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During early childhood (ages 1 to 4), a

child’s world expands to include

friends, schoolmates, and others in the

community. The child’s physical, cog-

nitive, social, and emotional development are tight-

ly linked. For this reason, physical activity affects

not only the physical health of children but also

their overall health status.

Early childhood is divided into two stages: the

toddler stage, ages 1 to 2, and the young child stage,

ages 3 to 4. The toddler stage can be stressful for

parents as toddlers develop a sense of indepen-

dence. As they get older, children become more

interested in trying new activities.

Early childhood is a key period for promoting

physical activity. During these years, fundamental

motor skills, basic movement patterns that all chil-

dren tend to develop (e.g., walking, running, gallop-

ing, jumping, hopping, skipping, throwing, catching,

striking, kicking, balancing), begin to develop. If chil-

dren are encouraged to be physically active, these

skills can develop into advanced patterns of motor

coordination that can last a lifetime. Unfortunately,

many children barely acquire fundamental motor

skills and some will not develop advanced patterns of

motor coordination because they are not encouraged

to participate in physical activities that provide

opportunities to practice these skills.

Participation and instruction in various physi-

cal activities help children develop motor skills.

Although other factors (e.g., genetics) influence

whether a child will become an athlete, physical

activity in early childhood helps ensure that chil-

dren will have the motor skills they need through-

out life. Children will not develop motor skills

without intervention.

Children of this age usually play and explore;

however, many spend only 10 to 20 percent of their

time participating in gross motor physical activities,

which require whole-body participation (e.g., walk-

ing, running, climbing). Many children spend too

much time participating in sedentary behaviors

(e.g., watching television and videotapes, playing

computer games, playing with toys that do not

require the child to move).

Children benefit from physical activity in a

number of ways. Physical activity can

• Give children a feeling of accomplishment.

• Reduce the risk of certain diseases (e.g., coronary

heart disease, hypertension, colon cancer, dia-

betes mellitus), if children continue to be active

during adulthood.

• Promote mental health.

Growth and PhysicalDevelopment

A child’s birthweight quadruples by 2 years of

age. Between the ages of 2 and 5, children gain an

average of 41/2 to 6 1/2 pounds per year and grow

2 1/2 to 31/2 inches per year.

The child’s head and trunk size are large in pro-

portion to the rest of the body, making locomotion

more difficult. However, as the legs grow, the child

is able to move faster and more easily. Skeletal

growth is steady in early childhood, and noninten-

sive physical activity does not damage growing

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bones. Joints are flexible, and they get even more

flexible during this period.

During early childhood, other physical changes

take place that enhance the child’s ability to move

and participate in physical activity:

• Muscles continue to grow.

• The nervous system continues to develop.

• Vision and visual perception improve. (Chil-

dren’s vision does not fully mature before ages 6

or 7. Imprecise eye movements limit their ability

to track and judge the speed of moving objects.)

• Kinesthesia—the sense that detects body posi-

tion, weight, and movement of the muscles, ten-

dons, and joints—improves.

• Sense of balance improves.

• Cognition improves.

Healthy LifestylesEarly childhood is a key time for promoting

the development of motor skills and physical

activity behaviors. Most children are active but

may not have the opportunity to play and explore

because of space or safety concerns, or because

their parents do not encourage them to be physi-

cally active.

Children in early childhood should be encour-

aged to participate in physical activity. Simple

games such as “Simon Says,” chase, and tag are

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appropriate. Physical activities (e.g., tumbling, gym-

nastics, dancing) tailored to the developmental

needs of children are also appropriate. Because most

children need to develop motor skills, they are not

ready for organized sports, which require visual acu-

ity, control, and balance.

Building PartnershipsPartnerships among health professionals, fami-

lies, and communities are essential for ensuring that

families receive guidance on physical activity.

Health professionals need to give parents the oppor-

tunity to discuss physical activity issues and con-

cerns affecting their children, and need to identify

and contact community resources to help parents

promote physical activity in their children.

The community can help promote physical

activity by providing programs that

• Encourage families to promote physical activity

in children.

• Teach families about physical and motor skill

development during early childhood.

• Give children the opportunity to be physically

active.

In addition, communities can provide (1)

affordable, skilled child care providers who promote

physical activity in children, (2) safe environments

for physical activity, and (3) support for families of

children with special health care needs.

Many children spend time with child care

providers or participate in Head Start or other

preschool programs that provide opportunities for

physical activity. Children in community programs

can be introduced to new activities and may try

them more readily if their peers seem to be enjoy-

ing them.

Strengths, and Issues andConcerns

During health supervision visits, health profes-

sionals should emphasize the physical activity

strengths of the child, family, and community

(Table 5) and address any physical activity issues

and concerns (Table 6).

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Table 5. Physical Activity Strengths During Early Childhood

Child■ Participates in physical activity

■ Enjoys physical activity

■ Enjoys playing with parents, sib-lings, grandparents, and others

■ Enjoys playing with objects andtoys

■ In addition to walking, oftenruns, gallops, jumps, and skips

■ Enjoys throwing, catching, hit-ting, and kicking a ball

■ Enjoys climbing and balancingactivities

Family■ Encourages the child to partici-

pate in physical activity

■ Provides opportunities for thechild to participate in physicalactivity

■ Supervises the child duringphysical activity

■ Ensures that the child usesappropriate safety equipment(e.g., helmet) during physicalactivity

■ Participates in physical activitywith the child

■ Provides positive role model byparticipating in physical activity

Community■ Promotes physical activity

■ Provides programs that teachfamilies about physical andmotor skill development

■ Provides opportunities for chil-dren to participate in physicalactivity

■ Provides affordable, skilled childcare providers who promotephysical activity in children

■ Maintains policies (e.g., preser-vation of green space) and pro-vides environmental support(e.g., well-maintained side-walks) that promote physicalactivity

■ Provides safe environments forindoor and outdoor physicalactivity (e.g., walking and bik-ing paths, playgrounds, parks,recreation centers)

■ Provides support for families ofchildren with special health careneeds

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Table 6. Physical Activity Issues and Concerns During Early Childhood

Child■ Has health problems

■ Experiences motor skill or devel-opmental delays

■ Experiences discomfort withphysical activity

■ Is afraid to try new physicalactivities

■ Is more interested in sedentarybehaviors (e.g., watching televi-sion and videotapes, playingcomputer games)

■ Lacks friends or siblings to bephysically active with

Family■ Lacks knowledge of physical

and motor skill development

■ Does not encourage the child toparticipate in physical activity

■ Does not advocate for physicaleducation in programs

■ Does not provide positive rolemodel by participating in physi-cal activity

■ Does not participate in physicalactivity with the child

■ Has health problems that affectthe amount of time spent withthe child

■ Has a work schedule or othercommitments that reduce theamount of time spent with thechild

■ Lacks space or equipment forphysical activity

Community■ Lacks programs that promote

physical activity in children

■ Lacks affordable, skilled childcare providers who promotephysical activity in children

■ Lacks safe environments forindoor and outdoor physicalactivity (e.g., walking and bik-ing paths, playgrounds, parks,recreation centers)

■ Lacks policies (e.g., preservationof green space) and does notprovide environmental support(e.g., well-maintained side-walks) that promote physicalactivity

■ Does not provide support forfamilies of children with specialhealth care needs

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A child’s level of physical activity should be

assessed as part of health supervision visits. (For

more information on health supervision, see Bright

Futures: Guidelines for Health Supervision of Infants,

Children, and Adolescents, listed under Suggested

Reading in this chapter.)

Health professionals can begin by gathering

information about the child’s level of physical

activity. This can be accomplished by selectively

asking key interview questions (listed in this chap-

ter), which provide a useful starting point for iden-

tifying physical activity issues and concerns.

Health professionals can then use this chap-

ter’s screening and assessment guidelines, and

counseling guidelines, to provide families with

anticipatory guidance. Interview questions, screen-

ing and assessment, and counseling should be used

as appropriate and will vary from visit to visit,

child to child, and family to family.

Desired outcomes for the child, and the role of

the family, are presented to assist health profession-

als in promoting physical activity.

Interview QuestionsThe following questions are intended to be

used selectively to gather information, to address

the family’s issues and concerns, and to build

partnerships.

Do you have any concerns about Benita’s

development?

How often do you play with her?

What are some physical activities you do with

Ethan?

How often does he get a chance to run?

How often does Benita play with a ball?

How does her development compare to that of

your other children when they were her age?

How much television do you allow Ethan to

watch each day?

Is your neighborhood safe enough for him to

play outside?

Do you participate in physical activity? If so,

which ones?

Did you participate in physical activity when you

were a child?

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Screening and Assessment■ Measure the child’s length or height and weight,

and plot these on a standard growth chart (see

Tool H: CDC Growth Charts). Deviation from the

expected growth pattern (e.g., a major change in

growth percentiles on the chart) should be evalu-

ated. This may be normal or may indicate a

problem (e.g., difficulties with eating).

■ Assess the child’s visual acuity and eye move-

ment. Vision problems hinder the development

of motor-visual (hand-eye) coordination, an

important component of physical activity.

■ Assess the child’s coordination. Poor coordina-

tion may result from lack of physical activity or

other factors, or it may be a symptom of develop-

mental coordination disorder (DCD). If DCD is

suspected, refer the child for neurodevelopmen-

tal assessment. (See the Developmental Coordi-

nation Disorder chapter.)

■ Assess the child’s motor skill development (Table

7). Children usually acquire fundamental motor

skills by a particular age.1

CounselingGeneral■ Children should be physically active every day or

nearly every day, as part of play, games, physical

education, planned physical activities, recreation,

and sports, in the context of family, school, and

community activities.

■ Encourage parents to promote daily physical

activity (e.g., walking, running, riding a tricycle

or bike, dancing, playing with a ball or at the

playground, playing on equipment that requires

balance, playing games such as “Simon Says”).

■ Developmentally appropriate organized activities

such as tumbling, gymnastics, and dancing are

excellent for children if they are taught by quali-

fied, experienced instructors.

■ Encourage parents to wait until their children are

6 years old before beginning organized sports. In

early childhood, children are too young to

understand rules and strategies and to handle the

emotional and social stress sometimes associated

with organized sports.

■ Encourage parents to let children do things for

themselves (e.g., letting them climb up into the

child safety seat).

■ Explain to parents how to encourage their chil-

dren to participate in physical activity. For exam-

ple, parents can play with their children before

watching television, then gradually extend play-

time and decrease television time.

■ Encourage parents to participate in physical

activity with their children and to be positive

Table 7. Motor Skill Development DuringEarly Childhood

Motor Skill

Running

Galloping

Jumping

Hopping

Skipping

Age Range

1 1/2 to 2 years

2 to 2 1/2 years

2 1/2 to 3 years

3 to 4 years

4 to 5 years

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role models by participating in physical activity

themselves.

■ Discuss with parents the importance of using

child care providers who promote physical activi-

ty and have the space and equipment for it.

Physical Development■ Children do not develop catching, throwing, and

kicking skills by a specific age. However, if chil-

dren have not attempted any of these activities

by age 4, they may have difficulties keeping up

with their peers.

■ Tell parents that organized sports, which require

visual acuity, control, and balance, are inappro-

priate for children less than 6 years old because

they need time to develop their motor skills.

Injury Prevention■ Emphasize that children should be supervised

when they participate in physical activity.

■ Emphasize the importance of safety equipment

(e.g., helmets, goggles) when children participate

in physical activity. (See the Injury chapter.)

■ Emphasize the importance of reducing children’s

exposure to sunlight while playing outdoors and

thus their risk of developing skin cancer. Recom-

mend that parents practice preventive strategies

such as (1) applying a broad-spectrum sunscreen

with a sun protection factor (SPF) rating of 15 or

greater to children’s exposed skin 30 minutes

before they go outdoors, (2) reapplying sunscreen

every 2 hours, and (3) ensuring that children

wear broad-spectrum child-sized sunglasses and

brimmed hats and clothing that protect the skin

as much as possible.

Safety■ If the safety of the environment or neighborhood

is a concern, help parents find other settings for

physical activity (e.g., Boys and Girls Clubs of

America, recreation centers, churches and other

places of worship).

■ Remind parents that children can do many activ-

ities indoors with soft equipment that can be

used in tight spaces (e.g., playing tag or hide-and-

seek, tossing a ball, crawling through an obstacle

course).

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Educational/Attitudinal■ Enjoys physical activity

Behavioral■ Participates in daily physical

activity

■ Uses appropriate safety equip-ment (e.g., helmet, goggles)during physical activity

Health/Physical Status■ Improves motor skills, coordina-

tion, and muscle tone

■ Grows and develops at anappropriate rate

■ Maintains good health

Table 8. Desired Outcomes for the Child, and the Role of the Family

Child

Educational/Attitudinal■ Promotes physical activity

■ Understands the importance ofdevelopmentally appropriatephysical activity

■ Has resources that allow thechild to participate in physicalactivity

Behavioral■ Provides opportunities and safe

places for the child to partici-pate in physical activity

■ Participates in physical activitywith the child

■ Provides positive role model byparticipating in physical activity

■ Advocates for physical educa-tion in programs

Health/Physical Status■ Maintains good health

Family

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Reference1. Gabbard CP. 1999. Lifelong Motor Development (3rd

ed.). Needham Heights, MA: Allyn and Bacon.

Suggested ReadingAssociation of State and Territorial Directors of Health

Promotion and Public Health Education. 1997. Howto Promote Physical Activity in Your Community (2nded.). Washington, DC: Association of State and Terri-torial Directors of Health Promotion and PublicHealth Education.

Clark JE. 1994. Motor development. In RamachandranVS, ed., Encyclopedia of Human Behavior (pp. 245–255).San Diego, CA: Academic Press.

Clements RL, Lee M. 1998. Parent’s Guide to Physical Play.New York, NY: American Association for the Child’sRight to Play.

Gabbard CP. 1999. Lifelong Motor Development (3rd ed.).Needham Heights, MA: Allyn and Bacon.

Green M, Palfrey JS, eds. 2000. Bright Futures: Guidelinesfor Health Supervision of Infants, Children, and Adoles-cents (2nd ed.). Arlington, VA: National Center forEducation in Maternal and Child Health.

Hammett CT. 1992. Movement Activities for Early Child-hood. Champaign, IL: Human Kinetics.

Haywood KM. 1993. Life Span Motor Development. Cham-paign, IL: Human Kinetics.

Malina RM, Bouchard C. 1991. Growth, Maturation andPhysical Activity. Champaign, IL: Human Kinetics.

McCall RM, Craft DH. 2000. Moving with a Purpose: Devel-oping Programs for Preschoolers of All Abilities. Cham-paign, IL: Human Kinetics.

Payne VG, Isaacs LD. 1998. Human Motor Development: ALifespan Approach. Mountain View, CA: Mayfield Pub-lishing.

Pellegrini AD, Smith PK. 1998. Physical activity play: Thenature and function of a neglected aspect of play.Child Development 69(3):577–598.

Rowland T. 1990. Exercise and Children’s Health. Cham-paign, IL: Human Kinetics.

Sanders SW. 1992. Designing Preschool Movement Programs.Champaign, IL: Human Kinetics.

Torbert M, Schneider LB. 1993. Follow Me Too: A Hand-book of Movement Activities for Three- to Five-Year-Olds.Menlo Park, CA: Addison Wesley.

U.S. Department of Health and Human Services; U.S.Department of Education. 2000. Promoting BetterHealth for Young People Through Physical Activity andSports: A Report to the President from the Secretary ofHealth and Human Services and the Secretary of Educa-tion. Atlanta, GA: U.S. Department of Health andHuman Services.

Virgilio SJ. 1997. Fitness Education for Children: A TeamApproach. Champaign, IL: Human Kinetics.

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Why Isn’t Charlie DevelopingMotor Skills?

Charlie Spooner, a quiet 4-year-old boy, and hismother are going to see Dr.

Higgs, the family physician. Dr.Higgs notices that Charlie iscontent to sit in a chair and gazeat whomever is speaking. He hasno interest in getting up andlooking around or playing withthe toys in the room. Charlie’smother is concerned that Charlieis lagging behind his sister inmotor skill development.

Dr. Higgs reassures Charlie’smother that boys usually takelonger than girls to developmotor skills. Dr. Higgs discoversthat Charlie and his sister go todifferent child care providers.Charlie’s provider does notpromote physical activity, andthe children are allowed to spendhours watching television andplaying with toys that do notrequire much physical activity.On the weekends, Charlie’sparents run and bike; however,they place him in a stroller orbike seat. Charlie’s mother andfather wonder why their childdoes not seem interested inrunning or learning how to ride a bike.

Dr. Higgs explains thatCharlie needs the opportunity totry out various activities that areappropriate for his skill level. Dr.Higgs suggests that rather thanfocusing on running and biking,Charlie’s parents shouldencourage him to try otheractivities (e.g., playing with aball, climbing, jumping) and tomake these activities fun. Dr.Higgs also provides twoadditional suggestions: (1) chang-ing child care providers to onewho promotes physical activityand (2) allowing Charlie toparticipate in organized, super-vised activities (e.g., gymnasticsprograms, play groups). Charlie’smother agrees to give thesesuggestions a try.

EARLY CHILDHOOD • 1–4 YEARS

Dr. Higgs explains

that Charlie needs the

opportunity to try out

various activities that

are appropriate for his

skill level.

FREQUENTLY ASKED QUESTIONS ABOUT PHYSICAL ACTIVITY IN EARLY CHILDHOOD

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■ How can I help my 3-year-old learn newskills, such as throwing a ball?

Children go through stages as they learn some-thing new, whether it’s learning to feed them-selves or to coordinate their arms and legs. Somechildren learn more quickly than others. Somemay need extra help from an adult. All childrenneed practice when they are learning new skills,just like adults do.

■ What physical activities are appropriatefor my child?

Physical activities (for example, running, jump-ing, climbing, and throwing, catching, or hittinga ball) and simple games (for example, “SimonSays,” chase, and tag) are appropriate for chil-dren. Your child can also participate in develop-mentally appropriate organized activities (forexample, tumbling, gymnastics, and dancing).Children less than 6 years old do not have themotor skills, or mental and emotional capabili-ties, to participate in organized sports.

■ How often should my child participate inphysical activity?

Your child will benefit most from daily physicalactivity. Children tend to be active in spurts andknow when they need to rest.

■ My neighborhood isn’t very safe. How can my child be active if he can’t playoutdoors?

Community organizations, recreation centers,and churches and other places of worship pro-vide opportunities for children to participate inphysical activity. Work with community leadersto ensure that your child has safe places for par-ticipating in physical activity (for example, walk-ing and biking paths, playgrounds, parks, andrecreation centers). Also, your child can do manyactivities at home such as hopping, dancing,playing tag or hide-and-seek, tossing a ball, orcrawling through an obstacle course.

■ Why is my daughter afraid of playing onplayground equipment?

Be patient, and try holding on to her when she ison the equipment. If this doesn’t work, try tofind other activities that do not frighten her.

■ My son is lagging behind my daughter inmotor skill development even though mydaughter is a year younger. Why?

Boys often take longer than girls to developmotor skills. However, once boys learn a skill,they usually perform it as well as girls. Boys tendto perform better than girls in activities requiringstrength (for example, throwing), and girls tendto perform better in activities requiring balanceand fine motor skills (for example, tap dancing).

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■ Should I enroll my child in a gymnasticsor dancing class?

Classes taught by qualified and experiencedinstructors can be excellent for children. Alwayscheck on instructors’ qualifications, and observethe classes as much as possible.

■ Our child care provider does not encour-age physical activity. What should I do?

Talk to your child care provider and encourageher to incorporate physical activity into the day.If lack of space or equipment is the problem,work with her to come up with creative ideas toprovide physical activity opportunities for thechildren. If this is not possible, consider chang-ing child care providers to one who promotesphysical activity.

Resources for FamiliesSee Tool F: Physical Activity Resources for con-

tact information on national organizations that can

provide information on physical activity. State and

local departments of public health and education

and local libraries are additional sources of

information.

Centers for Disease Control and Prevention, NationalCenter for Chronic Disease Prevention and HealthPromotion. 1999. Promoting Physical Activity: A Guidefor Community Action. Champaign, IL: Human Kinetics.

Cooper KH. 1999. Fit Kids! The Complete Shape-Up Programfor Birth Through High School. Nashville, TN: Broad-man and Holman Publishers.

Corbin CB, Pangrazi RP. 1998. Physical Activity for Chil-dren: A Statement of Guidelines. Reston, VA: NationalAssociation for Sport and Physical Education.

Institute for Research and Education HealthSystem Min-nesota, Health Education Center. 1996. Building YourActivity Pyramid. Minneapolis, MN: Institute forResearch and Education HealthSystem Minnesota,Health Education Center.

Kalish S. 1995. Your Child’s Fitness: Practical Advice for Par-ents. Champaign, IL: Human Kinetics.

Katzman CS, McCary R, Kidushim-Allen D. 1993. HelpingYour Child Be Healthy and Fit with Activities for ChildrenAged 4 Through 11. Washington, DC: U.S. Departmentof Education, Office of Educational Research andImprovement.

Koch T, Kamberg M. 1997. Cabin Fever Relievers: Hundredsof Games, Activities, and Crafts for Creative Indoor Fun.St. Paul, MN: Redleaf Press.

Kranowitz CS. 1995. 101 Activities for Kids in Tight Spaces.New York, NY: St. Martin’s Press.

Landy J, Burridge K. 1997. 50 Simple Things You Can Do toRaise a Child Who Is Physically Fit. New York, NY:Macmillan.

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National Association for Sport and Physical Education.1999. Help Your Child Achieve a Fit and HealthyLifestyle. Reston, VA: National Association for Sportand Physical Education.

National Association for Sport and Physical Education.1994. Developmentally Appropriate Practice for YoungChildren, Ages 3–5. Reston, VA: National Associationfor Sport and Physical Education.

National Institutes of Health, National Heart, Lung, andBlood Institute. 1995. Asthma and Physical Activity inthe School: Making a Difference. Bethesda, MD: Nation-al Institutes of Health, National Heart, Lung, andBlood Institute.

President’s Council on Physical Fitness and Sports. 1992.Kids in Action: Fitness for Children. Washington, DC:President’s Council on Physical Fitness and Sports.

Shisler J, Killingsworth R, Schmid T. 1999. Kidswalk-to-School: A Guide for Community Action to Promote Chil-dren Walking to School. Atlanta, GA: Centers forDisease Control and Prevention, National Center forChronic Disease Prevention and Health Promotion.EA

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