physical activity in early childhood...1 a report by the all-party parliamentary group on a fit and...

AREPORTBYTHEALL-PARTYPARLIAMENTARYGROUPONAFITANDHEALTHYCHILDHOOD

PHYSICALACTIVITYINEARLYCHILDHOOD

PleasenotethisisnotanofficialpublicationoftheHouseofCommonsortheHouseofLords.IthasnotbeenapprovedbytheHouseoritsCommittees.All-PartyGroupsareinformalgroupsofmembersofbothHouseswithacommoninterestinparticularissues.TheviewsexpressedinthisReportarethoseoftheGroupbutnotnecessarilytheviewsofeachindividualGroupOfficer.ThisReportseekstoinfluencetheviewsofParliamentandtheperformanceofGovernmenttobetteraddressissuesrelatingtophysicalactivityinearlychildhood.WethankWaterBabiesforthefinancialsupportthatmadethisReportpossibleandwishtomakeitclearthatWaterBabiesneitherrequestednorreceivedapprovalofitscontents.

ThisreportwaspreparedbyaWorkingGroupoftheAllPartyParliamentaryGrouponaFitandHealthyChildhoodandwearegratefulforthecontributionsof:HELENCLARK ChairoftheWorkingGroupPHILROYAL APPGSecretariatDR.LALAMANNERS activemattersLINDABASTON-PITT CambridgeChildhoodPartnershipEDWINAREVEL EarlyStartGroupGEORGIALEECH LondonBoroughofNewhamCHARLOTTEDAVIES Fit2LearnDR.ESTELLEMACKAY PublicHealthNutritionistELAINEWYLLIE TheDailyMileFoundationDR.AVRILNASH UniversityofHertfordshireSHARONSMITH UniversityofNorthamptonSTEVEFRANKS WaterBabiesLimitedCHRISBROADBENT WaterBabiesLimitedDR.DEBORAHALBON UniversityofRoehamptonNEILCOLEMAN OPALMidlandsDANIELLEE MytimeActiveGILESPLATT BromleyPrimarySchoolSports&ClubsDAKATHRYNPECKHAM IndependentConsultantDR.VICTORIARANDALL UniversityofWinchester

THEALL-PARTYPARLIAMENTARYGROUPANDTHEWORKINGGROUP

TheWorkingGroupthatproducedthisReportisasub-groupoftheAllPartyParliamentaryGrouponaFitandHealthyChildhood.ThepurposeoftheAPPGistopromoteevidence-baseddiscussionandproducereportsonallaspectsofchildhoodhealthandwellbeingincludingobesity;toinformpolicydecisionsandpublicdebaterelatingtochildhood;andtoenablecommunicationsbetweeninterestedpartiesandrelevantparliamentarians.GroupdetailsarerecordedontheParliamentarywebsiteat:http://www.publications.parliament.uk/pa/cm/cmallparty/register/fit-and-healthy-childhood.htmTheWorkingGroupischairedbyHelenClark,amemberoftheAPPGSecretariat.WorkingGroupmembersarevolunteersfromtheAPPGmembershipwithaninterestinthissubjectarea.ThosethathavecontributedtotheworkoftheWorkingGrouparelistedonthepreviouspage.TheReportisdividedintothemedsubjectchapterswithrecommendationsthatwehopewillinfluenceactiveGovernmentpolicy.TheOfficersoftheAPPGare:CHAIRJimFitzpatrickMPCOCHAIRBaroness(Floella)BenjaminOBEVICECHAIRSIanAustinMP,NicDakinMP,DianaJohnsonMP,LordMcCollofDulwich,JulieElliottMP,NigelDoddsMP,Dr.PhilippaWhitfordMP.

CONTENTS: Page:

EXECUTIVESUMMARY 5

SUMMARYOFRECOMMENDATIONS 8

INTRODUCTION 15

1. THEQUALITY,NATUREANDDIVERSITYOFCURRENTPHYSICALACTIVITYPROVISIONWITHINTHEHOME,WIDERCOMMUNITYSETTINGSANDEDUCATIONALSETTINGS

2. PHYSICALACTIVITYBESTPRACTICEINTHEPRE-PREGNANCY,ANTENATALANDPOSTNATALPERIODFORPARENTS/CARERSANDBABYTOINCLUDETHEADVISORYROLEOFEDUCATIONANDHEALTHCAREPROFESSIONALSANDTHEIROWNTRAININGNEEDS

3. THEROLEOFLOCALAUTHORITIES,VOLUNTARYORGANISATIONSANDBUSINESSINPROMOTING,FACILITATINGANDDEVISINGAHOLISTICRANGEOFEARLYCHILDHOODPHYSICALACTIVITYOPPORTUNITIES;ALSOWORKPLACECRECHES

4. THEROLEANDRESPONSIBILITYOFGOVERNMENTINTHEDEVOLVEDUKWITHCLOSEREFERENCETOOFSTED,THEFOUNDATIONSTAGECURRICULUMANDTHENATIONALCURRICULUMINMESSAGING,FUNDING,RESEARCHINGEARLYCHILDHOODACTIVITYANDPROMOTINGITSCENTRALROLEINCHILD(ANDTHENCEADULT)FITNESSANDHEALTHALONGSIDENUTRITION,PLAYANDEMOTIONALWELLBEING

5. ACOMPARATIVEANALYSISOFGOODPRACTICEINOTHERCOUNTRIESANDEXISTINGUKLEGISLATIVEPRACTICE

6. SOCIOECONOMICISSUSES,ETHNICDIVERSITYANDCULTURALPRACTICEANDTHEPLANNINGSYSTEM(INBOTHRURALANDURBANCONTEXTS)ASTHEYIMPACTUPONEARLYCHILDOODANDACTIVITYPATTERN

7. THEROLEOFADVERTISING,TRADITIONALANDSOCIALMEDIAANDTECHNOLOGY(INCLUDINGTHEUSEOFAPPS)ASSTIMULANTANDPROMOTEROFEARLYCHILDHOODPHYSICALACTIVITY

8. THERELATIONOFPHYSICALACTIVITYTOCOGNITIVEANDACADEMICPROGRESS

9. THERELEVANCEOFPHYSICALACTIVITYTOCHILDRENWITHMENTAL/PHYSICALDISABILITY

10. THELEGISLATIVEWAYFORWARDINTHEPROMOTIONANDEXPANSIONOFPHYSICALACTIVITYPROGRAMMESANDTAKE-UPFORALLCHILDRENINTHEUK

11. DIVERSITYANDCHOICEINACTION:GOODPRACTICECASESTUDIES

12. ANIN-DEPTHANALYSISOFTHEIMPORTANTROLETHATBABYANDINFANTSWIMMINGHASTOPLAYINHELPINGTOACHIEVEPHYSICAL,COGNITIVEANDEMOTIONALGOALS

EXECUTIVESUMMARYThepublicationoftheGovernment’sChildhoodObesityStrategyin2016followedapledgebyformerPrimeMinister,DavidCameron,inthewakeofhis2015GeneralElectionvictory.ThecurrentMayGovernmentwascriticisedfordraggingitsheelsoverpublication.TheeventualStrategywasalsoconsiderablyshorterthantheoriginaldraftandadvocatedvoluntaryagreementratherthanstatute.On18thAugust2017,theDepartmentofHealthandPublicHealthEnglandannouncedPhaseTwo:https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-actionpromotingvoluntarytake-upofacaloriereductionscheme:‘Readymeals,pizzas,burgers,savourysnacksandsandwichesarethekindsoffoodslikelytobeincludedintheprogramme.’ChildhoodobesitywasaddressedbyMinisterofStateforHealth,PhilipDunneandChiefExecutiveofPublicHealthEngland,DuncanSelbie,whoannouncedtheintentiontosetupanObesityResearchPolicyUnit.Followingpublicationofevidenceinearly2018,thefoodindustry,tradebodiesandnon-governmentalhealthorganisationswillbeinvolvedwiththeGovernmentinthedevelopmentofguidelinesanda‘timeline’forthecaloriereductionprogramme.Thisvoluntaryactionplanmajorsinfoodconsumptionbutignoresthevitalroleofphysicalactivity.‘PhysicalActivityinEarlyChildhood’bytheAllPartyParliamentaryGrouponaFitandHealthyChildhoodwillargueherethatfacilitatingandfundingphysicalactivityinearlychildhoodisanotanoptionalextra,butanessentialcornerstoneofafitandhealthyadultsociety.‘PhysicalEducation:AReportbytheAllPartyParliamentaryGrouponaFitandHealthyChildhood’(2016)contendsthatPEoverallisa‘Cinderella’subjectbutthephysicalactivityneedsoftheveryyoungestchildrenaremoreurgentstill.TheDepartmentofEducationisyettopublishupdatedcriteriaforhowschoolsmustspendthePrimaryandSportsPremiumgrantthatistobedoubledforthenewacademicyearcommencingSeptember2017.Todate,itisonlyallocatedtopupilsinYears1-6(omittingReceptionageclasses).PhysicalEducationandPersonalandHealthEducation(PSHE)arenon-coresubjectswithintheNationalCurriculum.Bywayofguidance,PrimaryPEsubjectleadersareinitiallyreliantuponthebriefprogrammesofstudyissuedbyDfEintermsofwhattodeliverinphysicallearningfortheyoungestpupilsinPrimaryschools.Giventheneedtoaddressthecoremovementskillsfromasearlyschool-ageaspossible,itisevidentlyvitalthatsuchprofessionalsaretrainedandcompetentatsupportingtheup-skillingofearlyyears’practitionerssoastoensurethatbothconfidenceandabilityareabletoflourishwithintheagegroup.TheAllPartyParliamentaryGrouponaFitandHealthyChildhoodrecommendsaccessible,sustainableandinformativeprogrammesofphysicalactivityasessentialcomponentsofchildhealthandwellbeing.Weshowthatratherthanbeing‘worldleaders’inearlychildhoodphysicalactivity,theUKtrailsothercountrieswithnocohesiveapproachbetweenthedevolvedUKnations.Childrenwithmentalorphysicaldisabilitiesareby-passed(despiteprovenresearchintothebenefittheyderivefromphysicalactivity)andtheinequalitiesinprovisionforyoungchildrenfrompoorersocioeconomicbackgroundsanddiverseculturalbackgroundsarenotprioritised.

Missedopportunitiesareplentiful.No‘ChildObesityStrategy’succeedswithoutstrongphysicalactivitycontentandresearchfindsthatphysicalactivityfromtheearliestdayshaspositiveoutcomesforemotional,social,academicandcognitivegrowthaswellasbodilyhealth.Suchbenefitsprecedebirth,extendingtobothparentsandduringthepostnatalperiod.Yetherethereisamarkedlackofaccreditedandfundedtrainingforhealthcareandeducationprofessionalscombinedwithalackofnationallyfundedresearchintothebenefitsofearlyyears’physicalactivity.TheseissuesmustbeconfrontedbyanygovernmentintentuponboostinghealthoutcomesandtheAPPGillustratesadditionally,the‘whole-child’developmentalbenefitsofbabyandtoddlerswimminginamuchwidersensethantheobvioussafetyconcerns.TheAllPartyParliamentaryGrouponaFitandHealthyChildhoodmaintainsthattheresponsibilityofbringingtogetherallthoseconcerneddirectlyorindirectlywithphysicalactivityintheearlyyears(localauthorities,sportingbodies,thevoluntarysector,industry,mediaandadvertising)belongstotheGovernment.Manyexamplesofcurrentgoodpracticearelistedbelow,butifnobodyknowsaboutthem,theireffectwillbeconfinedtoresidentsintheimmediatevicinity.Government’spriorityshouldbetocollate,cascadeandchampionbestpractice,therebyempoweringparents,schoolsandhealthagenciestomakeinformeddecisionsaboutphysicalactivityfortheyoungestchildren.Aboveall,theUKwillnot‘leadtheworld’inharnessingphysicalactivitytoimprovetheoverall,health,wellbeing,fitnessandhappinessofyoungchildrenifmeasuresadvocatedaremerelyvoluntary.Governmentmustgraspthestatutorybatonforthesakeoffuturegenerationalhealth–andthesavingstotheExchequer(occasionedbythefinancialcostoftreatingavoidablelifestyle-relateddisease)thatwewillallenjoynow.Thisshouldformthebasisof21stcenturyprogressivepolicy,butaswithalltheverybestideas,itishardlynew.AccordingtoWordsworth:‘Thechildisfathertotheman’(‘MyHeartLeapsUp’)andevenfartherback,‘GivemeachilduntiltheageofsevenandIwillshowyoutheman’(Aristotle).TheAllPartyParliamentaryGrouponaFitandHealthyChildhoodhopesthattheGovernmentwilllisten,learnandact.HELENCLARK:SEPTEMBER2017

SUMMARYOFRECOMMENDATIONS

TherearemanyrecommendationsflowingfromthisReport.Therecommendationsalsoappearattheendofeachrelevantsection.

Recommendations:1.1 AUKoverallhealth/wellbeingassessmentforyoungchildrenasthey

startschool,commensuratewiththeAustralianAEYC(AustralianEYcensus)

1.2 Multidisciplinarypolicymakers(education,welfare,planning,health,socialdevelopment)tobeawareoftheimportanceofphysicalactivityinearlychildhoodwhendesigningpolicy

1.3 Physicalactivityintheearlyyearstobeembeddedinallrelevantpoliciesnationally,regionallyandlocally

1.4 Fundingtobemadeavailablefortrainingforearlyyears’practitionersinphysicalactivity

1.5 Allteachers,fromEYs/FoundationthroughtoHeadteacherstoreceiveaminimum20hoursoftraining,updatedeveryfiveyearsonbestpracticeinenablinganddeliveringplaytimelearning.Suchtrainingshouldincludecoverageofpolicyareas,forwardplanning,communication,safety/risk,design,materialsresourcingandreflectivepractices

1.6 Healthandeducationpractitionersshouldshareinformationaboutphysicalactivityanditsroleinchilddevelopmentbydemonstratingintegratedandpurposefulworking

1.7 Everysettingaimingtoprovideahighqualityofoutdoorplayprovision(under5s–primaryschool)tomeetthe18areasidentifiedbyOPALasaminimumrequirement.

Recommendations:2.1 Governmenttoestablishanationalphysicalactivityandhealthyeating

campaigntargetedatprepregnancy,pregnancyandpostpregnancystagesformotherandbaby;partofwhichwillinvolvelocalauthoritiesestablishingandupdatingaccessibledirectoriesoflocalprovision

2.2 Governmenttoestablishphysicalactivity/healthyeatingpilotprogrammesbasedonexistinggoodpracticeforevaluationandpotentialnationalroll-out

2.3 Comprehensivemodulesinvolvingphysicalactivity/healthyeatingtobeembeddedintotheinitialtrainingforthosecomingintocontactwithprepregnancy,pregnantandpostpartumwomenduringthecourseoftheir

professionalduties2.4 HealthandeducationalprofessionalsincludingmidwivestohaveCPDon

physicalactivity/healthyeatingasacontractualrequirementwithregulartimespanupdate;toincludetheuseofappsandelearning

2.5 IncreasedemphasisontheimportanceofphysicalactivityacrosstheEarlyYears’FoundationStagecurriculum

2.6 Prioritisingtheroleofphysicalactivityinassessmentofphysicaldevelopmentintheearlyyearscurriculum

2.7 CreatingaHealthyEarlyYearsAwardschemetopromoteandenhancetheprogressionofphysicaldevelopmentandphysicalactivitywithintheEarlyYears’FoundationStagecurriculum

2.8 Promotingandensuringasystematicanduniformsharingofinformationbetweenearlyyearssettingsandinfant/primaryschoolsregardingindividualchildren’sphysicaldevelopmentandactivitylevelspriortotransition.

3. THEROLEOFLOCALAUTHORITIES,VOLUNTARYORGANISATIONSAND

BUSINESSINPROMOTING,FACILITATINGANDDEVISINGAHOLISTICRANGEOFEARLYCHILDHOODPHYSICALACTIVITYOPPORTUNITIES;ALSOWORKPLACECRECHES

Recommendations:3.1 TheEarlyYearsFrameworkofDeliverytocontainstatutoryrequirement

forphysicaldevelopmentandactivityratherthanthecurrent‘recommended’requirement

3.2 Primaryyears’receptionagegrouptobeincludedinthePrimaryPEandSportsPremium

3.3 EvaluationandstandardisationofHMIinspectionrequirementsforphysicalactivity

3.4 Keycentralgovernmentrequirementstobeestablishedforearlyyears’physicalactivity

3.5 Nationalanti-obesitystrategiestoberevised/upgradedtoincludesubstantialphysicalactivitycontentandforthistobefullypromotedviaanationalawarenesscampaign

3.6 Physicalactivitycomponenttobearequirementforgovernmentfundingofantiobesitystrategies

3.7 DepartmentofBusiness,InnovationandSkillsandDepartmentofEducationtopromoteworkplacenurseriesandcrèchesanddrawupadirectorywiththeaimofpromotinggoodpracticeandcascadingskillandexpertise.

4. THEROLEANDRESPONSIBILITYOFGOVERNMENTINTHEDEVOLVEDUK

WITHCLOSEREFERENCETOOFSTED,THEFOUNDATIONSTAGECURRICULUMANDTHENATIONALCURRICULUMINMESSAGING,FUNDING,RESEARCHINGEARLYCHILDHOODACTIVITYANDPROMOTINGITSCENTRALROLEINCHILD(ANDTHENCEADULT)FITNESSANDHEALTHALONGSIDENUTRITION,PLAYANDEMOTIONALWELLBEING

Recommendations:

4.1 UKGovernmenttoinitiateanannualforum/summitwherebydataandpolicyinitiativesinthedevolvedgovernmentscanbestudiedwiththeaimofco-ordinatingUK-widenutrition/physicalactivitypolicyasadriverofchildhealthandwellbeing

4.2 Replacementof‘trafficlight’foodlabellingwith‘activityequivalent’calorielabels

4.3 Investmentincommunitylevelprogrammesincludinginfrastructuretoenableitssuccess–suchasfoot/cyclepathslinkingcommunitieswiththeresourcesandactivitiesthatappealtothefamilyunit,thuspromotinginclusiveparticipation

4.4 Clearandconciseguidelinestobeissuedbygovernmentthatincludetheeffectsofexcessivescreenandsedentarytimeinaformatthatisaccessibletotheenduser;parents,practitionersandteachers

4.5 Cohesiveresearchtobecommissionedregardingthebenefitsofphysicalactivityforchildrenfrombirthandinearlychildhood

4.6 Acurriculumframeworkthatendorsesoutdoorplayandactivelearningandaninspectionsystemthatchallengesitsineffectivedelivery

4.7 Governmenttoworkwithmanufacturers/advertisers/sportspromotersandhealthprofessionalstoensurethatmessagingabout‘sports’and‘energy’drinksdoesnotleadtofalseassumptionsaboutspurious‘healthbenefits.’

Recommendations5.1 ReviewthePDcomponentoftheEYFStoreflectthedemandsoftheCMO

guidelinesandensureafocusongross-motorskillsinbothindoorandoutdoorenvironments

5.2 OfstedinspectionprocesstobeadaptedtoaccountforlevelsofPAandprovisionforchildreninindoor/outdoorsettings

5.3 CreationofNationalQualityGuidelinesforEY/PD/PA5.4 Trainingtobeprovided(ideallycentrallyorlocallyfunded)tosupport

practitioners’understandingsoftheimportanceofphysicalskills/playandtobuilduponexistingknowledgetodesignanddeliversafeandeffectiveactivesessions

5.5 AdesignatedPD/PAco-ordinatorchampionforeverysettingwithresponsibilityforliaisonwithstaff,parents,familiesandcommunitieslinkedtoHealthyEarlyYears’Schemes

5.6 Anationalreviewoftheconceptof‘schoolreadiness’therebyencouraginggreaterpractitionerunderstandingoftheimportanceofphysicalskillstoensurechildren’ssmoothoveralldevelopmentandencouragingparentalsupportforchildren’sphysicalplay

5.7 DfEtoreviewtherequirementsoftheKS1curriculumforPEtoalignwiththeEYFS/PDcomponent

5.8 Aprofessionalbodytobedevelopedasan‘umbrella’organisationtosupportEYPD/PAprofessionals

5.9 TheestablishmentofanEYPD/PAtaskforcetoinformanddrivepolicyand

practiceinthisfield.

6. SOCIOECONOMICISSUSES,ETHNICDIVERSITYANDCULTURALPRACTICEANDTHEPLANNINGSYSTEM(INBOTHRURALANDURBANCONTEXTS)ASTHEYIMPACTUPONEARLYCHILDOODANDACTIVITYPATTERNS

Recommendations:6.1 Create‘NationalQualityGuidelinesforEarlyYearsPhysicalDevelopment

andPhysicalActivity’6.2 ReviewtheOfstedinspectionrequirementsfor‘EarlyYearsPhysical

DevelopmentandPhysicalActivity’6.3 Createhighqualitytrainingopportunitiesfortheearlyyears’workforceto

ensuretheirinclusionandeffectiveparticipationinthePHE‘widerworkforce’initiative

6.4 DesignateaPhysicalDevelopment/PhysicalActivityco-ordinatorineveryearlyyears’setting

6.5 MaketheearlyyearsakeycomponentoftheworkofthenewNationalPhysicalEducationTaskforce.

Recommendations:7.1 GovernmenttoreviewChange4LifeandStart4Lifeintermsoftake-upand

effectinglastingbehaviourchangewithaviewtoupdateordevisingnewandcoreresponsiveschemesinlinewithcurrentneed

7.2 LocalGovernmentAssociationtoworkinconjunctionwithpioneerorganisations(suchastheLondonBoroughofNewhamandMytimeActive)toproduceareadilyavailable‘directory’ofsocialmediaprogrammesandrelatedappsforuseinactivityplansforfamilieswithyoungchildren

7.3 DepartmentsofHealth,EducationandCulture,MediaandSporttoconveneapolicyforumwiththeadvertising,sportspromotionandfoodanddrinkindustriestochartapositivewayforwardforthepromotionofchildhealthandwellbeingviaphysicalactivity

7.4 Socialmediapromotionalmaterialrephysicalactivitytoincludegamesandappstargetedforaccessbyyoungchildrenaswellasseparatematerialsdirectedatadults.

8. THERELATIONOFPHYSICALACTIVITYTOCOGNITIVEANDACADEMIC

PROGRESSRecommendations:8.1 ANationalCurriculumframeworkthatendorsesoutdoorplayand

learningandaninspectionsystem(Ofsted)thatchallengesitsineffective

delivery8.2 TheNationalCurriculumtoincludeexamplesofhowphysicalactivity

contentcanbeincludedwithintheclassroomaspartoftraditionallearningfromearlyyears’settingsupwards

8.3 Cohesive,unifiedresearchtobecommissionedregardingthebenefitsofphysicalactivityinachildfrombirthonwards,includingathoroughconsiderationoftheinherentconsequencesofexcessivescreentime

8.4 Clearandconciseguidelinestobeissuedthatincludetheeffectsofexcessivescreentimeinaformatthatisaccessibleandappropriatetotheenduser;parents,practitionersandteachers

8.5 Investmentincommunitylevelactivityprogrammesincludinginfrastructuretoenableitssuccesssuchasfoot/cyclepathstolinkcommunitieswiththeresourcesandactivitiesthatappealtothewholefamilyunit,encouragingunifiedparticipation

8.6 Recommendationsactivelytobepromotedandsupportedthroughpublication,trainingandresourcingsuitabletoaudience

8.7 Planningforoutdoorenvironmentstobemindfulofenvironmentalandculturalpracticessothatchildrenmayperceivethespaceasfun,withgreaterprovisionofportableequipment,playspaceperchildandregularinfusionsofinterest.

9. THERELEVANCEOFPHYSICALACTIVITYTOCHILDRENWITHMENTAL/PHYSICAL

DISABILITYRecommendations:9.1 FurtherresearchtobecommissionedintohowPAguidelinescanbemetfor

youngpeopleintheearlyyearswithspecialneedsanddisabilityfromasocialandpsychologicalperspective.Examplesofgoodpracticeshouldbecascadedtoallrelevantsettings(school,home,community)

9.2 NationalbodiesforPE,PAandsporttoprioritisefundingforchildrenwithdisabilitiestoimproveandincreaseaccessandinfrastructureforincreasingparticipation.Thesebodiesshouldfurtherpromotemoredisabledrolemodelswhoparticipateinphysicalactivity,educationandsportingactivities

9.3 Freeaccesstophysicalactivityforallyoungpeoplewithaspecialeducationalneedordisability

9.4 Developmentofguidanceforthemodificationofactivitiestosupportyoungpeoplewithspecialeducationalneedsordisabilities

9.5 AllinitialteachertrainingprogrammesfortheEarlyYearsFoundationStageandPrimaryeducationtodedicateexplicittimeintheircorecurriculumtosupporttraineesinteachingchildrenwithspecialeducationalneedsanddisabilities

9.6 Freetrainingforschoolstosupportteachersandearlyyears’practitionersinhelpingyoungdisabledchildrentomatchhighqualityoutcomesforphysicalactivity,motordevelopmentandbroaderphysicaleducationgoals

9.7 Whereappropriate,aproportionofPrimaryPEandSchoolSportsPremiumtobespentontargetpopulationsofdisabledchildrenbetweentheagesof5-7toincreasephysicalactivitypatternsthroughouttheday.

10. THELEGISLATIVEWAYFORWARDINTHEPROMOTIONANDEXPANSIONOF

PHYSICALACTIVITYPROGRAMMESANDTAKE-UPFORALLCHILDRENINTHEUK

Recommendations:10.1 Increasedgovernmentfundingforresearchintothepartplayedbyphysical

activityinearlychildhooddevelopmentinallaspects10.2 Physicaldevelopmentchecksforallchildrenatagesevenwithfollow-up

dependentuponoutcomes10.3 AdditionaltrainingandCPDforhealthandeducationprofessionalsin

physicalactivity/motorsensoryintegration10.4 Employerstobeencouragedtosupportalltheiremployeesinachieving

goodskillsinmotorsensoryintegration(therebysupportingthechildbymakingit‘everyone’sbusiness’)

10.5 Basic,accessiblesupportpackagesprovidedforallparentsandcarersonappropriateplayandactivitiestoensureoptimumdevelopmentgoals

10.6 Annualchilddevelopmentaltimetabledfacetofacesessionswithhealth/educationprofessionalsforparents/carers

10.7 GovernmenttoestablishaPhysicalActivityChampionsTaskforcewherebypromotersofsuccessfulschemes(likeTheDailyMile)canactasnationalrovingambassadors,encouragingtakeupinotherinstitutionsandareas.

11. DIVERSITYANDCHOICEINACTION:GOODPRACTICECASESTUDIESRecommendations:11.1 LocalAuthorities,HealthandEducationalconcernsinvitedtosubmit

PAcommunityschemesforcentralevaluationbyGovernmentTaskForcewiththeaimofestablishingasetofrecommendedpilotsfornationalrollout.Goodpracticefrominternationalsources(asabove)toinformthiswork

11.2 Agreateruseofqualitativeresearchdata;merelyfillinginquestionnaireswillnotnecessarilyrevealthetruepictureoftheamountofcurrentactivityandthencethebasefromwhichimprovementsmustbemade.

12. ANIN-DEPTHANALYSISOFTHEIMPORTANTROLETHATBABYANDINFANT

SWIMMINGHASTOPLAYINHELPINGTOACHIEVEPHYSICAL,COGNITIVEANDEMOTIONALGOALS

Recommendations:

12.1 Widespreadoverhaulandreviewoftheearlyyears’andprimarycurriculumsastheyaffectbaby/infantswimmingwithguidelinesandpolicydevelopedthatconcernwhole-childdevelopment

12.2 SwimmingteachingandtrainingtoformpartofallearlyyearsandprimaryprofessionaltrainingwithregularupdateaspartofCPD

12.3 Antenatalcare/postnatalproviderstosignpostparentstoswimming

andwatertherapyclassesandforthesetoformpartofantenatalandpostnatalmaternalhealthprogrammes

12.4 Allchildswimmingproposedsafetytechniques/teachingpackagestobesubjectedtogovernmentresearchandscientificproofingbeforebeinglicensedforuseinUKswimmingandteachingfacilities.Currentmethodsthathavenotbeenexaminedtoundergothetestingprocedurebeforebeinglicensedtocontinue

12.5. Grants/SportsPremiumfinancetobemadeavailablefortransportationcostsforschool-basedinfantswimmingopportunities.

INTRODUCTION‘Hewriggled,Andgiggled,Andthen,Ideclare,SwungbackwardandforwardAndtiltedhischair,Justlikeanyrockinghorse;-‘Philip!Iamgettingcross’Seethenaughty,restlesschild,Growingstillmorerudeandwild’‘TheStoryofFidgetyPhilip’DrHeinrichHoffman:http://germanstories.vcu.edu/struwwel/philipp_e.html‘FidgetyPhilip’,writtenin1845,hailsfromanerainwhichreceived‘wisdom’necessitatedchildrearingtoprioritiseinfantsbeingseenandnotheard,observingquietpatternsofbehaviourandaboveallrefrainingfromunrestraineddisplaysofphysicalactivity.Philip’sbodilyexperimentationiscondemnedas‘naughty’,‘rude’and‘wild.’Yettodismissthiscautionarytaleasaproductofitsdayandthereforenotrelevanttothe21stcenturyistomissthepoint.Apopular2016USblog‘NoFussParenting’hasmuchincommonwithHoffman,asaparentconfidesthat‘TeachingmykidstositstillisthebestthingIeverdidasaparent,andbysitstill,Ireallymeantositquietlyonmylaporbesidemewithminimalfidgeting.’http://thedomesticfringe.com/no-fuss-parenting-teach-kids-to-sit-still/Whatthewriterdescribesistheexperienceofattendingchurchwithitsownsmallnurseryatwhichtheruleappertainedthatallchildrenaged12monthsandaboveshouldsitwiththeirparentsbecause‘thechildrenwhocouldwalkwerebecomingadangertoalltheweelittlebabies.’TheconscientiousMumadoptsthemantrawithmissionaryzealanddecidestoinstil‘acceptable’behaviourathome:‘IwouldmakemychildsitwithmeonthecouchwhileIreadhimastory.Iwouldn’tlethimjumparoundorclimballoverme.’Atmealtimes:‘Mychildrensatandatealloftheirmealsatthetablewithoutgettingupandwalkingaround.’Unsuitablyactivebehaviouratchurchmeritedpunitivesanction;justifiedinthelightof‘learninganewskill.’‘Ittookwalkingoutofchurchwhenhebecamefussy.’Themotherconcludesonanoteofselfcongratulation;thechildrenwhodidn’tliketheregime,wereforcedtoconformanditwasgoodforthemanyway:‘Mykidsarejustlikemostotherkids.Theyhatesittingstillandbeingquiet,buttheydidit.Theylearnedhowtositstill.Tilltoday,Isayit’sthebestthingIhaveevertaughtmy

children.Childrenwhoknowhowtositandbequietareablessingtotheirparentsandallthosearoundthem.’DrHoffmanwouldcertainlyhaveapproved,buta‘NewYorkTimes’articlewrittenjustayearafter‘NoFussParenting’suggeststhatthesupposedvirtueofchildinactivityisindireneedofamendment.Inanarticleentitled‘WhyKidsShouldn’tSitStillinClass’,DonnaDeLaCruzarguesthatphysicalactivityisapositiveaidtolearningratherthanacloguponacademicprogress:‘Weneedtorecognizethatchildrenaremovement-based,’saidBrianGatens,thesuperintendentofschoolsinEmersonNJ.‘Inschools,wesometimesarepushingagainsthumannatureinaskingthemtositstillandbequietallthetime’.‘Wefallintothistrapthatifkidsareattheirdeskswiththeirheadsdownandaresilentandwriting,wethinktheyarelearning….Butwhatwehavefoundisthattheactivetimeusedtoenergiseyourbrainmakesallthosestillmomentsbetterormoreproductive’.(‘NewYorkTimes’,March21st2017)ThesamearticlequotesJohnRatey,anassociateprofessorofpsychiatryatHarvardMedicalSchoolallegingthat‘Movementactivatesallthebraincellskidsareusingtolearn,itwakesupthebrain’.Similarly,ScottMcQuigg,co-founderof‘GoNoodle’,aclassroommovementprogrammedeployedbyover60,000elementaryschoolsintheUSpraisesMichelleObamaforher‘Let’sMove’initiative,claimingthatithashelpedraisepublicawarenessofthebenefitstohealthofchildmovement.A2014‘WashingtonPost’article,‘Whysomanykidscan’tsitstillinschooltoday’,(ValerieStrauss,July8th2014)mightseemtoreturnusto‘FidgetyPhilip’territory,asthejournalistnotesanincreasingnumberofchildrenbeingdiagnosedwithAttentionDeficitandHyperactivityDisorder(ADHD):‘Alocalelementaryteachertellsmethatatleasteightofhertwenty-twostudentshavetroublepayingattentiononagoodday.Atthesametime,childrenareexpectedtositforlongerperiodsoftime.Infact,evenkindergartenersarebeingaskedtositforthirtyminutesduringcircletimeatsomeschools.’However,thewriterfindsherselfdrawingradicallydifferentconclusionsforthefidgeting,afteraseriesoftestsonthesupposedlyADHDchildrenwereundertaken:‘Wequicklylearnedthat…mostofthechildrenintheclassroomhadpoorcorestrengthandbalance.Infact,wetestedafewotherclassroomsandfoundthatwhencomparedtochildrenfromtheearly1980s,onlyoneoutoftwelvechildrenhadnormalstrengthandbalance.Onlyone!Ohmygoodness,Ithoughttomyself.Thesechildrenneedtomove!……..Childrennaturallystartfidgetinginordertogetthemovementtheirbodysodesperatelyneedsandisnotgettingenoughof‘toturntheirbrainon.’Whathappenswhenthechildrenstartfidgeting?Weaskthemtositstillandpayattention;thereforetheirbraingoesbacktosleep.’Ashasbeenseen,akeyareaimpactinguponratesandfrequencyofphysicalactivityinearlychildhoodsettingsistheprizingofyoungchildrensittingstillforextendedperiodsoftime.Theassumptionappearstobethatstasisequateswithchildlearningandthat

beingphysicallyactivebothinandoutdoorsistantamounttoalearningdesert.Thisinaccurateassumptionisrefutedvigorouslybymanyearlychildhoodcommentators(Davies,2001‘HelpingChildrentoLearnThroughaMovementPerspective’,Tovey,H2007‘PlayingOutdoors:PeopleandPlaces,RiskandChallenge’,Bilton,H2010‘OutdoorLearningintheEarlyYears’).Youngchildren’sphysicalactivityshouldbeseenasthenorm;somethingtobepositivelyencouragedeveryday.Linkedtothis,identificationofa‘good’childasonewhositsstill-asopposedtoahappilymobilechild,needtoberesistedandchallenged(Albon,D2011‘AResponsetoPhysicalActivityatDaycare:Issues,ChallengesandPerspectives’,VanZandvoortetal,2010,‘EarlyYears:AnInternationalJournalofResearchandDevelopment,31(2):193-200).However,thisrequiresasignificantshiftinattitudetowardsyoungchildren.Plannedphysicalactivityprogrammesarevaluable,butaculturalshiftwouldtreasuretheyoungchild’snaturalinclinationtobephysicallyactive.Earlychildhoodpractitionersshouldbeurgedtomaximisespontaneousphysicalactivityopportunitiesforextendedtimespansthroughouttheday;notablythroughuseoftheoutdoorsbutincludingindooractivitiestoo(Albon,D2014‘Play,PlayfulnessandYoungChildren’sWell-Being’,JManning-Morton(Ed),’ExploringWell-BeingintheEarlyYears’).Thisreportcontendsthatphysicalactivityinearlychildhoodisnotan‘addon’oroptionalextra,butthatthebenefitsthatitbestowsarebothimmediateandlong-term.Agrowingbodyofresearchindicatesthatchildrenwithhigherphysicalactivitylevelsintheearlyyearswillmaintainthesepatternsinlaterchildhood,throughadolescenceandintoadulthood.Theywillalsocascadethemtothenextgenerationandbysodoing,maximiseopportunitiesforhealthandwellbeingacrossthelifespan.Activityshouldstartfrombirth–andevenbeforethat.The2011ScottishHealthSurveyillustratesthesignificanceofmaternalactivity;findingsdemonstratingthat80%ofboysaged2-15and71%ofgirlsofthesameagespanwhosemothersfulfilledadultrecommendationsforphysicalactivity,metthechildrecommendationsthemselves,asagainst62%ofgirlsand72%ofboyswhosemothersfellshort.Physicalactivitiesfrombirth,priortowalkingcaninclude:

• Reaching,grasping,pushingandpulling• Supervisedfloorplay,including‘tummytime’• Kickingandrollingfroma‘lyingonback’position• Activitiesatplaygroups,Children’sCentres,leisurecentres• Provisionoftoysthatencourageco-ordination• Swimmingandwaterplay

Timespentstrappedinhighchairs,walkingaids,babybouncers,carseatsandbuggiesshouldbeminimisedasshouldsedentaryandsupinetimeinfrontofatelevision.Already,patternsofactivityasdescribedassistinthedevelopmentofmotorskills,emotionalandsocialeducation,muscularandbonedevelopmentandcognitiveawareness.Onceachildcanwalk,movementpatternsshouldbespreadthroughouttheday,involvingactivitiessuchasstanding,walking,climbing,ridingabicycle,dancingandunstructured,freelychosenplayaswellasmoredefinedactivitiesthatmaybeledby

adults.Theemphasisshouldbeonchild-directedchoicebutshouldbepleasurableandwhenundertakenaspartofactivitiesjointlyenjoyedbythewholefamily,candeepenandstrengthenemotionalbonds.Atthesametime,nutritionandsleephabitsshouldcomplementphysicalactivityandincombination,contributetosocialconfidence,healthybones,confidentco-ordinationandmovementandthemaintenanceofahealthyweight.Farfrompursuingthe19thcentury‘FidgetyPhilip’moralitythemeintothe21stcentury,parents,carers,healthandeducationalprofessionalsshouldpromoterobustpatternsofphysicalactivityforallyoungchildren.Inthiswaytheyandfuturegenerationswillenjoythebeststarttolife,lesseningtheirriskoflaterchronicillnessessuchasstroke,diabetesandcardiovasculardisease.Forthepurposesofthisreport,theAllPartyParliamentaryGrouponaFitandHealthyChildhoodhaschosentofollowtheUnitedNationsConventionontheRightsoftheChild’sdefinitionofearlychildhoodasbeingbelow8years;therebyincludingchildrenatbirth,throughoutinfancyandpre-schoolyearsaswellasthetransitiontoschoolwhichcanvarydependinguponregion/countryfromsoonafterfouryearsofagetoanupperentryageofsevenyears.

‘Physicalactivitybehavioursacrossthelife-coursecanbeheavilyinfluencedbychildhoodexperiences.Creatingsafe,physicallyactive,friendlycommunities,whichenableandencouragetheuseofactivetransport(walking,cycling,etc)andparticipationinanactivelifestyleandphysicalactivitieswillbenefitallcommunities.Particularattentionneedstobegiventoimprovingaccesstoandparticipationinphysicalactivityforchildrenalreadyaffectedbyoverweightandobesity,disadvantagedchildren,girlsandchildrenwithdisabilities’(WHO,2016EndingChildhoodObesity.WHO,Geneva).Asinallmattersrelatingtohealthandwellbeing,itisnevertooearlytoinstilgoodpractice.Atpresent,oneinfiveofUKchildrenbeginprimaryschoolalreadyoverweightorobeseandaccordingtostatisticsfromPublicHealthEngland,11%oftoddlersareobese(amongstchildrenlivinginpovertythefigureishigher).Overafifthoffourandfiveyearoldsareoverweightorobeseandobesechildrenhavea40-70%likelihoodofbecomingobeseadults.Regularphysicalactivityisthereforecrucialandemergingevidencesuggeststhatsedentarybehaviourintheearlyyearsisassociatedwithoverweightandobesity(NHS2010)aswellaslowercognitivedevelopment(Hawkins,SSandCLaw,2006Areviewofriskfactorsforoverweightinpreschoolchildren:Apolicyperspective,InternationalJournalofPaediatricObesity1(4):195-209).ThenumberofphysicalactivityprogrammesacrosstheUKtargetedattheearlyyearssectorhasincreasedandmanyarefundedanddeliveredwithinthemaintainedschoolssectorandinthecommunitybyexperiencedsportscoachesandleaders.However,thephysicalactivityopportunitiesavailabletoyoungchildrenremainlargelyunregulatedandunder-funded–andoutsidetheremitofmanysportsorganisations’governingbodies.Itisworryingthatdespitetheincreaseof30minutesofphysicalactivityeachdayviaactivebreaktimes,PE,extra-curricularclubsandactivelessons,fundedbyanincreaseinthePEandSchoolSportPremium,evidencefromtheGatesheadMillenniumCohortStudyonchildren’sphysicalactivity(FarooqMA,ParkinsonKN,AdamsonAJ,etal:Timingofthedeclineinphysicalactivityinchildhoodandadolescence:GatesheadMillenniumCohortStudyBRJSportsMedPublishedOnlineFirst:13thMarch2017.doi:10.1136/bjsports-2016-096933)presentsableakpicture.Thereis,asyet,nosignificantdatatodeterminethephysicalactivitypatternsofyoungchildrenintheUK–eitherinnurserysettingsorinthehomeenvironment.Weknowthattheirlevelofphysicalactivityisworryinglylow-butwedonotknowpreciselywhattheydo–wheretheydoit–andwhotheydoitwith.EarlyYears’practitionersarenowincreasinglyfacedwiththeresponsibilityandgrowingchallengeofaddressingobesityinpreschoolchildren.LittleisknownabouttheUKpreschool0-5children’sactivitypatternandevenlessabouttheirchildcareenvironment.LimitedavailableevidencesuggeststhatUKchildrenspendlargeperiodsoftimesedentaryatpreschoolandthatanyactivityispredominantlyofalightintensity(ReillyJJ,LowLevelsofobjectivelymeasuredphysicalactivityinpreschoolersinchildcare.MedSciSportsExerc2010Mar;42(3):502-7).

PhysicalDevelopmentremainsaPrimeAreaoftheEarlyYears’FoundationStagecurriculum,butcurrentresearchfurthersuggeststhatphysicalactivitylevelsinchildcarearelow,indicatingthatchildrenaccumulatelessthan60minutesofmoderateorvigorousactivityoveran8hourday(PhysicalActivityintheEarlyYears:BritishHeartFoundationNationalCentreforPhysicalActivityandHealth,October2015).Thesamesurveyalsoobservesthatchildrenaremuchmoreactivewhenadultsbehavesimilarlyandthatwhenadultssuperviseratherthanparticipatinginphysicalactivity,childrenmoveless.Itisthereforeimportantthatthesectoracknowledgesavailableresearchfindings–andusesthemtosupportpractice,liaiseeffectivelywithparentsandinstilinchildrenthepositivedispositions,habitsandbehaviourstowardsphysicalactivitythatareknowntoensurelong-termenjoymentandengagement.Thereare,ofcourse,manyexcellentexamplesofgoodpracticetobefoundinUKnurseries,primaryschoolsandwithinhomesettings.Here,thecomprehensiveprogrammesprovidedbyOutdoorPlayandLearning(OPAL)inavarietyoflearningenvironmentsandthefamily-basedinitiativesofferedbyMytimeActivearedescribedinsomedetailasthesesupplyabreadthofgoodpracticeasusefulexemplarmaterial.Overall,‘goodpractice’throughouttheUKispatchyandmuchmustbedonetoimprovethequality,natureanddiversityofphysicalactivityprovisionforyoungchildren.Thefollowingissuesarerelevant:

• TeacherswhetherdeliveringtheEarlyYears’FoundationStage(EYFS)orKeyStage1(uptoeightyearsofage)receivelimitedtrainingintheplanninganddirectionofoutdoorplaythatcanbeutilisedforthepromotionofchildren’shealthandcontinuallearninganddevelopment.In90%ofUKeducationsettings,thebestresourcesofferedtochildrenareoftenproduceden-masse,designedtoa‘onesizefitsall’philosophy.Children’splayitemsaregenerallyexpensive‘toys’oflittleenduringinterest,orplasticresourcessuchassport/PEitemslikeballsandhoops.Outdooractivitiesandfeaturesthatdonotmatchthecriteriaoffreelychosen(bythechildfromawiderangeofrandomitemsandsituationsonoffer),personallydirected(thechilddeterminestheactivity)andintrinsicallymotivated(thechildcontrolswhy,whatandwherewithoutproscriptionbyanadult)cannotbecalled‘play’andwillnotoccupyachildforsufficientlylongtoengendermaximumphysicalanddevelopmentalbenefit(‘CreatingExcellenceinPrimarySchoolPlaytimes’,MFollett,April2017).www.kpp.com

Similarly,iftheplayelementsofrotationandtrajectory,envelopingandorientation,positioningandconnection,enclosure,transportationandtransformationareinsufficientlypresent,thenanyoutdoorplay-learningsettingcannotperformtooptimumpotentialandchildrenwillnotbeasphysicallyengagedandactiveastheycouldbe.• ThePersil/UnileverProjectDirt/DirtisGoodcampaignfoundthatmostprimary

schoolagechildrenspendlesstimeinoutdoorplaythanprisonersarerequiredtohavebylaw. https://www.youtube.com/watch?v=6pVM1okMN8o

• Asschoolsareincreasinglypressuredtosupplyservicesthatwereformerlytheprovinceofotherprofessionals(mentalhealthmonitoring)orparents(potty

training,dressing,cutleryskills,additionalmeals)freeplaytimecontinuestograduallyerode.http://www.breaktime.org.uk/team.htmlIfschoolplayopportunitiesfurtherdecreasecombinedwithacontinuinglossofplayopportunitiesoutsidetheschoolday,thenchildren’sburgeoningconfidence,leadership,characterbuilding,determination,teamworkandachievementofgoodmentalhealthandhappinesscanonlydegradefurther.Thiswillthenexacerbatetheexistingcrisesinchildren’sfitness,wellbeingandweightmanagementandtheresultantcoststosociety,theNHSandtheeconomy.Thiserosionofplaymustbeaddressedwithzeal.

• EarlyYearsTeachersandPlaytimeSupervisorsinNursery,ReceptionandKS1

withalackofbestpracticedesign/deliverytrainingtosupportthem,arelesslikelytoperceivethesignificanceofagoodqualityoutsidetofacilitateactiveplaythatsatisfiestheneedsofallchildren.Anysettingwherebyupto50%ofpupilsaresedentaryforthemajorityofdailyplaytimes,cannotsupplythebasicfacilitiesforhealthy,child-engagingactivity.

• Upuntilnow,moststudiesofactiveplayininfant/primaryschoolshave

considered‘whattheyhavegot’ratherthanaddressinglargegapsincurrentprovision.Genderassumptionshttp://journals.sagepub.com/doi/abs/10.1177/1356336X15591135wherebydecisionsweremadeaboutwhatgirlsandboysmightprefer,predicatedbytraditionandguesswork,arenotthewaytodeterminemodernpolicymaking.

• Thelevelofphysicalactivityinyoungerchildrenisdependentuponmotivation,

opportunity,freechoiceandtheremovalofbarriers.OutdoorPlayandLearning(OPAL)www.outdoorplayandlearning.org.ukwithoverfifteenyears’researchandpracticeinprimaryschools,identified18categoriesofplaybarriercoveringfivebroadareasofLeadershipandPlanning,AccessibilityandInclusion,CareandMaintenance,StaffSkillsandPlayValue.TheOPALprogrammedefinesprogressacrossawiderange,includingincreasedphysicalactivityingirlsandboys,betterplaytimeandclassbehaviour,socialandemotionaldevelopment,increasedintegrationof‘statemented’childreningeneralplayactivities,plusadditionallevelsofresilience,happinessandcontentmentwithinthecontextofgeneralschoollife.

Suchbenefitsaccruewhenthereisa‘wholeschool’culturalandattitudinalcommitmenttoeveryaspectofchildren’splayandoncesuchashiftisachieved,parentscomeonboard.Keycriteriafortheprovisionofengagingandinclusiveplayenvironmentsineducationalsettingsthatengenderconsistentphysicalactivityandmentalwellbeingmightinclude:

1. Socialspaces2. Journeys3. Affordance,differenceandmaterialrichness4. Changeopportunities

Socialspacesareplaceswhereachildfeelssafeandcalm;hencetheimportanceofdensandtheneedforavarietyofsocialareaswithcharacteristicsinwhichtobetobecontentedlyaloneoraspartofapairorsmallgroup.Inajourney,achildmayprogressfromAtoBtoanimaginarylocationandaninterestingroute(enabledbutnotcontrolledbyadults)shouldberichwithsurpriseandextraplayopportunitiesalongtheway.Affordances,differencesandmaterialrichnessrepresent‘playcues’;objectsandsituationstotriggerachild’simaginationand‘changeopportunities’offerachancetobeuninhibitedwithfreematerialslikewater,soilorsand.Thoroughsafetyassessmentsareessentialandplaytimewrittenpolicyshouldbeprominentlydisplayedonschoolnoticeboardsandwebsites.http://www.hse.gov.uk/entertainment/childrens-play-july-2012.pdfUndertheEYFS,providersarerequiredtodemonstratehowtheyaremanagingriskandarereferencedtotheHealthandSafetyExecutiveguidance.MytimeActive,anestablishedUKproviderofcommunity-based,family-focusedhealthylifestyleandweightmanagementprogrammeshasaspecificinterestindeliveringkeyhealthmessagesviainteractivegamesandphysicalactivitysessions.In2015,thethreeLondonBoroughsofWestminster,KensingtonandChelseaandHammersmithandFulhamcommissionedMytimeActivetodeliverarangeofintegratedhealthservicesforchildren.Thisdecisionreflectstheincreasingevidencebasethatcommissioningservicesforchildrenshouldbeholisticwhilstpoolinglimitedresources.Servicesaddressingphysicalactivityinisolationarelesslikelytoachievethegoalsofsustainedbehaviourchangeandlongtermoutcomes.MytimeActiverunsMEND(Mind,Exercise,Nutrition,andDoIt)familybasedcommunityinterventions,deliveredbyteamsofRegisteredDieticians,NutritionistsandPhysicalActivitySpecialists.Theholisticapproachisattunedtochildfitnessandweightmanagementand10-weeksessionsaredeliveredinchildren’scentresandcommunityhalls.Atpre-schoollevel,MENDMini(targetingthe2-4agegroupandtheirparentsorcarers)increasesawarenessofhealthyeating,boostingselfconfidenceandenhancingphysicalandsocialawareness.Parentsandchildrenengageinskills,gamesanddevelopmentalexercises,followedbyfoodpreparationandtasting,givingchildrentheopportunitytoexperiencearangeoffruits,vegetablesandhealthyfoods.MiniMENDiscommittedtothephysicaldevelopmentlearningoutcomesofthestatutoryframeworkfortheEarlyYearsFoundationstage.MEND5-7isforfamilieswithchildreninthisagegroupwhohaveconcernsabouttheirweightandnutrition.Parents/carersandchildrenparticipateinarangeofgames,exercisesandworkouts;alsoaffordingopportunityfornutrition,physicalactivityandrelatedparentingtopicstobeaddressed.Familiesareencouragedtodeterminecrediblehealthandactivitygoals.

ThemulticomponentMENDinSchoolsisawholeschoolobesitypreventionprogrammeembeddedinthecurriculumandaimingtoachievesustainablechangesinhealthyeating,strongoralhealthandphysicalactivityinhomeandschoolsettings.Childrenandfamiliesareencouragedtoachieveandmaintainhealthyweightandlifestyles.MENDinSchools(initiatedSeptember2015)isnowadoptedby46primaryschoolsacrossWestLondonandtodate,4,999childrenacrossmultipleyeargroupshaveparticipatedintheprogramme.KeyStage1childrenjoinweeklyworkshopsandphysicalactivitysessionsoveraterm.Physicalactivitysessionscontinueascurriculumactivitiesduringthefollowingthecurriculumandthencethephysicalactivitysessionsbecomepartoftheextracurricularprogramme.Thepackageisthenrepeatedwithdifferentyeargroups.InPhaseOneofMENDinSchools,teachingstaffworkwiththeMytimeActiveteamtodeliverthreeonehourworkshopsforthewholefamilyinthefirstterm.PhaseTwoprovidesaphysicalactivityprogrammeforonehourperweekdesignedforalunchtimeorafterschoolclub.Thesessionscombinephysicalactivitywitheducationabouthealthylifestyles;healthyeating,thedevelopmentofphysicalliteracyandpromotingengagementinphysicalactivity.Childrenaresettasksandchallengestocompleteathometohelpreinforcethesessionmessages.AllMENDprogrammesincludeparentandchildactivitysessionsandseektobuildparentalconfidenceinfacilitatingplay,increasethefamily’sactivitylevelsandcreatebetterphysicalactivityrolemodels.Parent-childimaginativeandphysicalplayislinkedwiththechild’scompetence,grossmotorskills,peergroupleadershipandcognitivedevelopment(Lindsey,EW&Mize,J.2000.Parent-childphysicalandpre-tenseplay:Linkstochildren’ssocialcompetence:Merrill-PalmerQuarterly,46(4),565-591).Interactiveplayhelpsachildtolearnhowtoregulatetheiremotionsbetter(Sunderland,M.2006.Scienceofparenting;practicalguidanceonsleep,crying,playandbuildingemotionalwell-beingforlife).MENDalsoencouragesparticipantstotakeadvantageoflocalphysicalactivityopportunities,includingparksandgreenspaces.AnewMENDinSchoolprogramme,‘WiggleWeek’isdesignedtointroduceReceptionchildrentohealthybehavioursandreinforceYearOnechildren’slearning.Sixwiggles(songs)combiningfamiliarnurseryrhymeswithnewlyricsaimtoembedhealthyroutinesincludingtryingnewfoods,drinkingwater,stayingactive,beinganactivefamilyandestablishingagoodbedtimeroutine.Home-gamevideosarealsousedtoequipfamilieswithnewgamingideasthatcanbeplayedanywhereatnocost.Familiesaresignpostedtothevideosviasocialmedia,workshopsandhandoutslipsthatchildrentakehomeeachweek.Asalways,thebesttestamenttoaprogramme’ssuccesscomesfromthoseitisintendedtobenefitandthisistheverdictfromasatisfiedYearOnepupil:‘Ienjoydoingsportsandmostofall,Ilovetryingnewfruitsandvegetables.Whenwearedoingsports,wealsogettolearnatthesametime.ILoveMEND.’Itisimportantthatinitiativesdesignedtoincreasephysicalactivityinyoungchildrenareholistic;especiallyinlightofthefightagainstobesityandoverweightandagreater

prioritymustbeplacedonactivitylevelsoutsidetheschool.AnotherimportantareainneedofattentionisPrimaryCareashighlightedbyDr.WilliamBird:‘….theGPsparticularlyneedtohavetheirknowledgeincreased.Physicalactivityshouldbepartofbeingagooddoctor.Itisnotquitethereyet.Theevidenceistherebutitneedstobeputintotheheartsandmindsofdoctors’,(HouseofCommonsHealthCommittee1015ImpactofPhysicalActivityandDietonHealth,SixthReportofSession2014-15,TheHouseofCommons:TheStationaryOffice,London).AccordingtoJaneLandonoftheUKHealthForum:‘Wehavethetoolsavailabletous;wehavethedietaryguidelines;wehavephysicalactivityguidelines.WeareonlyreallyusingthemwhenwetalktotheindividualwhentheseshouldbeguidingpolicydecisionsacrossGovernmentdepartments.Weneedtore-framesomeofthediscussions,’(HouseofCommonsHealthCommittee,2015ImpactofPhysicalActivityandDietonHealthSixthReportofSession2014-15.TheHouseofCommons:TheStationaryOffice,London).Recommendations

1.1 AUKoverallhealth/wellbeingassessmentforyoungchildrenastheystartschool,commensuratewiththeAustralianAEYC(AustralianEYcensus)

1.2 Multidisciplinarypolicymakers(education,welfare,planning,health,socialdevelopment)tobeawareoftheimportanceofphysicalactivityinearlychildhoodwhendesigningpolicy

1.3 Physicalactivityintheearlyyearstobeembeddedinallrelevantpoliciesnationally,regionallyandlocally

1.4 Fundingtobemadeavailablefortrainingforearlyyears’practitionersinphysicalactivity

1.5 Allteachers,fromEYs/FoundationthroughtoHeadteacherstoreceiveaminimum20hoursoftraining,updatedeveryfiveyearsonbestpracticeinenablinganddeliveringplaytimelearning.Suchtrainingshouldincludecoverageofpolicyareas,forwardplanning,communication,safety/risk,design,materialsresourcingandreflectivepractices

1.6 Healthandeducationpractitionersshouldshareinformationaboutphysicalactivityanditsroleinchilddevelopmentbydemonstratingintegratedandpurposefulworking

1.7 Everysettingaimingtoprovideahighqualityofoutdoorplayprovision(under5s–primaryschool)tomeetthe18areasidentifiedbyOPALasaminimumrequirement.

Physicalactivityisimportantintheprepregnancyperiod;duringpregnancyitselfincreasingevidencesuggeststhatphysicallyactivewomenarelesslikelytoexperience

problemsinlaterpregnancyandduringlabour(NationalChildbirthTrust2017:Goodexercisesandsportsinpregnancy):https://www.nct.org.uk/pregnancy/good-exercises-sports-pregnancyPhysicalactivityinpregnancyreducestheriskofexcessiveweightgainandadverseconditionsincludinggestationaldiabetes,pre-eclampsia,pre-termbirth,varicoseveinsanddeepveinthrombosis(RoyalCollegeofObstetriciansandGynaecologists,2006.Exerciseinpregnancy):https://www.rcog.org.uk/en/guidelines-research-services/guidelines/exercise-in-pregnancy-statement-no.4/Someevidencelinksphysicalactivityduringpregnancywithshorterlaboursandfewerdeliverycomplications.Psychologicalbenefitsincludereducedtiredness,stress,anxietyanddepression.Physicallyactivewomenarealsolikeliertocontinuebeingphysicallyactivepostpartum.PhysicalactivityduringpregnancyisendorsedbySportMedicineAustralia(SMAPositionStatement;ExerciseinPregnancyandthepostpartumPeriod2016)makingthepointthatmoderate-intensitywalking,jogging,cycling,swimming,muscle-strengtheningexercises(includingpelvicfloor)water-basedexerciseandpregnancy-specificclassesforexpectantwomenarebeneficialandarealsoapositivefactorinpostpartummentalhealth.Itiscrucial,however,thatdeliveryofantenatalandpostnatalexercise(includingnewbabyactivity)isconductedandoverseenbyprofessionalswhoareappropriatelyqualifiedandupdatedontraining.Continualprofessionaldevelopment(CPD)isnecessarytoensureaconstantstandardofoccupationalcompetency.TheWorldHealthOrganisation(WHO)recommendsthatindividualsaged18-64engageinmoderatephysicalactivityforatleast150minutesacrosstheweekoratleast75minutesofvigorousintensityaerobicactivity.Muscle-strengtheningactivitiesshouldcomplementthistwoormoredayseveryweek.WHOadvisespregnantwomentotakeextraprecautionandseekmedicaladvicebeforestrivingtomatchtheserecommendations.Previouslyinactivepregnantwomenshouldbeginwith15minutesofcontinuousaerobicactivitythreetimesaweek;increasedto30minutesatleastfourtimesaweek(NHSChoices2017.ExercisesinPregnancy):http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspxInactivewomen/womenwithahighriskpregnancy/pre-existingmedicalconditionshouldconsultahealthprofessionalbeforecommencinganactivity/exerciseprogramme.Ingeneral,pregnantwomenshouldminimisesedentaryactivitiessuchassittingforlongtelevisionviewingsessionsorworkingatacomputerunlessadvisedtothecontrarybyahealthprofessional(NationalInstituteforHealthandCareExcellence2010.Weightmanagementbefore,duringandafterpregnancy):https://www.nice.org.uk/guidance/ph27Asignificantbodyofresearchadvocateswaterexerciseforpregnantwomen:‘AstudyintheUnitedStatesshowedthatpregnantwomenwhoexercisedinwaterhadlowerheartratesandbloodpressurethanwomenwhodidordinaryexercises.Thebabiesalsobenefittedbyhavinglowerfoetalheartratesafterwaterexercisesthanwhenthesameexercisesweredoneonland’,(Harmonizingexercisesinwaterforpregnancy,birthandbeyond,AquaYoga,FrancoiseBarbaraFreedman,2002,p12).FreedmancitesthesupportthatwatercangivetojointsandmusclesandMeratietal(2006citedBolithoS,HathV.AquaExerciseforpregnancyandpostnatalhealth,2014)affirmthatexercisingin

water,thusmimickingverylowgravity,canrelievefeelingsofdiscomfortfromtheweightofthefoetusanduterus,inparticulartosupinepositions,exercisingandbreathingdepth.ResearchfromQueenMary,UniversityofLondon(TheDailyMail,July20th2017)hasfoundthat,accordingtodataassessedfrom36previoustrialsconsistingof23studiesofpregnantwomenofvariableweight,sixtargetedatoverweightandobesewomenandsevenconsistingofonlyobesewomen,womenofanyweightwerelikelytoderivebenefitfromatailoreddietandexerciseprogrammeduringpregnancyandwerethuslesslikelytodevelopdiabetesinpregnancy,gainexcessiveweightorrequireaCaesareansection.Ofequalimportanceiscontinuingphysicalactivityafterbirth,bothintermsofmatterssuchaspelvicfloorhealthandmuscletrainingtopreventincontinenceandprolapseinlaterlife,butalsoasabulwarkagainstpostnataldepression:‘Exercisecanhelpreducethesymptomsofpostnataldepressionbecauseitservesasadistractionfromthemanyproblemsandstressesofdailylife.Exercisesalsonaturallyenhancemoodandesteem,andprovideanopportunityfornewmotherstomeetfriends,shareexperiencesandincreasetheirlevelofsocialsupportandinteraction.’(Health,FitnessandEducation(HFE),2013,p51).Duringpregnancy,theadviceandsupportofhealthprofessionalsisvital.NICEadvisesthatideallybeforethe10weekgestationperiod,theinitialvisittoahealthprofessionalshouldaddresseatinghabitsandlevelsofphysicalactivity.Concernsaboutmoderate-intensityphysicalactivityshouldbeallayedandadvicegivenastospecifictypesofphysicalactivityduringpregnancy(rateandfrequencydependentupontheindividual)andtheimportanceofavoidinganexcessivelysedentarylifestyle.Pregnantwomenshouldalsobewarnedagainstengaginginhigh-impactsportsthatmayinvolvetheriskofabdominaltrauma,fallsorexcessivejointstressandembarkinguponscubadivingwhichmayresultinbirthdefectsandfoetaldecompressiondisease.NICEguidelinesalsolayimportanceondietaryadviceIn2010,theRoyalCollegeofMidwives(RCM)conductedasurvey,withparentingwebsite‘Netmums’canvassingover6,000womenabouttheadvicetheyreceivedconcerningweight,dietandphysicalactivityduringpregnancy.Theresultsweredepressing:

• 64%regardedtheadvicereceivedas‘neutral’,‘poor’or‘verypoor’• NearlythreequarterswantedNHSmidwife-ledantenatalclassestoaddress

weightanddiet• Twothirdsreportedthattheirmidwifedidnothavetimeforsuchdiscussions

(Netmums,2010.AGrowingProblem-Doesweightmatterinpregnancy?)https://www.netmums.com/assets/images/2012/A_Growing_Problem_Nov2010.pdfMidwivesareideallyplacedtoexploreissuesofphysicalactivityandweightmanagementbutneedtheconfidenceinstilledbytrainingtoraisethesetopics.AnexampleofgoodpracticeissuppliedbyTheEarlyStartWellbeingandNutritionTeamwhodeliveranAssociationofNutrition(AfN)certifiedPhysicalActivitytrainingcoursewhichaimstoincreasetheknowledgeofearlyyearspractitionersandhealthprofessionalsinthebenefits,recommendations,andbarriersforphysicalactivitythroughoutthelifecourse,includingpregnancy(EarlyStartWellbeingandNutrition

Team,2017).Inaddition,anumberofonlineresourcesaimtoinformandencouragepregnantwomentobephysicallyactivethroughoutpregnancy.Healthprofessionalsshouldensurethattheysignpostwomentoreliable,evidencebasedinformationsources,suchasNHSChoices,NCTandTommy’s.Itisalsoimportantforprofessionalsworkingwithexpectantmotherstobeawareofthelocalprovisionofexercisegroupsandleisureactivitiessuitableforexpectantmotherssuchasantenatalyoga,Pilatesandswimming.Evidencebothforpsychologicalandphysicalwellbeingofregularphysicalactivityfortheunderfivesisincreasing(Startactive,stayactive:reportonphysicalactivityintheUK):http://www.ssehsactive.org.uk/userfiles/Documents/startactivestayactive.pdfIninfantsandveryyoungchildren,physicalactivitystrengthensdevelopingmusclesandbonesandassistsgoodcoordinationandmovement.Avarietyofphysicalactivitiesalsohelpsmaintainahealthyweight,boostsselfconfidenceandsocialskillsandfurthersthedevelopmentoffriendships.Asearlyphysicalactivityfrequentlypresagesbeneficenthabitsbeingcarriedintolaterlife,itisakeycomponentofpromotingalifelonghealthylifestyle.Whilstphysicalactivityformostunderfivecarriesverylowrisk,thepotentialthatchildhoodinactivitywillleadtopoorlaterhealthisveryhigh.In2011,theDepartmentofHealthadvisedatleast180minutesofphysicalactivityforambulantunderfives.However,theStayActivereportmentionedabove,statesthatonlyoneintenchildrenagedtwo–fourarecurrentlymeetingtheseguidelines,withmanyspending10-11sedentaryhoursperday.TheChiefMedicalOfficerhasadvisedthefollowingphysicalactivityrecommendationsinchildrenundertheageoffive:

• Physicalactivitytobeencouragedfrombirth;especiallywater-basedactivitiesinsafeenvironmentsandfloor-basedplay

• Ambulantpre-schoolchildrenshouldbephysicallyactiveforatleastthreehoursspreadthroughoutaday

• Allunderfivestominimisesedentarytimewhetherunderrestraintorsittingsoloforextendedperiods(exceptsleeping).

Healthprofessionalsarewellpositionedtoofferadviceandalsosourcesoflocalactivitiesandsupportgroupsbutneedcontinuallyrefreshedprofessionaldevelopmentopportunities(CPD)tokeepuptodate.InScotland,theNHSprovidesaflexiblee-learningresourcewhichengagesavarietyofdifferent-sectorindividualswhoareinvolvedinadvancingthecauseofphysicalactivityinScotland.Themoduleseducateandraiseawarenessaboutphysicalactivityandtrainingpackagesincludebehaviourchange,raisinganissueofchildandmaternalhealthyweightandphysicalactivitywithsensitivityandsignpostingtoothersourcesofprovisionandhelp.(NHSHealthScotland2017):https://elearning.healthscotland.com/course/index.php?categoryid-113TheBritishHeartFoundationhasproducedarangeoffreeresourceswhichaimtosupportearlyyears’practitionerstoplanandorganisephysicallyactiveplayenvironmentsfortheunderfives.TheEarlyMoversGuide(BritishHeartFoundation2015:PhysicalActivityStatistics2015):https://www.bhf.org.uk/publications/statistics/physical-activity-statistics-2015includeseducationalandsupportbookletsforpractitionersandalsoinformativeleafletsforparents/carersontopicssuchas‘Helpyourchildmoveandplayeveryday’and‘Ideasforactiveplaywithyourbabyorchild.’

TheNewham-basedEarlyStartWellbeingandNutritionTeamofferanAssociationforNutrition(AfN)certifiedPhysicalActivitytrainingcoursewhichaimstoincreasetheknowledgeofearlyyears’practitionersandhealthprofessionalsaboutthebenefit,recommendationsandideasforphysicalactivityintheearlyyears.ThistrainingalsoexploreshowphysicalactivityisreflectedintheEarlyYears’FoundationStageFramework(EYFS)andinOfsted’sCommonInspectionFramework.Staffaregivenconfidencetonotonlyencourageandplanactivitiesintheirsettingbutalsoinsharinginformationandsupportingfamiliestobephysicallyactiveathome(EarlyStartWellbeingandNutritionTeam2017.PhysicalActivity):https://www.earlystartgroup.com/wellbeing&nutrition/training/pagAnothertrainingproviderdeliveringCachesupportedleveltwoandthreetrainingcoursesinthefieldofEarlyYearsPhysicalDevelopmentisActiveMatters.ThistrainingissuitableforarangeofprofessionalsincludingSpeechandLanguageTherapists,nurserypractitioners,sportscoachesandoccupationaltherapists.TheaimofActiveMattersistoensurethatpractitioners/professionalsreceiveappropriate,highqualitytrainingthatsupportsthedesignanddeliveryofsafeandeffectivepracticalsessions(ActiveMatters2017.AboutActiveMatters):http://www.activematters.org/about-section/aboutPhysicalactivityprogrammes,combinedwithinformationaboutahealthydietareessentialprepregnancy,duringapregnancyandforthenewmotherandherchildafterthebirthandintheearlyyears.Therearemanyexamplesofgoodpractice,butalltoooftenthisisnotreadilyaccessibleand,asaconsequence,underused.Itisnowessentialthatgoodpracticeiscollated,pilotschemesadvancedandgovernmentbothlocallyandnationallytakesaleadinensuringthatgoodpracticeisestablishedfromtheoutset,givingparentsandprofessionalsconfidenceandtherebypavingthewaytogoodstartswiththepotentialtofacilitatelifelonghealth.Recommendations2.1 Governmenttoestablishanationalphysicalactivityandhealthyeating

campaigntargetedatprepregnancy,pregnancyandpostpregnancystagesformotherandbaby;partofwhichwillinvolvelocalauthoritiesestablishingandupdatingaccessibledirectoriesoflocalprovision

2.2 Governmenttoestablishphysicalactivity/healthyeatingpilotprogrammesbasedonexistinggoodpracticeforevaluationandpotentialnationalroll-out

2.3 Comprehensivemodulesinvolvingphysicalactivity/healthyeatingtobeembeddedintotheinitialtrainingforthosecomingintocontactwithprepregnancy,pregnantandpostpartumwomenduringthecourseoftheirprofessionalduties

2.4 HealthandeducationalprofessionalsincludingmidwivestohaveCPDonphysicalactivity/healthyeatingasacontractualrequirementwithregulartimespanupdate;toincludetheuseofappsandelearning

2.5 IncreasedemphasisontheimportanceofphysicalactivityacrosstheEarlyYears’FoundationStagecurriculum

2.6 Prioritisingtheroleofphysicalactivityinassessmentofphysicaldevelopmentintheearlyyearscurriculum

2.7 CreatingaHealthyEarlyYearsAwardschemetopromoteandenhancetheprogressionofphysicaldevelopmentandphysicalactivitywithintheEarlyYears’FoundationStagecurriculum

2.8 Promotingandensuringasystematicanduniformsharingofinformationbetweenearlyyearssettingsandinfant/primaryschoolsregardingindividualchildren’sphysicaldevelopmentandactivitylevelspriortotransition.

3. THEROLEOFLOCALAUTHORITIES,VOLUNTARYORGANISATIONSAND

BUSINESSINPROMOTING,FACILITATINGANDDEVISINGAHOLISTICRANGEOFEARLYCHILDHOODPHYSICALACTIVITYOPPORTUNITIES;ALSOWORKPLACECRECHES

Earlyyears’providersareresponsibleforbuildingandsupportingtheirworkforce,andthesuccessofthisstrategywilldependuponemployers,aswellastrainingprovidersandsectororganisations,continuingtoworktogetherandwithgovernment.Butgovernmenthasaroletoo.‘AstheMinisterfortheEarlyYears,Iamcommittedtosupportingthedevelopmentofawell-qualifiedworkforcewiththeappropriateknowledge,skillsandexperiencetodeliverhighqualityearlyeducationandchildcareforchildrenfrombirthtoagefive…..aneffectiveworkforcedriveshighqualityprovision,whichiscriticaltochildren’soutcomesandisimportanttoparentsmakingchildcarechoices.’(EarlyYearsWorkforceStrategy,March2017–CarolineDinenageMP,MinisterforWomen,EqualitiesandEarlyYears).ThegovernmentChange4Lifeinitiativeproducesresourcesannuallyforparents/teacherstoencouragechildren’sactivityduringthesummerholidaysandPublicHealthEnglandcollectdataonuptake/useofresources.The2017campaigninvolvestheuseofDisney-themedactivitycardsandwhilsttheyarechild-accessible;addressingtherecommendationslistedheremightenablemoreeffectivemonitoringoftheprogrammes:

• Procedurestobedevisedwherebyallschemesareevaluated• Feedbackonwhatworkedwithfamiliesandchildrenplusdataonthenumber

ofparticipants• Assessmentoftheactivities;dothe‘games’meettheneedsof21stcentury

childrenoristheirappealprimarilytoearliergenerations?• Safetypointstobeincludedingameprescriptions• Onceanactivityhasbeencompleted,whatisthenextstep?• Predicteddurationoftheactivity/numberofchildrenideallyinvolvedandage

rangeofparticipants• LinkingactivitiestotheChiefMedicalOfficer’srecommended180minutesof

physicalactivity,spreadthroughouttheday• Whataretheactivitiesexpectedtoachieve?

Currently(althoughBrexitwillbeinfluential)theWordHealthOrganisation’sRegionalCommitteeforEuropehasproducedadocumententitled‘PhysicalActivityStrategyfortheWHOEuropeanRegion–2016-2025’.

PriorityArea2isentitled‘Supportingthedevelopmentofchildrenandadolescents’andObjective2.2aimsto‘Promotephysicalactivityinpre-schoolsandschools.’Keyguidanceisasfollows:33. ‘MemberStatescoulduselegislationandothertoolstopromotephysicalactivityin

preschoolsandschools.Theinitiativescouldincludeinfrastructuretosupportphysicalactivity,suchasplayground,activebreaks,freeplay,activeextracurricularactivitiesandprovisionsforsafecommuting,e.g.bybikeor‘walkingbus.’MemberStatesshouldalsocontinuetoimplementexistingpolicydocumentssuchastheEUCouncilRecommendationonpromotinghealth-enhancingphysicalactivityacrosssectors(forMemberstatesoftheEU)andtheParmaDeclarationonEnvironmentandHealth.’

34. ‘Memberstatesshouldlaythebasisfortheparticipationofchildreninphysical

activity.Itisimportanttomakepreschoolsandschoolsmoreactivebyprovidingthemwithassistance,adequateresourcesandthenecessarytrainingaswellasopportunitiesformeaningfulinvolvement.Dependingontheirnationalcontexts,MemberStatesshouldconsiderusingregulationoffiscalmeasurestospecificallypromotetheinclusionofchildrenfromvulnerablegroupsandchildrenwithdisabilities.’

IntheUK,statutoryguidanceforLocalAuthoritiesstatesthatforthreeandfouryearoldsLocalAuthoritiesarelegallyrequiredto:Secureearlyeducationplacesof570hoursperyearovernofewerthan38weeksoftheyearforeachchildintheirareafromtherelevantdateuntilthechildattainscompulsoryschoolage(thebeginningofthetermfollowingtheirfifthbirthday).Therelevantdatesare:

• ChildrenbornintheperiodJanuary1st–31stMarch:thestartoftermbeginningonorfollowing1stAprilafterthechild’sthirdbirthday

• Childrenbornintheperiod1stApril-31stAugust:thestartoftermbeginningonorfollowing1stSeptemberafterthechild’sthirdbirthday

• Childrenbornintheperiod1stSeptember–21stDecember:thestartoftermbeginningonorfollowing1stJanuaryafterthechild’sthirdbirthday.

Two-year-olds-LocalAuthoritiesarelegallyrequiredto:Secureearlyeducationplacesoffering570hoursperyearovernofewerthan38weeksoftheyearforeveryeligiblechildintheirareafromtherelevantdateasoutlined.Achildmeetseligibilitycriteriaif:

• TheyqualifyforFreeSchoolMeals• TheirfamiliesreceiveWorkingTaxCreditsandhaveanannualgrossincomeof

nomorethan£16,190perannum.

https://www.gov.uk/government/publications/early-education-and-childcare--2

Achildisalsoeligibleforfreeearlyeducationandchildcareifanyofthefollowingcriteriaapply:

• Thechildislookedafterbyalocalcouncil• Thechildhasacurrentstatementofspecialeducationalneeds(SEN)oran

education,healthandcare(EHC)plan• ThechildiseligibleforDisabilityCareAllowance• Thechildhasleftcareunderaspecialguardianshiporder,childarrangements

orderoradoptionorder.However,LocalAuthoritieshavelimitedspacesacrosstheregionalchildcaremarketforchildrenagedtwoandcentralgovernmentfundingdoesnotnecessarilyreflectthehourlycostofpart-timechildcareinLondon.ADaycareTrustandFamilyandParentingInstitutereportclaimsthatworkingparentsinLondonpay11%morethanin2016foranurseryplaceforchildrenoftwoandover.Thereisalsolackofflexibilityconcerningthedifferingneedsofchildren.Theprovisionofregisteredchildmindingtrainingandforpreandnurseryschoolworkersisdependentuponfinanceforcontinuousprofessionaldevelopment(CPD)thatmost(ifnotall)LocalAuthoritieswouldhavepreviouslyself-funded.Differentfacilitiesarerequired(withseparatespacestypicallyallocatedtoeach)toaccommodatespecificagegroupneedsandteacher-pupilratioscanvarygiventhelevelofsmallgroupactivitytowards1:1carewithinthemoreextremecases.Ariseinlivingcostsandtheneedforbothparentstowork,involvesincreasedwraparoundcare.Earlyyearssettingsandprimaryprovidersmustrestructuretheworkingdaytoaccommodatethisneed.Otherpressuresarisebecauseoftheincreasedhirecostsofchildcarefacilities,theconfidenceofteachingstaffintheirowncommandofthePhysicalDevelopmentaspectofthecurriculumandproficientteachingofmovementskills.Theremayalsobeafinancialshortfalloverthepurchaseofnewresourcesandreplacementsforexhaustedequipment.Financialpressureshavepromptedequipmentsharingandsomegrantsareavailableforthepurchaseofcommunityaccessresourcessuchasboxesofmulti-skillequipment.Thesecanbeusedbydifferentplaygroupswithinaregion.Also,ForestSchoolsoffercross-curricularphysicalactivitythatenablesdifferentagegroupstoundertakemotivatingtaskswhilstutilisingphysicalandcognitiveskillswithinanoutdoorwoodlandenvironment.Thereisalackofdataaboutyoungchildren’sphysicalactivity;nosinglemethodofevaluatinglevelsofphysicalactivityinthisagegroupandnoagreeddefinitionofwhat‘moderatetovigorous’physicalactivitymeans.InFebruary2016,theLocalGovernmentAssociation(LGA)published‘Healthyweight-healthyfutures.Localgovernmentactiontotacklechildhoodobesity.Casestudies.’Thisusefulresourceshowcasesmuchgoodworkcurrentlyundertakenatlocallevelbutmanyprojectsdealpurelywithnutritionandmoneyisallocatedtohealthyeatingclubs/gardening/menuplanningandsugarreduction–withoutreferencetophysicalactivity.

InMedway,60settingshavejoinedan‘EatBetterStartBetter’programmethat‘providestrainingandsupporttostaffonplanninghealthiermenusandhelpingchildrentousemealtimestolearnsocialskills.’Thecouncilhasrecentlyreceived£2.5mfromthelocalGrowthFundtopromotecyclingoverathreeyearperiodbutthereisnofurtherphysicalactivitycomponentthanthis!Wigan,bycontrast,hasrespondedto‘theobesitychallenge’byintegratingsupportservices.Their‘InspiringHealthyLifestyles’programmesunitetheNationalChildMeasurementProgramme(NCMP),specialistweightmanagementservices,healthpromotions,workandthehealthylifestyles,earlyinterventionandpreventioneducationschemesthatareprovidedtoschoolsandnurseries.Familiesareencouragedtouselocalswimmingandleisurefacilities.Childreninpre-school/receptionandyear4undertakeasixweekprogrammeinvolvinghealthyeating,cookingandphysicalactivity.10,000childrenhaveparticipatedinitoverthepasttwoyears.However,thenatureofthephysicalactivityprogrammeisunrecorded;neitheristhereanyrecognitionofthecurrentChiefMedicalOfficer’sEarlyYearsPhysicalActivityguidelines.Fundingisavailableifhealthtargetsarespecificallyrelatedtoobesitypreventionandthelinkbetweenphysicalactivityandobesitypreventioninyoungchildrenis–atbest–‘undecided.’Majorityfundingisallocatedtonutritionandphysicalactivityisfelttobean‘addon.’Itisuncommontofindanyhealthprogrammefortheearlyyearswhoseprimaryfocusisphysicalactivity.InManchester,athirdoffiveyearoldsfailtoachievea‘good’levelofdevelopmentintheEarlyYears’FoundationStageProgramme(EYFSP).Healthvisitorsreportedanincreaseinchildrenwitharrestedphysicaldevelopment(notedatninemonths)duringthetwoyearoldintegratedReviewandbyEarlyYears’practitioners.Thereislittlestatutoryfundingforphysicalactivity;financeisfocuseduponmandatoryareassuchassafeguardingandfirstaid.SportEnglandmoneyisonlyprovidedforchildrenoffiveyearsupwards.TosupporttheGreaterManchesterStartwellStrategyfortheEarlyYears,fundingissoughtfromnationalcharitiesbutavailabilityisuncertainFundswererecentlyobtainedfromtheGreaterManchesterMovingInvestmentScheme.Asumof£2,200wasgiventoanurserychainwithsignificanteffectincluding:

• 86EarlyYears’professionals(20PhysicalDevelopmentchampions,RegionalManagers/NurseryManagers)receivedtraininginphysicalactivity,engagingover2,000youngchildren

• Two10weekprogrammes‘Let’sPlayToddler’and‘Let’sPlayPre-School’wereintroduced,enablingpractitionerstoeitherprovideaonehourphysicallyactivesessioneveryday–orrollingphysicalactivityopportunitiesforchildrenthroughouttheday

• Physicalactivityisembeddedintodailypractice;timeandspaceisdesignatedforthis‘primearea’oftheEarlyYears’curriculumandonenurserynowhasaspecial‘PhysicalDevelopment’room

• Practitionersreportincreasedconfidenceandcompetenceinthisfield• Practitionersreportincreasedinterest/awareness/engagementrephysical

activitybyparentsandcarers• On-goingsupportisoffered.

In2014,‘Startwell’wascommissionedtosupporttheobesitystrategyforBirmingham.ThiscollaborativearrangementisfundedbyBirminghamCityCouncilanddesigned

specificallyforEarlyYears’settingsbetweenBirminghamCommunityHealthcareTrustandBillesleyPrimarySchool.ItispartoftheEarlyYears’Reviewbutthecontracthasrecentlybeentenderedoutandthereisnoconfirmationoffutureplans.Theemphasisistoup-skillEarlyYears’staff,enhancingtheirknowledgeofwhathealthandwellbeingmeansforyoungchildrenandbuildingeffectivesolutionstoobesityintodailypractice.Ofthesixelementsoftheprogramme,threefocusuponphysicalactivity:

• 180minutes• AvoidInactivity• PhysicalActivityaidsLearning.

All480EarlyYears’providersinthecityhavebeenofferedtheprogrammeandsofar,450haveengaged.TheStartwellteamworkwithanetworkofchildren’scentresandeachlocalityhasa‘leadperson’tosupportpractitionerdelivery.ThereisarangeofawardsandlevelsforcentrestoworkthroughwithsupportfromanallocatedStartwellconsultant.Theoutcomeshavebeenoverwhelminglypositive:

• 89%ofsettingsreportthatstaffhaveincreasedthetimeforchildrentoenjoyphysicalplay

• 955ofsettingsreportchangesthattheyhavemadetotheenvironmenttobettersupportphysicalplay

• 95%ofsettingsreportthattheyhavealteredtheenvironmenttoensurethatagreaterelementofphysicalskillisdemandedfromtheactivitieschildrenexperience.

InLondon,CityHallandtheMayorareplanninga‘HealthyEarlyYearsLondon’initiative(HEYL).Theaimisto‘Providetools,supportandnetworkingopportunitiestoEYsettings,enablingthemtocreatehighquality,healthylearningenvironmentstoincreaseaccesstohealthyfood,provideopportunitiestobemorephysicallyactiveandhelpimprovephysical,socialandemotionalhealthandwellbeingandlearning.’All13,000nurseries/playgroups/children’scentres/crèchesandchildmindersinLondonwillhavetheopportunitytobeinvolvedandatpresentapilotstudyisbeingconductedinCroydon,Havering,Hounslow,Lambeth,SouthwarkandTowerHamlets.ThisperiodwillcontinueuntilSeptember2017.HEYLisdesignedasacomplementtotheEYFSframeworkandmayprovideadditionalevidenceforthepurposeofOfstedinspections.TheawardhaseightstrandsofwhichPhysicalActivity,PhysicalDevelopment,ReducingSedentarybehaviourisone:

• TheAwardsstartwithaFirstStepsaward;progressingthroughbronze,silverandgold

• AllsettingsmustachieveaFirstStepsaward,lastingforatwoyearperiodbeforeprogressingfurther

• ThisawardincludesdesigningacomprehensivePhysicalActivitystatement;knowledgeoftheChiefMedicalOfficer/EarlyYears/PhysicalActivityguidelines–waysofsupportingPhysicalActivityandPhysicalDevelopmentandreducingsedentarybehaviourandwaysofsupportingactivetravel

• FortheBronzeaward,examplesarerequestedofhowstaffactivelyandpositivelysupportchildren’soutdoorexperiences

• Howtheenvironment,resourcesandplannedactivitiesenablechildrentobeactivebothinsideandoutside

• Howsedentarytimemaybeminimised• Supportinginclusivepractice• Engagingfamilies.

Theinitiativehascentralfundinganditishopedthatthepilotwillprovidethequantitativeandqualitativeevidencetosecurelong-termfundingandsupport.TheexistingHealthySchoolsProgramme(andaccompanyingAwards)hasbeenverysuccessfulwithaprovenrecordofimprovingphysicalactivitybehaviourchange.ByplacingphysicaldevelopmentandactivityattheheartoftheHEYLscheme,thereisrealistichopethatthisareaofthecurriculumwillfinallyachieveparityofstatus;thusimprovinglifechancesofyoungchildren.InruralLeicestershire,fundingforthreeEY/PD/PAprogrammesisappliedforannuallyandreceivedfromLeicestershireCountyCouncilPublicHealthTeam.BlabyDistrictCouncilactivelysupportsthisspecialistEarlyYearspostandensuresthatfundingfromavarietyofsourcesremainsallocated.However,since2015therehasbeenasignificantreductionoffundingfortheEarlyYearsingeneralandfewersettingshavebeenabletosignupforthisparticularservice.ThefulltimecontractforanEarlyYears’practitionertosupportthecurrentEarlyYearsPhysicalDevelopmentOfficerhasbeencancelled.Thethreeprogrammesofferedaimtopromoteabalanceddiet,areductioninsugarintakeandanincreaseinlevelsofphysicalactivityinpre-schoolchildren:

• ActiveBeanClub(for3-5yearolds)settingsaresuppliedwithasetofphysicalactivityresourcecardsandanequipmentbag.Practitionersaretrainedintheimportanceofphysicalactivityandthedesignanddeliveryofsafeandeffectivesessions.Follow-upsupportvisitsmayalsocoverparentalengagementandfurtherstafftrainingandcontinuedmailsupportisavailable.Since2013,ActiveBeanhasinvolved73settings/2,750children/450practitionersand120seniorstaffmembers

• MiniMovers–parentsandcarersareencouragedtosupportchildren’sphysicaldevelopmentinthehome;usinglow/nocostavailableequipment.Avarietyofprintedresourcesaremadeavailableandemailsaresentregularlytoinformadultsofothergroups/sessionsofinterest

• WildChild–anoutdoorholidayprogramme,deliveredduringschoolholidaysinlocalgreenspacestosupportparentsandcarers.

Theseprogrammeshavemodestaimsbutonesthatarerealisticandachievablefortheruralsettingsinvolved.Thestressisuponempoweringpractitionersandparentstobeactivelyengagedinsupportingtheirchildren’soverallhealthandwellbeing.However,thefundingofkeypersonneltocascadespecialistknowledgeandinformationisparamount.Ruralcouncils;OadbyandWigston,CharnwoodandMeltoncannotfundfurtherinterventionsinEY/PAPDandsotherewillbenoinputinthephysicaldevelopmentofchildreninthesedistrictsfortheforeseeablefuture.Inconclusion,giventheincreaseddemandsuponthetypicalfamilytohavebothparentsworking,thecreationofworkplacecrècheshasitsplacetosupportthework/life

balance.Thequalityofworkproductivitythatcanconsequentlybereturnedisarichemploymentbenefitthatcompaniesaresteadilyrealisingwiththestumblingblocksofcost,facilitationandimplementationprovidingcorebarriers.Ofcourse,thechallengeistoensurethatsuchcrèchessupplythetypeofoptimumphysicalactivityopportunitiestobefoundinotherearlyyears’settings.InvestmentbankingfirmGoldmanSachsopenedtheCityofLondon’sfirston-sitecorporateofficecrèche.Itopenedin2003toinitiallyofferallemployeeswithchildren20days’freechildcareayearwhichcanbebookedeitherinadvanceoronthedayifthereisanurgentneed.In2010,theyexpandedthefacilityandofferedworkingparentsfreeuseofthenurseryforfourweekstosupporttransitionbacktoworkfromparentalleaveandthenfull-timepaidchildcareavailableforthosewhosayalternativearrangementsarechallenging.‘Thereisnothingmorestressfulthanworryingaboutchildcare,’explainsonefemalemanagingdirectorwhosesonusedthefacilityfromsixmonthstothreeyearsold.‘Ijustcouldn’tconcentrateuponmyjobifIwasworriedthatmynannywasn’tfeelingwellorshedidn’tturnupontime.Itwasincredibletobeabletohavehimthere.Iknewthathewashappy.Icouldgodownanytime.’GoldmanSachshasrolledouton-sitecrèchesintheirofficesinTokyoandNewYork.Inlocationswheretheycannotprovideafacilitytheytrytofindalocalnurserythattheycansubsidiseforemployees.https://www.theguardian.com/sustainable-business/2016/jan/13/babies-at-work-onsite-childcare-office-goldman-sachs-addison-leeForGoldmanSachs’Children’sCentre,Ofstedcommented:‘Childrenhaveexcellentopportunitiestodeveloptheirall-roundphysicalskills.Forexample,babieslovetoclimbtheirappropriatelysizedclimbingapparatuswhichtheyconfidentlyusetolearnhowtoclimbupanddownstairscarefully.Theyoungestbabieshavesoftplayresourcesandampleopportunitiestogainconfidenceinpullingthemselvesuponfurniture.Olderchildrenenjoydailytripstothelocalparkswheretheycanaccessavarietyofchallengingclimbingequipment.However,withinthenurserythereisalsoaspeciallybuiltclimbingwallwithropeswingsfortheolderchildrenwhoshowgreatconfidenceintakingonthesephysicalchallenges.’(AGlimpseInsideTheGoldmanSachsNursery:business-40658619).Parliamentisarguablyaleadingexampleofrecognisingthevalueofworkplace-basednurserycreation.Thereisanon-sitefacilitymadeavailableforMembers,Members’staff,HouseofCommonsandDigitalServiceemployees,HouseofLordsPeersandstaff,PressGallerymediapassholders,Whitehallparliamentarypassholdersandcontractorssituatedontheparliamentaryestate.Dayandeveningsessionsareavailablewithacapacityfor40children(agedthreemonthstofiveyears).Ofsted’smostrecentinspectionreportfortheHouseofCommonsnurserymakesparticularreferencetothehealthandwellbeingoftheattendees,statingthat‘Staffpromotechildren’sphysicaldevelopmentwellinthenurseryandmakeextensiveuseofoutdoorareasinthelocalcommunitytoprovidechildrenwithgoodexperiences.’LondonEarlyYearsFoundation

(LEYF)isthequality-assuredcontractedserviceproviderandhaveproducedarichlyinformativewebsitethatincludespracticalideastosupportthechild’slearningathome,thereforeencouragingcontinuityandprogressionwiththeirphysicaldevelopmentwithinafamily-basedenvironment(LondonEarlyYearsFoundation:IdeasToSupportYourChild’sLearningAtHome):https://www.leyf.org.uk/ideas-for-parents/Recommendations3.1 TheEarlyYearsFrameworkofDeliverytocontainstatutoryrequirement