Childhood Obesity in Children Under 5: How Child Care Centers Can Help

Childhood obesity is often thought of as a problem for older children, but it begins much earlier than most people realize. In fact, about 13% of children ages 2 to 5 in the United States are already considered obese, and many more are overweight. Research shows that children who are overweight in preschool are far more likely to remain overweight into adolescence and adulthood, increasing their risk for diabetes, high blood pressure, and other chronic health issues later in life【CDC, 2024】.

For child care providers in Massachusetts and Rhode Island, this issue is especially important. Most young children spend a significant part of their day in care settings, meaning child care centers play a critical role in shaping their eating habits, activity levels, and overall health. By following state regulations and building on best practices, centers can help prevent obesity and set children on a path toward lifelong wellness.

Why Obesity Develops in Early Childhood

Obesity in children under 5 usually results from a combination of diet, inactivity, sleep disruption, and environmental influences. Sugar-sweetened beverages, oversized portions, and limited access to fruits, vegetables, and whole grains contribute to excess weight. Long stretches of sedentary time, especially when screens are used heavily, reduce opportunities for energy balance. Inadequate or inconsistent sleep further disrupts appetite regulation and growth. And finally, the child care environment itself — what foods are served, how much active play is scheduled, and what policies are in place — has a major impact on whether children develop healthy or risky habits.

Massachusetts EEC Regulations: Supporting Healthy Growth

The Massachusetts Department of Early Education and Care (EEC) has standards that help reduce obesity risk in young children:

• Nutrition: Meals and snacks must follow USDA Child and Adult Care Food Program (CACFP) patterns, emphasizing fruits, vegetables, whole grains, lean proteins, and limited sugar. Programs must also provide clean drinking water throughout the day.

• Physical Activity: Programs are expected to include daily opportunities for active play and outdoor time, weather permitting.

• Rest: EEC requires age-appropriate rest periods, promoting healthy sleep schedules.

• Screen Time: While not heavily regulated, best practice guidance advises avoiding screen exposure for children under 2 and keeping it limited and educational for older preschoolers.

By meeting and exceeding these requirements, Massachusetts centers can directly support obesity prevention while staying in compliance.

Rhode Island Child Care Licensing Regulations: Building Healthy Habits

Rhode Island’s Department of Human Services (DHS) Child Care Licensing Regulations also emphasize nutrition and wellness in early education programs:

• Nutrition: Programs must serve meals and snacks that meet the USDA CACFP guidelines. Water must be available at all times, and sugary drinks are restricted.

• Physical Activity: Rhode Island requires programs to provide at least 60 minutes of physical activity daily for preschool-aged children, with opportunities for both structured and unstructured play.

• Screen Time: DHS regulations state that children under 2 should not be exposed to screen time, and preschoolers should have no more than 30 minutes per week of screen exposure in child care, unless it is educational and interactive.

• Rest: Programs must provide quiet, comfortable, and age-appropriate rest periods.

These regulations are among the strongest in New England and are designed to ensure that Rhode Island child care centers actively promote healthy weight and overall wellness.

How Centers Can Put This Into Action

Meeting state regulations is only the first step. Centers can go further by encouraging children to serve themselves in small, supervised portions, incorporating fun movement activities throughout the day, and developing written wellness policies that staff, children, and families all follow. Sharing menus, daily schedules, and wellness policies with families helps ensure healthy habits are reinforced at home. Staff training is also essential — caregivers need confidence and tools to model healthy eating, lead engaging activities, and maintain consistent routines.

Why It Matters

Early childhood is a critical window for establishing habits that last a lifetime. By promoting nutritious meals, daily active play, limited screen time, and consistent sleep routines — and by following Massachusetts and Rhode Island licensing regulations — child care centers can play a vital role in preventing obesity in children under 5. These efforts not only improve health outcomes but also support learning, behavior, and overall well-being.

At PediNurse, LLC, I work with child care centers across Massachusetts and Rhode Island to provide expert guidance, staff training, and policy support. Whether you need help with compliance, wellness policies, or staff education, PediNurse can partner with your center to create the healthiest environment possible for children to thrive.

Visit www.pedinurseconsulting.com to learn more about how I can support your program.