Eat move talk toolkit

Toolkit

November 2016 Georgia Department of Public Health

Authors

Amy Becklenberg, MSN, APRN/FNP-BC

Audrey Idaikkadar, MPH

Instructor

Eat. Move. Talk! Program Manager

Nell Hodgson Woodruff School of Nursing

Georgia Department of Public Health

Emory University

Christi Kay, MEd

Ashley Darcy-Mahoney, PhD, NNP, FAAN

President

Assistant Professor & Director of Infant Research HealthMPowers, Inc.

George Washington School of Nursing

Nitza Vega-Lahr, PhD

Dana Geller, MATESOL

Director of Dual Language Learners Program

Family Literacy Coordinator

Rollins Center for Language and Literacy

Friends of Refugees

Atlanta Speech School

Acknowledgments
The Office of Minority Health's Special Partnership to End Health Disparities has provided a five-year grant for this early child care and education professional development program. The development of this program has pulled together experts and organizations that specialize in nutrition, physical activity, Language Nutrition, early child care and education, and culturally and linguistically competent services. The authors thank Suzanne Glenn, Chinwe Ejikeme, Maria Fernandez, Kelsey McDavid, Jean O'Connor, Kia Powell-Threets, Kimberly Ross, Chris Stewart, Emily Anne Vall, Arianne Weldon, and the following organizations:

Atlanta Speech School atlantaspeechschool.org
Emory University School of Nursing nursing.emory.edu
Friends of Refugees Refugee Family Literacy Program friendsofrefugees.com
Georgia Coalition for Dual Language Learners nvegalahr@atlspsch.org
Georgia Department of Public Health dph.georgia.gov

Georgia Department of Early Care and Learning/Bright From the Start decal.ga.gov
Georgia Early Education Alliance for Ready Students geears.org
Georgia SHAPE georgiashape.org
Get Georgia Reading Campaign --Georgia Campaign for Grade-Level Reading getgeorgiareading.org

This publication was supported by Cooperative Agreement 5 STTMP151104-02-00 from the U.S. Department of Health and Human Services Office of Minority Health (OMH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of OMH.
For more information in regards to the Toolkit and/or the associated training contact Chronic.Disease@dph.ga.gov.

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Georgia Department of Public Health

Table of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Eat: Healthy Eating General Information on Healthy Eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Kids in the Kitchen.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Tips for Healthy Eating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Cultural Considerations in Nutrition and Food Preparation. . . . . . . . . . . . . . . . . . . . . . . . 11 Conversation Starters: Healthy Eating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Developmental Guidelines and Behavioral Milestones: Healthy Eating....................... 15 Success Story: Eat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Move: Lots of Movement General Information on Movement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Conversation Starters: Movement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Healthy Tips for Active Play.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Developmental Milestones: Movement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Success Story: Move. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Talk: Language Nutrition General Information on Language Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Language Nutrition Skills Checklist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 13 Easy Ways to Practice Language Nutrition at Home. . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Conversation Starters: Talk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Developmental Milestones: Language and Communication. . . . . . . . . . . . . . . . . . . . . . . 30 Benefits of Bilingualism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Success Story: Talk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Additional Professional Development Opportunities. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Additional Resources.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Next Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

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Introduction
Welcome to Eat. Move. Talk!
As educators of young children, it's important to help children in your care grow up to be healthy and able to succeed in school. Good health and educational success are deeply connected. Children that are healthy are able to learn better. Children who have positive experiences in learning and school, have healthier lives. This connection is also important for the future since academic success is linked with more stable employment, higher income and longer healthier lives.
Research over the past decade has consistently concluded that children who eat well and are physically active learn better.
The opposite also seems true. Poorly nourished, overweight, sedentary or hungry children tend to have weaker academic performance and score lower on standardized achievement tests over time.
In addition to healthy nutrition and physical activity improving a child's ability to learn, research has shown that early language exposure is the single strongest predictor of third grade reading proficiency.
Reading proficiently by the end of third grade is an important indicator of later academic achievement, including the likelihood of graduating high school, and health and economic outcomes.
The most effective action early childhood educators and families can take to optimize outcomes for their children is to integrate healthy eating, movement and "talk" with their babies/children.
Language Nutrition is the use of language that is sufficiently rich in engagement, quality, quantity and context that it nourishes the child's brain, social skills and language development. Language Nutrition includes not only talking, but reading books, telling stories and singing.
Georgia ranks 40th in health status, overall. Improving both health outcomes and the potential for high educational attainment is critical to improving population health and overall lifelong health outcomes in Georgia.
Early childhood represents one of the most important opportunities to address lifelong health since an estimated 360,000 young children each year are cared for in licensed early childhood education settings in the state of Georgia.
For these reasons, we have developed Eat. Move. Talk! After completing this training, we hope you will be empowered to lead the way to healthier eating, more movement and enhanced Language Nutrition in both your early care setting and in the homes of the children you care for and teach. We believe that this is an extraordinary opportunity to increase learning and to improve long term health outcomes and wellbeing for our children.
Thank you for joining us in this exciting work!

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Georgia Department of Public Health

How to Use This Manual
We have divided this Training Manual into three main sections, one for each of our healthy habits:
Each section contains general information on the healthy habit as well as handouts that 1) contain ideas about how to integrate the healthy habit into the center or 2) can be copied and shared with families so they can practice the healthy habit at home. We have also included conversation starters with ways to increase the quality and quantity of words used with children while engaging in healthy habits. And finally each section contains a success story that provides an example of how an early learning care center was able to improve the healthy habit in their environment. Following the healthy habits section is information about additional trainings, resources, and a next steps planning document. The next steps planning document will help you and your colleagues identify ways to increase all three healthy habits at your center, as well as ways to help families so they can consistently practice the healthy habit at home.
Enjoy!

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General Information on Healthy Eating
Eating more fruits and vegetables is important for disease prevention, weight management and ensuring kids continue to eat a healthy diet into adulthood. Most children consume too few fruits and vegetables. In 20072010, 60% of children aged 118 years old did not meet fruit intake recommendations, and 93% did not meet vegetable recommendations.
How much fruit and vegetables do children need daily?

Age Two to Three Years Old Four to Eight Years Old

Fruit 1 cup 1-1 cups

Vegetables 1 cup 1 cups

These amounts are for children who get less than 30 min/day of moderate physical activity, beyond normal daily activities. More active children may be able to consume more while staying within calorie needs.
Source: USDA, www.ChooseMy Plate.gov

Because of the benefits of eating fruits and vegetables and because childhood dietary patterns are associated with food patterns later in life, encouraging children to eat more fruits and vegetables is important. Over the past few years, whole fruit consumption has increased and juice has decreased. However, vegetable intake has not changed.
Early care professionals can make a difference in the amount of fruit and vegetables that children eat and in establishing healthy habits at a young age. Some ways early child care centers can encourage healthy eating are sharing healthy food at meals family-style, preparing healthy snacks as a class, including fruits and vegetables in celebrations, and sending home tips for fruit and vegetable snacking to families.

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Georgia Department of Public Health

Kids in the Kitchen
Encourage the children in your care to try new foods by having them help you in the preparation of snacks and meals. Children are less likely to reject foods that they help to make. Kids feel good about doing something "grown-up." Give them small jobs to do. Praise their efforts.
As toddlers and preschoolers grow, they are able to help out with different tasks in the kitchen. While the following suggestions are typical, children may develop these skills at different ages. Consider incorporating some of these ideas into your center and sharing these ideas with families.

5 Years
All that a 4-year-old can do, plus:
4 Years
All that a 3-year-old can do, plus:

Measure liquids Cut soft fruits with a dull knife Use an egg beater
Peel eggs and some fruits, such as oranges and bananas Set the table Crack eggs Help measure dry ingredients Help make sandwiches and tossed salads

3 Years
All that a 2-year-old can do, plus:

Add ingredients to a bowl Talk about cooking Scoop or mash potatoes Squeeze citrus fruits Stir pancake batter Knead and shape dough Name and count foods Help assemble a pizza

2 Years

Wipe tables Hand items to an adult to put away
(such as groceries after shopping) Place things in trash Tear lettuce or greens Help "read" a cookbook by turning the pages Make "faces" out of pieces of fruits and vegetables Rinse vegetables or fruits Snap green beans

Before 2 Years

Position babies so they can see what is happening Talk about what you are doing in the kitchen Talk about food items Encourage use of spoon and cup

Adapted from United States Department of Agriculture Kitchen Activities. Retrieved at www.ChooseMyPlate.gov.

Tips for Healthy Eating...Even for Picky Eaters
Children may eat only a certain type of food or refuse foods based on a certain color or texture. They may also play at the table and not want to eat. Picky eating behavior is common in children between 2 and 5 years old. Many family members and caregivers worry about what their children eat or do not eat. However, most children get the variety and nutrition they need over the course of the week. As long as your child has plenty of energy and is growing, he or she is most likely eating enough to be healthy. If you have concerns about your child's growth or eating behavior, talk to your child's doctor.
Try the following tips to help you promote healthy eating and deal with picky eating behaviors in a positive way.
Guidelines to healthy eating
Respect the child's appetite or lack of. If your child isn't hungry, don't force a meal or snack.
Don't bribe or force your child to eat certain foods. Don't force your child to clean his or her plate. Serve small portions allowing your child the opportunity to ask for more Encourage water as the drink between meals and snacks. Try to serve meals and snacks at about the same times every day. Minimize distractions by turning off the TV and other electronic gadgets or toys
at mealtime. Don't use dessert as a reward. This sends the message that dessert is the best
food. Consider serving dessert only a few times per week and use fresh fruit or yogurt as dessert.
Trying new foods Your child may not want to try new foods. It is normal for children to reject foods they have never tried before. Here are some tips to get your child to try new foods:
Small portions, big benefits. Let your kids try small portions of new foods that you enjoy. Give them a
small taste at first and be patient with them. When they develop a taste for more types of foods, it's easier to plan family meals.
Offer only one new food at a time. Serve something that you know your child likes along with the new food.
Offering more new foods all at once could be too much for your child.
Offer new foods first. Your child is most hungry at the start of a meal.

How to encourage healthy eating and deal with picky eaters
It takes time for children's food preferences to mature. They need repeated exposure, as many as 10-12 times of the same food, to determine their likes. If you don't make it a big deal, it will usually end before school age. Children's picky eating is often temporary.

Making food fun
Cut a food into fun and easy shapes with cookie cutters.
Encourage your child to invent and help prepare new snacks.
Create new tastes by pairing low-fat dressings or dips with vegetables. Try hummus or salsa as a dip for veggies.
Name a food your child helps create.
Make a big deal of serving "Maria's Salad" or "Peter's Sweet Potatoes" for dinner.

Tips for families
Let your kids be "produce pickers." Let them pick out fruits and veggies at the store or farmer's market.
Have your child help you prepare meals. Children learn about food and get excited about tasting food when they help make meals. Let them add ingredients, scrub veggies, or help stir food.
Offer choices. Rather than ask, "Do you want broccoli for dinner?" ask "Which would you like for dinner, broccoli or cauliflower?"
Enjoy each other while eating family meals together. Talk about fun and happy things. If meals are times for family arguments, your child may learn unhealthy attitudes toward food.
Offer the same foods for the whole family. Don't be a "short-order cook," making a different meal for your child. Your child will be okay even if he or she does not eat a meal now and then.
Be a good role model. Try new foods yourself. Describe their taste, texture, and smell to your child.
Our family ideas to make food fun:___________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Adapted from Choose My Plate Healthy Tips for Picky Eaters. Retrieved from ChooseMyPlate.gov/ preschoolers/ And adapted from Children's nutrition: 10 tips for picky eaters. Retrieved from mayoclinic.org/healthy-lifestyle/childrens-health/indepth/childrens-health/ art-20044948

Cultural Considerations in Nutrition and Food Preparation
It is important to understand cultural differences when working with children and families. The varied diets and eating patterns of different cultures may impact how families shop, prepare meals, and eat. Respecting families' traditions and cultures is important. You cannot assume that your past experiences with a person from a particular culture can be applied to everyone from that culture. It is important to seek more information by asking families questions about their culture and what kinds of foods they may prefer to eat and at what time of the day he/she prefers to eat a large meal. These foods and meals may be different from what you are used to eating.
A Few Meal Patterns:
Mediterranean Meal Pattern Pyramid

http://oldwayspt.org/traditional-diets/mediterranean-diet

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African Meal Pattern Pyramid

http://oldwayspt.org/traditional-diets/african-heritage-diet

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Georgia Department of Public Health

Latin Meal Pattern Pyramid

http://oldwayspt.org/traditional-diets/latin-american-diet

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Conversation Starters: Healthy Eating

Talking Tips
You could say things like:

Cooking
Whether you are cooking for your baby/child, yourself, or the rest of the family, cooking in the kitchen is a daily activity that is full of talking points. Make the most of the time by discussing foods, preparation, and ways your baby/child can contribute to the situation.
"We're making pasta for dinner! Pasta comes in many different shapes. This is spaghetti. It's long and straight. First, we have to boil the water."
"Your sister is setting the table for dinner. You can help too! Would you like to carry your napkin over to the table and give it to your big sister?"

Meal Time No matter how you are feeding your baby/child it's a great time to talk, because baby/child is especially focused on you.
Are you feeling hungry? Let's get you into your chair so you can eat. I'm going to pick you up and put you into your chair. Ready? 1, 2, 3...UP WE GO!" "That was a big bite! Chew it all up before you swallow it. Would you like another bite? No? All done? Okay, we're all done with eating our meal."

At a BBQ or A Picnic
A community BBQ or family picnic is a great time for your baby/child to experience new sights, smells and words. Encourage other family members to take over the talking as well, introducing your baby/child to everyone and everything that's happening around them.
"Mmm, smell that? That's a smoky barbecue smell. It makes me feel hungry. How does it make you feel? Let's go find out what everyone is cooking. Oh! I see some carrots, celery and broccoli. Those vegetables are so good for us."

Talking Tips

Food Shopping
The grocery store is a great place to talk with your baby/child about food, shapes and colors. It's also a good place for you and your baby to interact with other people and each other while you shop.

You could say things like:

"It's apple season! My favorite apples are green apples. Do you see the green apple? Green apples are fresh and tart to eat!
Let's get three green apples. 1, 2,3 green apples go in our cart."
"Ooh, look at all these orange carrots. You love mushed carrots! Would you like to get some carrots today? Here, why don't you hold the carrots while we shop?"
"Those vegetables are so goodfor us."

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Georgia Department of Public Health

Developmental Guidelines and Behavioral Milestones: Healthy Eating
Developmental Guidelines: The First Year
Breastfeeding Exclusive breastfeeding for the first year
B reastfed babies who are breastfed for at least 6 months have a reduced risk of being overweight, developing asthma or allergies, ear infections, and bouts of diarrhea
The duration of breastfeeding also is inversely related to the risk of obesity
Bottle Feeding Practice appropriate bottle feeding practices
Avoid bottle propping Only breastmilk or formula in bottle unless otherwise
directed by physician
6 months
Introduce solid foods around 6 months of age Encourage baby to drink from a cup starting at 6 months
of age Expose baby to a wide variety of healthy foods and textures E ncourage baby to use spoons and fingers to feed
themselves Families recognize hunger and satiety cues
9 months
Offer 2-3 healthy and nutritious snacks per day Continue offering fruits and vegetables after finger foods
are introduced
Healthy Drinks
Babies should drink breast milk or formula for the first year of life
Try to avoid introducing juice until a child is a toddler (1-3 years of age)
If juice is introduced, wait until 6-9 months and limit consumption to 4-6 ounces
Avoid introduction of sugar-sweetened beverages

Lots of parents are surprised to find out that babies who are breastfed for at least 6 months are less likely to be overweight or obese as they get older. Breastfeeding can be a lot of work, but it's a great way to bond with your baby and help him or her stay healthy.
Developmental Guidelines adapted from Infant Food and Feeding by the American Academy of Pediatrics. Retrieved from www.aap.org. Behavioral Milestones adapted from the USDA's Center for Nutrition Policy and Promotion, July 2015.

The preschool years are an important time for developing healthy habits for life. From 2 to 5 years old, children grow and develop in ways that affect behavior in all areas including eating. The timing of the milestones may vary with each child.
Developmental Guidelines adapted from Infant Food and Feeding by the American Academy of Pediatrics. Retrieved from www.aap.org. Behavioral Milestones adapted from the USDA's Center for Nutrition Policy and Promotion, July 2015.

Behavioral Milestones: Healthy Eating for 25 year olds!
2 Years Can use a spoon and drink from a cup Can be easily distracted Growth slows and appetite drops Develops likes and dislikes Can be very messy Can suddenly refuse certain foods
3 Years Makes simple either/or food choices, such as a choice of apples or orange slices Pours liquids with some spills Comfortable using fork and spoon Can follow simple requests, such as, "Please use your napkin." Starts to request favorite foods Likes to imitate cooking May suddenly refuse certain foods
4 Years Influenced by TV, media, and peers May dislike many mixed dishes Rarely spills with spoon or cup Knows what table manners are expected Can be easily sidetracked May suddenly refuse certain foods
5 Years Has fewer demands Will usually accept the food that is available Dresses and eats with minor supervision

Success Story: Eat
Three and Four Year Olds Can Love Spinach... Really!
How do you get three and four year olds to eat raw spinach? With Spinach Flowers, of course!
Teachers at Wee Care Early Learning Center led children in a fun HealthMPowers lesson about spinach that integrates language and math skills. After listening to a book about spinach to learn about its color, shape and texture, students made and showed off their own "spinach flower" creations. Each child received a red plate and chose either a dollop of ranch dressing for a white center or French dressing for an orange one. Using their math skills, each child counted out five spinach leaves and arranged them as flower petals before eating the leaves in order from smallest to largest. Children were given a small squeeze of lemon juice, "rain," for their flowers to try different tastes. To the delight of everyone involved, all of the children tasted the spinach!
The creative Wee Care teachers led children in follow-up activities, including pictures and information sent home to families about the spinach tasting, as well as planning for a spinach salad classroom snack the next day.

"What I like most was how the HealthMPowers' educator helped us learn how to engage the children and make the taste testing hands on."
Teacher, Wee Care Learning Center

General Information on Movement
Physical movement from infancy throughout our lives, plays a critical role in the creation of nerve cell networks which are actually the essence of learning. We also know that physical activity plays a critical role in preventing diseases like heart disease, stroke, and some forms of cancer. Therefore, it is essential that children be allowed to explore every aspect of movement and balance in their environment.
This body/mind connection is critical. For example, we know that children who miss the crawling stage, a cross-lateral movement, may experience learning difficulties later on in school.
National recommendations call for two kinds of physical activity for young children: structured and unstructured. Structured physical activity is led by a teacher, where unstructured physical activity is led or controlled by the child's exploration of movement.
Below are the recommended time targets per day for structured and unstructured physical activity.

Age

Structured

Unstructured

Physical Activity Physical Activity

Toddlers (1-3 years old)

30 minutes

90 minutes

Preschoolers (3-5 years old) 60 minutes

120 minutes

Both structured and unstructured physical activity are important. In structured activity, children learn movement skills that will allow them to be active in a variety of leisure, sports and fitness activities as they grow older. With unstructured physical activity they learn social skills, how to share and relate to other children during active playtime. Providing both types of activity during the day also helps with sleep patterns at night.
According to recent research, children in early care centers typically only get about 10 minutes of structured or teacher led physical activity per day and only about 33 minutes of outside play. Overall, children spend the majority of their time sedentary, with little time spent in activity that raises the heart rate. The more active a child is at an early age, the more likely they will remain active throughout childhood and into adulthood.
Clearly, movement is an area where early care professionals can make a difference. Since today's children spend so much of their time in early care settings, integrating more physical activity into the center day is important for the development of healthy, achieving children.
Considering children learn through movement, using movement as an instructional strategy can also help improve health and learning.

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Conversation Starters: Movement

Talking Tips

Dancing
Using singing, music, and dancing is a fun way to continue talking with your baby/child, while introducing new sounds and movements at the same time. Put some music on and dance around with your baby/child while talking about what you are doing.

Outside Time
Being outside, rather than indoors, provides lots of opportunities to talk about new observations. Watch what your baby/child is attracted to and help them describe their new surroundings.

Bath Time
A lot of babies/children love the bath and since you need to be constantly engaged with your baby/child, there are lots of opportunities to talk. Your baby/child will likely be active and happy in the bath, so use this time to describe their motions and identify their body parts.

You could "Ooh, I love this song. It makes

say things me want to dance! Would you like

like:

to dance with me? Let's dance

together! We can sway our hips

back and forth to the beat. Do you

like that?"

"I see you are bouncing to the music! Do you like this song? Wow! Look at you moving your arms while you bounce! Great movements! You seem to really like listening to this music!"

"Do you hear that? Sounds like birds "The water is nice and warm. Do

chirping and singing in the trees. you like the water? Look at these

Let's flap our arms and pretend we bubbles the soap makes. Bubbles

are flying like birds."

are round and go pop! When we

"Look at all the green grass in front touch them."

of us. Would you like to walk on the "Wow! You are making big splashes

grass? Let's take off your shoes so with your hands! Can you feel the

you can feel the grass under your water splashing all around you?

feet. Ooh, feel that? Let's walk and Great job moving your arms around

run in the grass"

to make splashes!"

Talking Tips

On a Walk
Whether you're in your neighborhood or out in about in the city, walks can be both stimulating and soothing for babies/children. Describingyour surroundings helps your baby/child process what's going on around you and gives them words to describe their feelings.

You could "The city is noisy, isn't it? Do you

say things feel safe? I'm here, you're safe,

like:

we're just hearing the sounds of our

city. Let's keep walking together,

okay?"

"Look at all the mailboxes! This is our mailbox. Let's see if we have any mail today. Ooh, we do! Would you like to hold a piece of mail? Thank you for helping me carry in the mail!"

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Georgia Department of Public Health

Healthy Tips for Active Play
Why is active play important?
Active children are more likely to be happy and feel good about themselves. Children feel proud when they learn a new skill, like how to catch or kick a ball
or ride a tricycle or bike. Active children learn better. Active children are less likely to be overweight. Active children have lower chances of developing diseases like Type 2 diabetes
or risk factors for heart disease. Active play promotes the growth and strengthening of bones and muscles, especially
weight bearing activities like running, jumping and climbing. Active play enhances creativity by playing pretend games.
Children need to be active throughout the day. Active play for children can happen in short bursts of time and can be led by you as the teacher or by a family member or by the child. Active play can include playing on the playground, pretending to be animals, dancing, playing chase with friends, or throwing and catching a ball.
Ideas for families
Encourage the whole family to play together. Let everyone help plan the activities. Focus on fun, not performance. All children like to play. They will "win" when they just
move, have fun and are active daily. Set limits on TV and screen time. Limit TV and other screen time to less than 2 hours
a day, as advised by many doctors. During inactive time, try reading, completing art projects or cooking activities. Be active yourself. It's not only good for your health but it provides good role modeling for your child. Active families tend to raise active children. You influence your child's behavior, attitudes, and future habits. So be more active and limit you own TV watching. Set the example for safety by using proper gear, like bike helmets.

Ideas for indoor and outdoor play
Indoor play Act out a story Pretend to move like different animals Dance Exercise while sitting in a chair (run, jump, hop, etc.) Play follow the leader Balance on different body parts Your ideas: ____________ ______________________
Outdoor play Play catch with a soft ball or bean bag Take a color walk where you look for different colors Garden Kick a ball Ride a tricycle or other Play shadow tag try to catch your shadow Your ideas: ____________ ______________________

Adapted from Choose My Plate Healthy Tips for Active Play. Retrieved from www.ChooseMyPlate.gov.

Development Milestones: Movement

5 years

Stands on one foot for 10 seconds or longer Hops; may be able to skip Can do a somersault Uses a fork and spoon and sometimes a table knife Can use the toilet on his or her own Swings and climbs

4 years 3 years
2 years
18 months/ 1 years
1 year 9 months 6 months

Hops and stands on one foot up to 2 seconds Catches a bounced ball most of the time Pours, cuts with supervision, and mashes own food
Climbs well Runs easily Pedals a tricycle (3-wheel bike) Walks up and down stairs, one foot on each step
Stands on tiptoe Kicks a ball Begins to run Climbs onto and down from furniture without help Walks up and down stairs holding on Throws ball overhand Makes or copies straight lines and circles
Walks alone May walk up steps and run Pulls toys while walking Can help undress herself Drinks from a cup
Gets to a sitting position without help Pulls up to stand, walks holding on to furniture ("cruising") May take a few steps without holding on May stand alone
Stands, holding on Can get into sitting position Sits without support Pulls to stand Crawls
Rolls over in both directions (front to back, back to front) Begins to sit without support When standing, supports weight on legs and might bounce Rocks back and forth, sometimes crawling backward before
moving forward

4 months

Holds head steady, unsupported Pushes down on legs when feet are on a hard surface May be able to roll over from tummy to back Can hold a toy and shake it and swing at dangling toys Brings hands to mouth When lying on stomach, pushes up to elbows

2 months

Can hold head up and begins to push up when lying on tummy Makes smoother movements with arms and legs

Adapted from CDC Developmental Milestones checklists. Retrieved from http://www.cdc.gov/ncbddd/actearly/pdf/checklists/all_checklists.pdf

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Success Story: Move
In 2015, Little Ones Learning Center completed a healthy eating and physical activity self-assessment and based on their results decided they wanted to increase teacher-led physical activity for their children. With no trained physical education staff and a shortage of outdoor equipment, Early Childhood Program Administrator Wande Okunoren-Meadows knew that some major changes had to be made. She partnered with HealthMPowers, a non-profit organization devoted to promoting healthy habits and transforming environments where children live, learn and play.
Through trainings and on-site visits, HealthMPowers' health educators demonstrated physical activities that can be incorporated into a classroom setting and provided resources. The staff and children were fully engaged in the exercises, and the classroom teachers noted that the lesson spurred several new ideas to integrate physical activity into their daily routines.
Encouraged, Ms. Okunoren-Meadows made it her personal goal to increase the physical activity of the children by making the following changes:
Purchased more outdoor physical activity equipment such as tether balls and poles, bouncing balls, and trikes
Hired a part-time yoga instructor in addition to the existing part-time dance instructor
Incorporated indoor movements taught by HealthMPowers into math, science, and literature lessons
Supported teachers in their efforts to lead children in physical activity games and to integrate physical activity into the daily classroom routine
The most significant result of this initiative was that the teachers now have the knowledge and resources necessary to lead children in physical activity throughout the day. The yoga instructor has taught the children balance, flexibility, and controlled movement. Ms. Okunoren-Meadows has also observed an increase in both student activity and teacher engagement in outdoor play.
"During the training I enjoyed learning that through certain techniques, even small and simple ones, you can get the children to fully engage and participate with different movement exercises," stated one teacher. HealthMPowers' guidance, combined with the efforts of the Little Ones' staff, has provided classroom teachers with the resources to create a more active learning environment for their students. These changes will continue to benefit the center for years to come.

"The more physical activity events and trainings in which teachers participate, the more they become engaged and staff buy-in increases. It's such a great thing when teachers willingly incorporate physical activity into more than just outdoor activities."
Ms. Okunoren-Meadows

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General Information on Language Nutrition
Language Nutrition is the use of rich and abundant language, beginning before birth, to nourish a child's language, social, and brain development. This not only feeds the child's brain, but helps to develop their vocabulary and their ability to comfortably interact with others. Reading, singing and telling stories are also ways to enhance Language Nutrition.
In addition to healthy nutrition and physical activity improving a child's ability to learn, research has shown that early language exposure is one of the strongest predictors of third grade reading proficiency.
Reading proficiently by the end of third grade is an important indicator of later academic achievement, including the highest predictor of graduating high school and significantly impacts health and economic outcomes.
Back and forth interaction, also known as serve and return, is the best way to advance language acquisition and will teach young children how conversation works. Avoid using TV, digital games or audio recordings for language development. These techniques do not have the same benefit as adult-child language interactions.
Language Nutrition is effective in any language. Teachers should encourage families who speak a language other than English at home to speak with their children in their home language, or the language they feel most comfortable speaking, so they can be empowered to be their child's best teachers. All babies have the ability to learn more than one language, and learning and developing in two languages has many benefits for children. It allows them to maintain close ties to their families and culture, and it makes their brains very active and flexible, and leads to increased job opportunities as adults.
The most effective action early childhood educators and families can take to help create a bright future for their children is to talk with their babies/children. Early childhood educators can model Language Nutrition for families so that families are empowered to talk, read, sing and tell stories with their babies and children at home as well.

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Language Nutrition Skills Checklist
Connect q Get on the child's level q Greet the child first (use the child's name) and pay attention to what the child is doing- connect! q Use eye contact q Use touch, gestures, facial gestures and a loving tone q Use child-directed speech - Song-like tone and higher pitch (i.e. "How are YOUUUU?")
Take Turns q Ask questions pause allow child to answer and/or answer yourself q Use back and forth communication, giving turns to infants and toddlers, even before they can talk q Short, simple and complete sentences q Use lots of interesting words and repeat! Repeat! Repeat! q Explain word meanings
Keep Talking q Follow the child's lead q Narrate your actions and the child's actions and emotions q Respond to the child's attempts to communicate- verbal and nonverbal q Keep asking questions or interacting pausing- and allowing child to answer in his or her own way q HAVE FUN!

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Georgia Department of Public Health

13 Easy Ways to Practice Language Nutrition at Home
1. Begin talking with your baby/child before she or he is born. Your baby/child can hear your voice and by the time your baby/child is born, he or she is already equipped to learn language.
2. Your baby/child begins to learn language before birth. Fetuses hear and respond to sound. Once your baby/child is born, your baby's/child's brain is forming connections with every word you say even though he or she cannot talk yet. This is because the brain grows very rapidly in the first three years of life.
3. Talking with your baby/child makes your baby/child smarter by building your baby's/child's brain. Like a house your baby/child needs a strong foundation for future learning to be built upon. Language provides the foundation for a lot of learning to take place, including learning to read later on!
4. Talk with your baby/child in the home language, or the language you are most comfortable using to ensure rich language exchanges. The home language is the language you would say "I love you" and the language you are most fluent in.
5. Talk with your baby/child using parentese or child directed speech. Parentese consists of unique speech features including a high pitch, melodic tone with varied intonation and elongated vowels.
6. Repeat words and short simple sentences over and over again to help your baby/child learn vocabulary.
7. Ask your baby/child questions and encourage your /child to answer with coos, babbles, and eventually words. The serve and return in language interactions makes a difference in your baby's/child's brain.
8. Narrate daily activities to the baby/child, such as changing diapers, feeding, getting dressed or ready for bedtime. Describe to your baby/child what you and your baby/child are feeling and doing.
9. Respond to your baby's /child's lead. Tune into what your baby/child looks at and expressions he or she makes.
10. Encourage others who spend time with your baby/child to talk with your baby/ child, including baby sitters, early child care and education staff, hospital and clinic staff, friends, and grandparents.
11. Talk with your baby/child as much as you can, whenever your baby/child is awake. Every word your baby/child hears is critical for his or her brain development and learning.
12. Introduce new vocabulary through singing, reading, telling stories, or as you go about your daily activities. Your baby's/child's brain forms a connection for each word he or she hears.
13. Avoid use of TV or music recordings for language development. Language interactions between adult and child make a difference and TV and recordings do not have the same benefit. Baby's/child's brain forms many connections with every interaction he or she has with you.

The most effective action families can take to increase their baby's/child's educational success and opportunities in life is to talk with their babies/ children. Make your promise to talk with all babies!!!

Adapted from Talk With Me Baby's TALKING WITH YOUR BABY MAKES YOUR BABY SMARTER. Retrieved from www.TalkWithMeBaby.org.

Conversation Starters: Talking

Talking At Home
Talking Tips

Reading

Play Time

Even though your baby/child can't Your baby/child is constantly read yet, introducing books and learning and play time is a wonstories is an important part of their derful time to talk about colors, early literacy. You don't have to shapes, actions, and feelings. Pay feel like you need to read every attention to what your baby word on each page. Let your baby/ is engaging with and let them lead child lead the discussion and watch your talking. what catches their interest. Talk about what they are looking at or pointing toward.

Clean Up Time
Babies/children need to be cleaned up many times a day and having a cold washcloth wiped across their face with no prior warning could be startling. Use this time to tell your baby/child what you are doing before you do it and encourage them to participate in washing up.

You could say things like:

"Which book would you like to

"Oh! I see you have your toy bunny "Oh, your hands are all sticky. I'm

read? Can you point to the book there. What are you and bunny going to wipe your hands with this

you'd like to read? Help me turn doing? Bunny has long ears.

cloth. Can you help me by putting

the page. Good job turning the pages!"
"Do you see the green frog on this

Where are bunny's ears? Can you your hands out, please? Thank you show me YOUR ears? You and for your help! All clean now, thank bunny both have ears but they look you."

page? He lives in that pond! Where different, don't they?"

"You're looking uncomfortable.

do you live? ... You live here, in our "These are blocks. We have red

home. The pond is the green frog's blocks, blue blocks and green

home."

blocks. 1, 2, 3, groups of blocks.

I'm going to wipe your neck with this cool cloth and get you feeling cooler. Ok? Here we go. That's better, right?"

Let's stack the block on top of each

other to make a pyramid."

Talking Tips

Changing Diapers
Similar to getting dressed, this every day situation is a perfect time to reassure your baby/child by explaining each of your steps.

You could say things like:

"Let's get you all cleaned up. I have to wipe your bottom before we put a new diaper on. The wipe is a little cold, are you ready?"
"There we go, now you have a clean, dry diaper on. Do you feel better? Let's continue our day!"

Adapted from Talk with My Baby Conversation Starters retrieved from www.TalkWithMeBaby.org

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Development Milestones: Language and Communication

Adapted from CDC Developmental Milestones checklists. Retrieved from cdc.gov/ncbddd/ actearly/pdf/checklists/all_checklists.pdf

5 years 4 years

Speaks very clearly Tells a simple story using full sentences Uses future tense, for example "Grandma will be here" Says name and address
Knows some basic rules of grammar such as "he" and "she" Sings a song or says a poem from memory such as "itsy bitsy spider"
or "wheels on the bus" Tells stories Can say first and last name

3 years

Follow instructions with two to three steps Can name most familiar things Understands words like "in", "on", and "under" Says first name, age, and sex Names a friend Says words like "I", "me", "we" and "you" and some plurals
(like cars, dogs, cats) Talks well enough for strangers to understand most of the time Carries on a conversation using 2-3 sentences

2 years

Points to things or pictures when they are named Knows names of familiar people and body parts Says sentences with 2 to 4 words Follow simple instructions Repeats word overheard in conversation Points to things in a book

18 months/ 1 years

Says several single words Says and shakes head "no" Points to show someone what he wants

1 year

Responds to simple spoken requests Uses simple gestures like shaking head "no" and waving "good-bye" Makes sounds with changes in tone (sounds more like speech) Says "mama" and "dada" and "uh-oh!" Tries to say words you say

9 months

Understand "No" Makes lots of different sounds like "mamamama" and "babababa" Copies sounds and gestures of others Uses fingers to point at things

6 months

Responds to sounds by making sounds Strings vowels together when babbling ("ah", "eh, "oh")
and likes taking turns with parent while making sounds Responds to own name Makes sounds to show joy and displeasure Begins to say consonant sounds (jabbering with "m", "b")

4 months

Begins to babble Babbles with expression and copies sounds he hears Cries in different ways to show hunger, pain, or being tired

2 months Coos, make gurgling sounds Turns head toward sounds

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Georgia Department of Public Health

Benefits of Bilingualism
All babies can learn more than one language, and learning and developing in two languages has many benefits for children.
What teachers can do each day:
Encourage families to use their home language with their children. This allows them to have conversations in the language they know best and feel most comfortable speaking.
Encourage families to read books, sing songs, play rhyming games, and tell stories in their home language. This keeps their cultural traditions alive and supports early literacy development in the home language and in English.
Support the home language in your classroom the home language is the first language children use to learn about the world around them. Allow children to use it to communicate.
Create an environment that celebrates children's language and culture use songs, rhymes, and fingerplays in different languages.

A few of the main benefits of being bilingual are:
It allows children to maintain close ties to their families and culture
It makes their brains very active and flexible
It leads to increased job opportunities as adults

Adapted from Supporting Dual Language Learners: The Benefits of Bilingualism by The Georgia Coalition for Dual Language Learners

Success Story: Talk
At the Mommy and Me Refugee Family Literacy Program in Clarkston, GA refugee women attend English as Second Language classes while their young children attend preschool classes. Mothers receive English instruction, but also attend informational seminars on a variety of parenting topics. This year the center focused on educating families about the importance of Language Nutrition. Mothers also learned how to engage their young children in early literacy activities through the use of songs, chants, storytelling, and reading together.
There are over twenty different languages spoken by students at the Refugee Family Literacy Program in Clarkston, GA. To encourage Language Nutrition, mothers are taught the importance of singing, talking, and reading with their children in the language they are most comfortable. The center provides many picture books and wordless picture books so that mothers can read with their young children without English or printed text becoming a barrier. Mothers are taught specific skills to engage their children with books using their first language, such as pointing and naming pictures, asking a question about a picture, and encouraging children to turn pages in a book while sitting in their mother's lap.
The mothers participated in beginning of year and end of year surveys about how often they engage in Language Nutrition activities at home.
The percentage of mothers who reported singing to their children daily increased from 48% to 81%.
The percentage of mothers who reported reading to their children daily increased from 48% to 68%.
The percentage of mothers who reported taking their child to the library at least once a month increased from 33% to 60%.

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Additional Professional Development Opportunities

Eat Move Professional Development Opportunity

Course Name Growing Fit

Age Group

Description

Infants/Toddler/ Learn how to create a healthy learning environment for Preschool/PreK Georgia's children.

Credit Hours 5 hours

Professional Development Opportunities

Rollins Center Cox Campus for Language and Literacy Start training at www.readrightfromthestart.org

Course Name Talk With Me Baby for Infant and Toddler Teachers
Power of Language TALK with Me
Read with Me: Part 1

Age Group

Description

Infant/Toddler

Discover a new role as Talk With Me Baby coach for the families of the children you teach. In this course you will learn how to transfer the skills you have developed for making children your conversational partners to families, so they too, can engage in Language Nutrition with their children.

Infant/Toddler In this course, you'll learn how to empower children for a lifetime by becoming their conversational partners.

Infant/Toddler

When you finish this course, you will be able to use the TALK strategy to have meaningful conversations with all infants and toddlers.

Infant/Toddler

When you finish this course, you will be able to use the TIPS strategy to transform reading books with children. You will have opportunities to have great conversations that will promote their language development and critical thinking every time you read together.

Credit Hours 2 hours
2 hours 3 hours 2.5 hours

Read with Me: Part 2 Power of Language

Infant/Toddler

Learn more about the TIPS strategy including how to adapt TIPS with DLLs, plan a TIPS read, and watch a case study of applying the TIPS strategy in the classroom.

Preschool/PreK Learn the importance of language and how to "push-in" and

Courses

"pull-out" language throughout the day.

3 hours 2 hours

Meaningful Conversations Transforming Story Time Building World Knowledge
Foundations of Learning to Read
Sharing Ideas Through Writing

Preschool/PreK Courses Preschool/PreK Courses Preschool/PreK Courses
Preschool/PreK Courses
Preschool/PreK Courses

Learn the importance of meaningful conversation with children and how to use the TALK strategy.
Learn the START strategy, a way of reading books with children that builds comprehension, language, and vocabulary.
Understand how world knowledge is necessary for comprehension and how to incorporate informational texts in the classroom.
Learn how phonological awareness, alphabet knowledge and concepts of print are necessary skills in preparing children to learn to read.
Learn the importance of emergent writing and how to facilitate children's use of writing to communicate thoughts, feelings, and ideas.

1 hour 4 hours 3 hours 4 hours 4 hours

Adapted from Read Right from the Start by the Rollins Center for Language & Literacy at the Atlanta Speech School. Retrieved from www.readrightfromthestart.org.

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Georgia Department of Public Health

Additional Resources
My Plate visual reminder to help build a healthy eating style choosemyplate.gov/MyPlate Nibbles for Health: Nutrition Newsletters for Families with Young Children - reproducible newsletters that staff can give to families providing helpful hints for healthy eating fns.usda.gov/tn/nibbles-health-nutrition-newsletters-parents-young-children
Best Practices for Physical Activity: For Organizations Serving Children and Youth includes physical activity guidelines, sample physical activity polices, resources and tip sheets for families. d3knp61p33sjvn.cloudfront.net/media-resources/ECELC/C2P2/LS3/ECE_Program_Participants/ English_PhysicalActivityGuide_FINAL.pdf Go Smart physical activity app for teachers from the National Head Start Association with simple ways to get young children active. Good ideas to share with families too gosmart.nhsa.org/ Spark PE physical activity lesson plans sparkpe.org/early-childhood/curriculum/lesson-plans/
Talk With Me Baby website includes a wealth of resources including educational videos, printable handouts, additional information and links to other organizations with additional resources. talkwithmebaby.org Too Small to Fail: Talking is Teaching website includes resources such as training materials, tip sheets for parents, tip sheets for preschool and infant/toddler teachers, videos and more. Many of the resources are in both English and Spanish. toosmall.org/ The Harvard Center on the Developing Child shares key concepts about the science of child development including how early brain development provides the foundation for learning and health. developingchild.harvard.edu

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NEXT STEPS
Identify one or two things you will do to build this healthy habit in your Center or Family Child Care Home?

Identify one or two things you will do to help families build this healthy habit in their Homes?

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Georgia Department of Public Health

Sources
The Campaign for Grade Level Reading (2014a). 3rd grade reading success matters. Retrieved from http://gradelevelreading.net
Forget-Dubois, N., Dionne, G., Lemelin, J. P., Perusse, D., Tremblay, R. E., & Boivin, M. (2009). Early child language mediates the relation between home environment and school readiness. Child Development, 80(3), 736-749. doi: 10.1111/j.1467-8624.2009.01294.x
GenYouth Foundation (2013). The Wellness Impact: Enhancing Academic Success through Healthy School Environments. Retrieved from http://www.genyouthnow.org/wp-content/uploads/2013/02/The_Wellness_Impact_Report.pdf.
Robert Wood Johnson Foundation (2013). Health Policy Snapshot: Why does education matter so much to health? Retrieved from http://www.rwjf.org/en/library/research/2012/12/why-does-education-matter-somuch-to-health-.html.
O'Connor, J., Ejikeme, C., Fernandez, M., Powell-Threets, K., Idaikkadar, A., Kay, C., Vall, E.A., Ross, K., Fitzgerald, B. (2016). Integrating Food and Language Nutrition to reach Georgia's children in early care and education environments. Unpublished manuscript.
Rowe, M. L. (2012). A longitudinal investigation of the role of quantity and quality of child-directed speech in vocabulary development. Child Development, 83(5), 1762-1774. doi: 10.1111/j.14678624.2012.01805.x
United Health Foundation (2015). America's Health Rankings. Retrieved from http://www.americashealthrankings.org/GA.
Weisleder, A., & Fernald, A. (2013). Talking to children matters: early language experience strengthens processing and builds vocabulary. Psychological Science, 24(11), 2143-2152. doi: 10.1177/0956797613488145
Weldon, A. (2014). Language Nutrition: Filling the word opportunity gap. National Meeting of State Leads for the National Campaign for Grade-Level Reading. Washington DC.

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Notes
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Notes
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