title: States lack physical activity policies in child care that are consistent with national recommendations.
abstract: BACKGROUND
  Child care facilities' policies can importantly impact health behaviors of toddlers and preschoolers. Our aim was to assess state regulations promoting physical activity (PA) in child care and compare regulations to national recommendations.
  
  
  METHODS
  We reviewed licensing and administrative regulations related to promoting PA for all states and territories for child care centers (centers) and family child care homes (homes). Three reviewers searched two sources (a publically available website and WestlawNext) and compared regulations with 15 Institute of Medicine recommendations. We used Pearson's and Spearman's correlations to assess associations between geographic region, year of last update, and number of regulations consistent with the recommendations.
  
  
  RESULTS
  The average number and range of regulations in centers and homes was 4.1 (standard deviation [SD], 1.4; range, 0-8) and 3.8 (SD, 1.5; range, 0-7), respectively. Nearly all states had regulations consistent with providing an outdoor (centers, 98%; homes, 95%) and indoor (centers, 94%, homes, 92%) environment "with a variety of portable play equipment and adequate space." No state had regulations for staff joining children, avoiding punishment for being physically active, yearly consultation from a PA expert, or providing training/education on PA for providers.
  
  
  CONCLUSIONS
  There is room for improvement in child care regulations around PA for young children; PA promotion should be included with future updates to regulations.
authors.affiliation: 1 Department of Human Nutrition, Foods, and Exercise, Virginia Tech , Blacksburg, VA.
authors.forename: Kiyah J
authors.initials: KJ
authors.lastname: Duffey
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Slining
authors.forename: Sara E
authors.initials: SE
authors.lastname: Benjamin Neelon
mesh_terms: D002656:Child Day Care Centers / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D033161:Government Regulation; D019983:Guideline Adherence; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D009043:Motor Activity; D010988:Play and Playthings; D017410:Practice Guidelines as Topic; D012931:Social Environment; D014481:United States / Q000453:epidemiology