title: A review of state regulations to promote infant physical activity in child care.
abstract: BACKGROUND
  The purpose of this study was to review state regulations promoting increased physical activity and decreased sedentary behaviors in infants in child care and to assess consistency with recent Institute of Medicine (IOM) recommendations.
  
  
  METHODS
  We compared existing state and territory licensing and administrative regulations to recent IOM recommendations to promote physical activity and decrease sedentary time in very young children attending out-of-home child care (both child care centers and family child care homes). Three independent reviewers searched two sources (a publicly available website and WestlawNext™) and compared regulations with five IOM recommendations: 1) providing daily opportunities for infants to move, 2) engaging with infants on the ground, 3) providing daily tummy time for infants less than six months of age, 4) using cribs, car seats and high chairs for their primary purpose, and 5) limiting the use of restrictive equipment for holding infants while they are awake. We used Pearson chi-square tests to assess associations between geographic region, year of last update, and number of state regulations consistent with the IOM recommendations.
  
  
  RESULTS
  The mean (SD) number of regulations for states was 1.9 (1.3) for centers and 1.6 (1.2) for homes out of a possible 5.0. Two states had regulations for all five recommendations, Arizona for centers and Virginia for homes. Six states and territories had zero regulations for child care centers and seven states and territories had zero regulations for family child care homes. There were no significant associations between geographic region and number of regulations consistent with IOM recommendations.
  
  
  CONCLUSIONS
  Out-of-home child care settings are important targets for optimal early child health interventions. While most states had some regulations related to the promotion of physical activity among infants, few states had regulations for more than three of the five IOM recommendations. Enhancing state regulations in child care facilities could aid in early childhood obesity prevention efforts.
authors.affiliation: Department of Health Sciences, Furman University, 3300 Poinsett Highway, Greenville, SC, 29613, USA. meghan.slining@furman.edu.
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Slining
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA. sara.benjamin@duke.edu.
authors.forename: Sara E Benjamin
authors.initials: SE
authors.lastname: Neelon
authors.affiliation: Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA. kduffey@vt.edu.
authors.forename: Kiyah J
authors.initials: KJ
authors.lastname: Duffey
mesh_terms: D002656:Child Day Care Centers / Q000331:legislation & jurisprudence / Q000592:standards; D003430:Cross-Sectional Studies; D006293:Health Promotion / Q000331:legislation & jurisprudence* / Q000592:standards*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000331:legislation & jurisprudence / Q000592:standards; D009043:Motor Activity; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D063766:Pediatric Obesity / Q000517:prevention & control; D014481:United States