeding needs of each child. This includes children who have disabilities or who have special diets. The nutritional services at Head Start programs serve a variety of foods, taking into consideration the ethnic or cultural preferences of the child to increase each child’s food experience and willingness to try new things. Programs encourage — not forces — each child to taste the food offered, and is careful never to use food as a reward or punishment.

A group of children eating at a long table.Head Start programs are required to offer meals and snacks that make up 1/3 of the child’s daily nutritional needs for part-day services, and 1/2 to 2/3 of the child’s daily nutritional needs for full-day services. The USDA sets the minimum standards for meal patterns. The Dietary Guidelines for Americans is the basis for the nutrition standards for meals and snacks. The standards list the food components, including portion size, by age. Programs must serve foods that are high in nutrients, yet low in salt, sugar, and fat.

Early Head Start staff work with families to identify nutritional requirements for infants and toddlers too. Discussions about current feeding schedules, the types and amounts of food served, meal patterns, and even how to introduce new foods can help new families meet their child’s needs.

To build healthy eating habits, all toddlers and preschool children benefit from eating “family style” with classroom staff and volunteers, sharing the same menu as nutritional and dietary requirements allow. Children also benefit when they help prepare basic foods and learn about healthy eating.

The Head Start program’s nutritional services are funded by one or more of the USDA Food, Nutrition, and Consumer Services (FNS) Child Nutrition Programs such as the Child and Adult Care Food Program (CACFP), the National School Lunch Program (NSLP), and the School Breakfast Program (SBP). Programs can use other Head Start and Early Head Start funds for costs that the USDA program doesn’t pay for.

Head Start Health Services Competencies

  • CFH-9 K Know about food safety and sanitation practices (e.g., food preparation, cross contamination, temperatures, and storage including breast milk and infant formula).
  • CFH-10 K Be familiar with individual child and adult nutritional needs, preferences, and special dietary requirements including feeding recommendations for infants (e.g., breastfeeding, introduction of solids) and young children (e.g., food allergy or intolerance, portion size, BMI).
  • CFH-11 K Know about physical activity and screen-time recommendations for infants, toddlers, and preschool children, and physical activity recommendations for adults.

HSPPS Related to Nutrition and Physical Activity

State, Tribal, Territorial, and Local Requirements

Besides following the mandates in the HSPPS, Head Start programs must follow their own state, tribal, or territorial requirements for feeding and physical activity. Many jurisdictions have guidelines, regulations, and codes on food safety, sanitation, permits, postings, certifications, etc. Head Start programs also need to follow rules about professional licenses for their staff and contractors.

Caring for Our Children

Social Determinants of Health and Equity Considerations

Mother and child buying produce in a supermarket. Food security measures how much access the households in a community have to nutritionally adequate and safe foods to help people have an active, healthy life. People who have weaker economic stability, have limited access to quality education, or live in unsafe and under-resourced neighborhoods are more likely to have food insecurity. These conditions can lead to unhealthy eating patterns and higher levels of diet-related diseases.

The neighborhoods people live in have a major impact on their health and well-being. Many low-income and historically underserved neighborhoods are food deserts (areas without stores that sell fresh, affordable, and nutrition foods). These neighborhoods may also be classified as “food swamps” because of the many corner stores and fast-food restaurants selling unhealthy foods.

An active lifestyle is harder in a community that doesn’t have places to walk or bike, or that has limited greenspace. It’s also harder in a community with violence that doesn’t allow families to safely do outdoor activities.

SDOH are defined as the conditions in the environments where people are born, live, learn, work, play, worship, and age.

To begin to address health disparities and achieve health equity, health and nutrition managers can help all program staff recognize the social determinants of health (SDOH) that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH reflect structural and systemic inequities that make it harder for children and families to make healthy choices.

The program can regularly:

  • Screen each family’s level of food security.
  • Help eligible families apply for food assistance programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP).
  • Partner with community gardens, local food banks, and farmers markets to increase families’ access to fresh, high-quality produce and groceries that are free or at lower cost.

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