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AREPORTBYTHEALL-PARTYPARLIAMENTARYGROUPONAFITANDHEALTHYCHILDHOOD

PHYSICALACTIVITYINEARLYCHILDHOOD

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

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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

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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.

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CONTENTS: Page:

EXECUTIVESUMMARY 5

SUMMARYOFRECOMMENDATIONS 8

INTRODUCTION 15

1. THEQUALITY,NATUREANDDIVERSITYOFCURRENTPHYSICALACTIVITYPROVISIONWITHINTHEHOME,WIDERCOMMUNITYSETTINGSANDEDUCATIONALSETTINGS

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2. PHYSICALACTIVITYBESTPRACTICEINTHEPRE-PREGNANCY,ANTENATALANDPOSTNATALPERIODFORPARENTS/CARERSANDBABYTOINCLUDETHEADVISORYROLEOFEDUCATIONANDHEALTHCAREPROFESSIONALSANDTHEIROWNTRAININGNEEDS

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3. THEROLEOFLOCALAUTHORITIES,VOLUNTARYORGANISATIONSANDBUSINESSINPROMOTING,FACILITATINGANDDEVISINGAHOLISTICRANGEOFEARLYCHILDHOODPHYSICALACTIVITYOPPORTUNITIES;ALSOWORKPLACECRECHES

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

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5. ACOMPARATIVEANALYSISOFGOODPRACTICEINOTHERCOUNTRIESANDEXISTINGUKLEGISLATIVEPRACTICE

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6. SOCIOECONOMICISSUSES,ETHNICDIVERSITYANDCULTURALPRACTICEANDTHEPLANNINGSYSTEM(INBOTHRURALANDURBANCONTEXTS)ASTHEYIMPACTUPONEARLYCHILDOODANDACTIVITYPATTERN

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7. THEROLEOFADVERTISING,TRADITIONALANDSOCIALMEDIAANDTECHNOLOGY(INCLUDINGTHEUSEOFAPPS)ASSTIMULANTANDPROMOTEROFEARLYCHILDHOODPHYSICALACTIVITY

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8. THERELATIONOFPHYSICALACTIVITYTOCOGNITIVEANDACADEMICPROGRESS

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9. THERELEVANCEOFPHYSICALACTIVITYTOCHILDRENWITHMENTAL/PHYSICALDISABILITY

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10. THELEGISLATIVEWAYFORWARDINTHEPROMOTIONANDEXPANSIONOFPHYSICALACTIVITYPROGRAMMESANDTAKE-UPFORALLCHILDRENINTHEUK

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11. DIVERSITYANDCHOICEINACTION:GOODPRACTICECASESTUDIES

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12. ANIN-DEPTHANALYSISOFTHEIMPORTANTROLETHATBABYANDINFANTSWIMMINGHASTOPLAYINHELPINGTOACHIEVEPHYSICAL,COGNITIVEANDEMOTIONALGOALS

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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.

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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

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SUMMARYOFRECOMMENDATIONS

TherearemanyrecommendationsflowingfromthisReport.Therecommendationsalsoappearattheendofeachrelevantsection.

1. THEQUALITY,NATUREANDDIVERSITYOFCURRENTPHYSICALACTIVITYPROVISIONWITHINTHEHOME,WIDERCOMMUNITYSETTINGSANDEDUCATIONALSETTINGS

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.

2. PHYSICALACTIVITYBESTPRACTICEINTHEPRE-PREGNANCY,ANTENATALANDPOSTNATALPERIODFORPARENTS/CARERSANDBABYTOINCLUDETHEADVISORYROLEOFEDUCATIONANDHEALTHCAREPROFESSIONALSANDTHEIROWNTRAININGNEEDS

Recommendations:2.1 Governmenttoestablishanationalphysicalactivityandhealthyeating

campaigntargetedatprepregnancy,pregnancyandpostpregnancystagesformotherandbaby;partofwhichwillinvolvelocalauthoritiesestablishingandupdatingaccessibledirectoriesoflocalprovision

2.2 Governmenttoestablishphysicalactivity/healthyeatingpilotprogrammesbasedonexistinggoodpracticeforevaluationandpotentialnationalroll-out

2.3 Comprehensivemodulesinvolvingphysicalactivity/healthyeatingtobeembeddedintotheinitialtrainingforthosecomingintocontactwithprepregnancy,pregnantandpostpartumwomenduringthecourseoftheir

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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:

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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.’

5. ACOMPARATIVEANALYSISOFGOODPRACTICEINOTHERCOUNTRIESANDEXISTINGUKLEGISLATIVEPRACTICE

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

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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.

7. THEROLEOFADVERTISING,TRADITIONALANDSOCIALMEDIAANDTECHNOLOGY(INCLUDINGTHEUSEOFAPPS)ASSTIMULANTANDPROMOTEROFEARLYCHILDHOODPHYSICALACTIVITY

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

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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.

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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

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andwatertherapyclassesandforthesetoformpartofantenatalandpostnatalmaternalhealthprogrammes

12.4 Allchildswimmingproposedsafetytechniques/teachingpackagestobesubjectedtogovernmentresearchandscientificproofingbeforebeinglicensedforuseinUKswimmingandteachingfacilities.Currentmethodsthathavenotbeenexaminedtoundergothetestingprocedurebeforebeinglicensedtocontinue

12.5. Grants/SportsPremiumfinancetobemadeavailablefortransportationcostsforschool-basedinfantswimmingopportunities.

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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

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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

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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

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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.

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1. THEQUALITY,NATUREANDDIVERSITYOFCURRENTPHYSICALACTIVITYPROVISIONWITHINTHEHOME,WIDERCOMMUNITYSETTINGSANDEDUCATIONALSETTINGS

‘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).

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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

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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

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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.

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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

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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.

2. PHYSICALACTIVITYBESTPRACTICEINTHEPRE-PREGNANCY,ANTENATALANDPOSTNATALPERIODFORPARENTS/CARERSANDBABYTOINCLUDETHEADVISORYROLEOFEDUCATIONANDHEALTHCAREPROFESSIONALSANDTHEIROWNTRAININGNEEDS

Physicalactivityisimportantintheprepregnancyperiod;duringpregnancyitselfincreasingevidencesuggeststhatphysicallyactivewomenarelesslikelytoexperience

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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

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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

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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.’

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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

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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’.

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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

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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.

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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

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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

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• 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

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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

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(LEYF)isthequality-assuredcontractedserviceproviderandhaveproducedarichlyinformativewebsitethatincludespracticalideastosupportthechild’slearningathome,thereforeencouragingcontinuityandprogressionwiththeirphysicaldevelopmentwithinafamily-basedenvironment(LondonEarlyYearsFoundation:IdeasToSupportYourChild’sLearningAtHome):https://www.leyf.org.uk/ideas-for-parents/Recommendations3.1 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. THEROLEANDRESPONSIBILITYOFGOVERNMENTINTHEDEVOLVEDUKWITHCLOSEREFERENCETOOFSTED,THEFOUNDATIONSTAGECURRICULUMANDTHENATIONALCURRICULUMINMESSAGING,FUNDING,RESEARCHINGEARLYCHILDHOODACTIVITYANDPROMOTINGITSCENTRALROLEINCHILD(ANDTHENCEADULT)FITNESSANDHEALTHALONGSIDENUTRITION,PLAYANDEMOTIONALWELLBEING

Recently,theprevalenceofoverweightandobesityinpreschoolchildrenhasincreased,particularlyinurbanareas,deprivedbackgroundsandcertainethnicminoritygroupssuchasBlackandAsianpopulations(DepartmentofHealth2011aTheNHSInformationCentreforHealthandSocialCare:NationalChildMeasurementProgramme2010/2011):https://catalogue.ic.nhs.uk/publications/public-health/obesity/nati-chil-meas-prog-eng-2010-2011/nat-chil-meas-prog-eng-2011-2011-rep.1.pdfTheearlyyearsareatimeofrapidgrowth;childrenshouldbehelpedtoestablishhealthyeatingpatternsandphysicalactivityshouldbeincorporatedfromtheoutsettoformanintegralpartofeverydaylife.In2011,theChiefMedicalOfficerarguedforconcertedactiontocreateenvironmentsandconditionsthatfacilitatephysicalactivitywithinitiativesspecificallydesignedformovementintheearlyyears(DepartmentofHealth,2011bStartactive,stayactive):

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http://www.gov.uk/government/uploads/system/uploads/attachment_data/file?216370/dh_128210.pdfThisiswelcome;butfuturepolicyprescriptionmustincludethediversecommunitieswithintheUK.SouthAsianchildrenarereportedtohavesubstantiallylowerlevelsofphysicalactivitythanWhiteEuropeans(FischbacherCM.2004:HowphysicallyactiveareSouthAsiansintheUnitedKingdom?Aliteraturereview.JournalofPublicHealth.26:250-258.10.1093/pubmed/fdh158).Thismaybeaddingtotheraisedriskofobesity,coronaryheartdiseaseanddiabetesrecognisedwithinSouthAsianpeoplelivingintheUK(Owen,CG.2009:Ethnicandgenderdifferencesinphysicalactivitylevelsamong9-10yearoldchildrenofwhiteEuropean,southAsianandAfrican-Caribbeanorigin:thechildhearthealthstudyinEngland(CHASEstudy).InternationalJournalofEpidemiology,38:1082-1093.10.1093/ije/dyp176)andclearlyrequiresseriousconsideration.TheChildhoodObesity–APlanforActionhttps://www.gov.uk/government/publications/childhood-obesity-a-plan-for-actionhighlightsthatonlyoneintenchildrencurrentlymeettheChiefMedicalOfficer’sphysicalactivityguidelines.Thesestatethatactivityshouldbepromotedfrombirth,especiallyviafloorplayandwater-basedactivitiesinsafeenvironments.Ambulantpre-schoolchildrenshouldbephysicallyactive;spreadthroughouteachday.Similarly,unduetimeengaginginsedentarypursuitsisundesirableandtheNationalLiteracyTrustin2009foundthatonaverage,UKchildrenspend24hoursperweekinfrontofaTVorcomputer.Justswitchingtheimplementoffcanstimulateincreasedactivity.Ofsted’scommitmenttotheprotectionandsafetyofallchildrenandlearnersisgiveninTheCommonInspectionFramework.Itevaluatesearlyyears’provisioninlinewithframeworks,nationalstandardsandregulatoryrequirements(Ofsted2015aThecommoninspectionframework;education,skillsandearlyyears):https://www.gov.uk/government/publications/common-inspection-framework-education-skills-and-early-years-from-september-2015Yettheguidelinesdonottakesufficientaccountofthewiderangeoffactorsimpactinguponchildren’sliveswhichcannotbeeitherquantifiedorcorrectlyobservedviasnapshotobservations.NeitherdoestheFrameworkendorseanoutdoor,activeelementthatwouldnaturallymaximisechildren’sopportunitiestodemonstratetheselearningfeaturesandtopursuetheirinterestsandneeds.Schoolsareincreasinglypressurisedtodemonstratechildren’sachievementviateststakeninsedentaryconditions(Peckham,K.2016‘DevelopingSchoolReadiness;CreatingLifelongLearners).Withacombinationofresearchcommunityguidanceandgovernmentpolicy,itwouldbepossibletorecommendappropriatelevelsofphysicalactivitytoeffectbeneficialchangeintheschoolclimate.Otherwise,childrenwillbedisadvantagedduetoacurriculumthatendorses‘whole-child’developmentwhilstsimultaneouslybeingundulystandardsbased.Infact,studiesshowthatregularphysicalactivity(especiallywhenbeguninearlychildhood)issignificantlylinkedtoimprovedcognitioninchildren(ChomitzVR,Slining,MM,McGowan,RJ,MitchellSE,DawsonGF&HackerKA,2009:Istherearelationshipbetweenphysicalfitnessandacademicachievement?Positiveresultsfrompublicschoolchildreninthenorth-easternUnitedStates,JournalofSchoolHealth,

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79(1),30-37,doi:10.1111/j.1746-1561.20008.00371.xWittenbergRA,Northrup,KL,&CottrellLA,2012.Children’saerobicfitnessandacademicachievement:Alongitudinalexaminationofstudentsduringtheirfifthandseventhgradeyears.AmericanJournalofPublicHealth,102,2303-2307).Withhealthindicatorsdirectlyandindirectlyassociatedwithacademicperformance,thosestartingschoolalreadyoverweight,orbecomingoverweightduringthetransitioningyears,achievelowerresultsinstandardisedteststhanchildrenofahealthybodyweight(DatarA,SturmR,200:Childhoodoverweightandelementaryschooloutcomes.InternationalJournalofObesity,30,1449-1460).Yetwhilststudiessuggestthatathresholdofvigorousphysicalactivityisnecessaryforacademicachievement,whatshouldthe‘physicalactivity’be?Whenitshouldstartandhowsignificantaredifferencesbetweengirls’andboys’play?‘ChildhoodObesity–Aplanforaction’statesthatatleast30minutesofphysicalactivityshouldbedeliveredinschooleverydaythroughbreaktimes,PE,extracurricularclubs,activelessons,orothersportandphysicalactivityeventswiththeremaining30minutessupportedbyparentsandcarersoutsideschool.OfstedwillassesshowleadersofthePrimaryPEandSportPremium,measureitsimpactuponpupiloutcomesandthewaysinwhichgovernorsholdthemtoaccount.FromSeptember2017,eachprimaryschoolinEnglandmustbeabletoaccessalocalandnationalco-ordinatedofferofhighqualitysportandphysicalactivityprogrammes.ASportEnglandStrategy‘TowardsanActiveNation’(2016)investmentwillfocusonchildrenacquiringabasiccompetenceinsportandphysicalactivityaswellassupportingthemtohavefunregardlessofability.Governmentwillinvestinwalkingandcyclingtoschool;showcasingaforthcomingCyclingandWalkingStrategy.AsoutlinedintheEarlyYearsFoundationStageFramework,thesevenareasofdevelopmentthatmustshapeeducationalprogrammesinearlyyears’settingsincludephysicaldevelopment.EYsettingsmustprovideopportunitiesforyoungchildrentobeactive,interactiveandtodevelopco-ordination,controlandmovement.Theymustalsobeinformedabouttheimportanceofphysicalactivityforgoodhealthandhelpedtomakehealthyfoodchoices.ThelinkbetweenfoodandphysicalactivityiscomplexandarecentWHOreportfromtheCommissiononEndingChildhoodObesitypresentedanImplementationPlanproposinginterventionsdirectedtowardspopulation-based,regulatory,legislativeandfiscalmeasures(WHO(2017)ReportoftheCommissiononEndingChildhoodObesity:implementationplan.ReportbytheSecretariat.13thJanuary,Geneva).Concernhasbeenexpressedaboutrecommendedactionfromtheprivatesectorto‘facilitateaccesstoandparticipationinphysicalactivity.’AccordingtotheWorldCancerResearchFund,NCDAlliance,WorldObesityandJamieOliverFoodFoundation:‘Thismayleadtoindustry,whosecorebusinessisthesupplyandpromotionoffoodsorbeverages,tofocusonphysicalactivityasapriorityratherthanaddressingharmfulpracticesrelatedtotheircorebusiness,suchasthemarketingofunhealthyfoodsandbeveragestochildren,’(WorldObesity,WCRF,NCDAllianceandJamieOliverFoodFoundation2017Statementtothe140thsessionofWHOExecutiveBoard–

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ImplementationofthereportoftheCommissiononEndingChildhoodObesity.AgendaItem10,4).Somesectionsofthefoodindustryover-promotetheirinvolvementinphysicalactivityinitiatives,therebydistractingfromnutritionalcriticism.Thereportacceptedthatinteractionsbetweengovernmentsandindustrymustbegovernment-led,health-goalorientated,transparentandaccountable.Thisisvulnerabletocompromiseifprofitispositionedabovehealthconcernsrelatingtodietandphysicalactivityinthechildandhasmajorimplicationsforfuturehealthpolicy.TheSugarTaxisasoftdrinksindustrylevy,providingfundingforphysicalactivityinschool.TheaccruingrevenuewillbeinvestedinprogrammestopromotephysicalactivityandbalanceddietsforschoolagechildrenandthePrimaryPEandSportPremiumwillbedoubled(DepartmentofHealth2016SoftDrinksIndustryLevy:12thingsyoushouldknow).TheApril2018projectedlegislationservesasanexampleofadjustingdietarymeasurestoproducefunding-notforphysicalactivityalone-butalsoforschoolbreakfastclubs.Thesesugarreductionfiscalmeasuresarewelltargeted.However,currentguidelinesmayrequireadjustmentbecausemanufacturersofbeverages(energy/sugardrinks)withaveryhighsugarcontenthavelittleincentivetoreducesugarcontentbecausetheproductremainswithinthesametaxrange(MartinO’Connell,2017,CommentatWestminsterFoodandNutritionForum,27thApril).Therelationshipbetweenenergy/sportsdrinksandphysicalactivityinchildrenisconvoluted.RosieBoycott(FoodAdvisertotheMayorofLondon)hassaid:‘Profitistobehadbythebucketfulbymixingupsomeflavouringwith15spoonsofcheaprefinedsugarandsellingitinabrightyellowplasticbottlecalleda‘sportsdrink’,’(RosieBoycott2016:Atwoyearwaitforasugartaxrobsthiswaronobesityoffizz,TheSundayTimes20thMarch).Thepositioningoftheenergy/sportsdrinkiscentraltochildren’sphysicalactivity.Childrenareattractedbytheircolourfulgraphics,shapesandpackaging.Yettheassociationofplayfulrunningwiththeconsumptionofacalorie-ladendrinkthattheyareassuredis‘required’isnothealthful.IntheUS,theenergydrinkmarketburgeonedby60%between,2008-2012andwasworth12.5billiondollars.Projectedsalesfor2017are21.5billiondollars;themarketisvastandUKsalesarepredictedtofollowsuit.TheBritishSoftDrinkAssociationAnnualReport(2016)recognisedthattheEnergyDrinkMarketisworthover£2billion;ariseofalmost8%from2014(BritishSoftDrinkAssociation2016,AnnualReport,GrowthofUKEnergyDrinkMarket).Theeffectofenergydrinksmaybetomakechildrengainweight.Fewexerciseenoughto‘burnoff’extracaloriesandstimulantscontainedwithinthedrinksinclude14timesmorecaffeinethaninothersoftdrinks(HollyBenjamin2017:EnergyDrinksMakeChildrenFatnotFit,TheIndependent,20thMay).Sportsdrinkscontaincarbohydrates,minerals,electrolytesandflavouringandareprimarilyintendedtoreplaceelectrolytesandwaterlostthroughsweating.Manyconsumersconsiderenergydrinksandsportsdrinkstobeinterchangeableandlinkbothtoactivity.Sportsdrinksutilisequestionablenutrition-relatedclaimsandhydrationmessageswhilstpromotingphysicalactivity(RobertWoodJohnsonFoundation2012:ConsumptionofSportsDrinksbyChildrenand

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Adolescents.HealthyEatingResearch,UniversityofMinnesota).AccordingtoHollyBenjamin(above):‘Sportsdrinkscontainextracaloriesthatchildrendon’tneedandcontributetoobesityandtoothdecay.It’sbetterforchildrentodrinkwaterduringandafterexerciseandtohavetherecommendedintakeofjuiceandlowfatmilkwithmeals.Sportsdrinksarenotrecommendedasbeveragestohavewithmeals.’ResearchfromtheUniversitiesofEastAngliaandCambridgesuggestthatsportsdrinksdonotboostexercise,castingdoubtuponmanufacturers’claimsthattheirproductsimprovehydrationandendurance.Parentsshouldberemindedclearlythatfresh,safeandfreedrinkingwatershouldbeaccessibleatalltimesforanexercisingchildbecausesportsdrinksarenotan‘essentialpiece’ofequipmentforphysicalactivity.Aboveall,correctingfalseassumptionsthathavebeenallowedtotakeroot,growandflourishastotheefficacyofenergydrinksshouldbedoneinawaythatisunambiguousandproperlyinformative,butalsosensitive.Itshouldbeborneinmindthatparentsgenuinelythinkthattheyarehelpingtheirchildbygivingthemadrinkthattheyhavebeenencouragedtobelieveimprovessportingprowess.Directingtowardsofferingchildrenhealthyoptionsshouldnotentailblamingandshamingtheirparentsandcarers.Parentalcalorieliteracyisgenerallypoorandmanydonotknowhowmanycaloriesachildneedsforahealthyweight.(RoyalSocietyforPublicHealth,2016:Introducing‘activityequivalent’calorielabellingtotackleobesity).’Frontofpack’foodlabellingmustbereadilyunderstandabletoinfluencebehaviourchangeand‘activityequivalent’calorielabelsarearelativelystraightforwardreferenceforparentstodecipherinbusysupermarkets.Thislabellingpromptsconsumersabouttheimportanceofactivityaswellasreferencingasimplebodyweightissue.Individualswereoverthreetimeslikeliertoindicatethattheywouldparticipateinphysicalactivityafterviewingthe‘activityequivalent’calorielabeloverthecurrent‘trafficlight’system(WHO2012:Population-basedApproachestoChildhoodObesityPrevention,Geneva’).Childrenthemselvesmustbesupportedandinformedabouttheirfoodchoices,particularlyinrelationtophysicalactivity.Thetwoareinseparablebecauseitisimpossibleto‘out-run’apoordiet,asShirleyCrameroftheRoyalSocietyofPublicHealthhasobserved(RSPH2015):www.rsph.org.ukTheUK’sdevolvedgovernmentsstresstheimportanceofphysicalactivityinearlychildhood.InScotlandthe‘CurriculumforExcellence’includeshealthandwellbeingasoneofeightareascontributingtotheexperiencesandoutcomesofpupilsinScotland.Similarly‘gettingitrightforeverychild’(GIRFEC)isanumbrellaapproachtoreformingchildren’sservices,overarchingallotherpoliciesforchildren,youngpeopleandfamilies.Itprovidesthestrategicpolicyframeworksupportingotherkeypoliciesandguidance,includingtheCurriculumforExcellence.Underthisculture,TheDailyMile(promotedbyElaineWyllie,headteacherofStirling’sStNinian’sprimaryschool)wasfirstabletoflourish.ElaineWylliebecameconcernedaboutthephysicalfitnesslevelsofherpupilsandtheDailyMile(inwhichchildrenrunforupto15minutesperdayinanon-competitiveatmosphere)wassubsequentlychampionedbythethenCabinetSecretariesforEducation,andHealth,AngelaConstanceandShonaRobisonwhowrotetoeveryprimaryheadteacherandDirectorofEducationinScotland,urgingthemto

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launchtheDailyMile.Byspring2016,itwasincludedintheScottishNationalParty’smanifestoandcreditedwithtransformingthehealthofprimaryagechildren.Themanifestostated:‘OurambitionisforScotlandtobethefirst‘DailyMile’nationwithrollouttonurseries,schools,colleges,universitiesandworkplacesacrossthecountry.EveryschoolwillbeofferedhelptobecomeaDailyMileschool.’TheDailyMileFoundationhascontinuedtoworkcloselywithleadersinpolicy,healthandeducationtoassistwithnationalandregionaleffortstoimplementtheschemeinprimaryandnurseryschoolsUK-wide.TheWelshGovernmenthasfocusedonpromotingregularphysicalactivityintandemwithencouragingahealthydiet.Ithasadoptedthiscombinedapproachtotacklingchildhoodobesity;invitingcompaniesandresearchorganisationstoapplyforashareof£1mfundingtomakethefoodanddrinkavailabletoyoungchildrenhealthierwhilstreducingcosts.Thosewhosubmitfundingideasareencouragedtoprovideinnovativesolutionssuchasnewprocessingtechnologies,reformulationtechniques,enablingtechnologies,freshengineeringdesignsandflexiblemanufacturingprocesses,todrivedownexpenditure.Aparallelinitiativeconcentratesuponthepromotionoffreeplay;specificallyplayingoutdoors,withPublicHealthWalesidentifyingplayingoutdoorsasoneofthe10StepstoaHealthyWeightforchildrenagedtwotofive(April2016):www.playwales.org.ukPlaywithloosepartsisadvocatedandtodemonstrateasupportiveattitudetowardsoutdoorplayweshouldensurewedonot:

• Dismissitasfrivolousandawasteoftime• Unintentionallybeunenthusiastic(eveniftheweatherisn’tfavourable)• Overregulateandoverorganiseit• Unnecessarilyrestrictitthroughfear.

TheNorthernIreland‘StateofChildHealth’2017:www.rcpch.ac.uk/state-of-child-healthfavoursanapproachtochildhealthcharacterisedbyearlyinterventionandpreventionandadvocatesthattheNorthernIrelandExecutiveadopta‘childhealthinallpolicies’approachtodecisionmaking,policydevelopmentandservicedesign.ItalsorecommendsthattheNorthernIrelandExecutiveworkwiththeotherUKnationstodevelopcommonstandardstoensurethatchildhealthdataareofhighquality,capturedtopre-specifieddefinitionsandcapableofconsistentanalysiswithEngland,ScotlandandWales.TheNorthernIrelandExecutiveisurgedtocontinuetoencouragephysicalactivityforallchildrenandyoungpeopleandsupportparentsandfamiliestoadopthealthylifestylesbyimprovingsocialandphysicalenvironmentsbyensuringthatlocalauthorityplanningdecisionsincludeapublichealthimpactassessmentandintroduce20mphspeedlimitinbuiltupareastocreatesafeplacesforchildrentowalk,cycleandplay.Recommendations:4.1 UKGovernmenttoinitiateanannualforum/summitwherebydataand

policyinitiativesinthedevolvedgovernmentscanbestudiedwiththeaim

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ofco-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.’

5. ACOMPARATIVEANALYSISOFGOODPRACTICEINOTHERCOUNTRIESANDEXISTINGUKLEGISLATIVEPRACTICE

IntheUK,threeseparateframeworks(acrossEducationandHealthDepartments)supportEarlyYearsPhysicalDevelopment,PhysicalActivity,HealthandWellbeing.

1) TheEarlyYearsStatutoryFramework(2012)undertheremitofOfstedprovidesLearningandDevelopmentrequirementsfortheEarlyYearsFoundationStageCurriculumandtheSafeguardingandWelfarerequirements.WithinEYFS,PhysicalDevelopmentisoneofthree‘PrimeAreas’oflearning,consistingofMovingandHandlingandHealthandSelfCare.‘MovingandHandling’requireschildrento‘showgoodcontrolandco-ordinationinlargeandsmallmovements.Theymoveconfidentlyinarangeofways,safelynegotiatingspace.Theyhandleequipmentandtoolseffectively–includingpencilsforwriting.’‘HealthandSelfCare’entailschildrenunderstanding‘theimportanceforgoodhealthofphysicalexerciseandahealthydiet.Theytalkaboutwaysinwhichtokeephealthyandsafe.Theymanagetheirownbasichygieneandpersonalneedssuccessfully.’The‘SafeguardingandWelfare’requirementsstatethat‘Childrenlearnbestwhentheyarehealthy,safeandsecure.Theprovidermustpromotethegoodhealthofchildrenattendingthesetting.’

2) TheUKChiefMedicalOfficer’s(CMO)PhysicalActivityguidelines(2011)statethatphysicalactivity(particularlyfloorplayandwater-basedactivitiesinsafeenvironments)shouldbeencouragedfrombirth.Ambulantpre-schoolchildrenshouldbephysicallyactiveforthreehoursspreadthroughoutthedayandallunderfivesshouldminimisesedentarytimeexceptwhensleeping.

3) Since2015,EYhasbeenincludedintheCommonInspectionFramework

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(CIF)Ofsted-designedandaimedtosimplifyinspectionacrossallagegroups.

• UnderPersonalDevelopment,BehaviourandWelfareInspectorsarerequiredto‘evaluatetheextenttowhichprovisionissuccessfullypromotingchildren’sknowledgeofhowtokeepthemselveshealthy,bothemotionallyandphysically,includingthroughexerciseandhealthyeating’.PhysicalDevelopmentisa‘PrimeArea’andrelevanttothethreeotherareasoftheCIF.Theseare:

• EffectivenessofLeadershipandManagement,possiblyincludingmanagement’sresponsibilityforthesetting’sresponsetoPD/PA,encompassingstafftrainingandliaisonwithparentsandcommunitiestosupporthealthylifestyles

• QualityofTeaching/Learning/Assessment:clearevidenceof‘relevantsubjectknowledge’reflectedinplanning,deliveryandassessmentthatisfullysupportiveofinclusivepractice

• OutcomesforChildrenandotherLearners:theCIFstatesthatchildrenwillbeevaluatedontheextenttowhichthey‘progresswellfromdifferentstartingpointsandachieveorexceedstandardsexpectedfortheirage.’ThisisrelevantforPDasitunderpinsallotherareasofdevelopmentandshouldbereflectedindailyPAprovisionforchildren.

Thedifferingremitsofthethreemechanismsdesignedtosupportyoungchildren’sphysicaldevelopmentandactivityhasledtoconfusion.Ofstedinspectors’judgementsaboutchildren’sPD/PAaresubjective:whatexactlyismeantbygoodcoordination,movingconfidentlyandhandlingequipmenteffectively?Whatistheknowledgebasisforthesejudgements?Intherevised(2017)EYFSC,theCMO/EY/PAguidelinesarementionedinfootnoteassomethingthat‘providersmaywishtoreferto,’thusremovinganycompulsionletaloneimperative,toembedorimplementguidelines.ThereisalsoacontradictioninthatthePhysicalDevelopmentComponentoftheEYFSisbasedonthebeliefthatphysical/movementskillsunderpinalllearninganddevelopmentacrosssocial,cognitive,spiritualandemotionaldomains(notpurelythephysical)yettheCMOguidelinesareprimarilyconcernedwithphysicalactivityforhealthreasonssuchasobesityprevention.TrainingfortheEYworkforceisinadequate.OnlysinceSeptember2015hasitbeenmandatorythatalllearnersfollowingLevel3traininginEYCareandEducationcompletethephysicaldevelopmentmoduleandthereislittlefundingforpractitionercontinualprofessionaldevelopmenttraining(CPD)thatisneithermandatory(Safeguarding/FirstAid)orfreetoaccesson-line(e.g.Prevent).Trainingislargelyadhoc;some‘inhouse’,someexternalandrarelyquality-assured,monitoredorevaluatedconsistently.Difficultiesaboundinprovidingcoverforstafftraining,andfamilycommitmentslimitattendanceateveningorweekendsessions.Trainingcoursescurrentlyavailableinclude:

• Level1Diploma(CACHE)‘CaringforChildren’• Level2Award(CACHE)‘IntroductiontotheEarlyYears’• Level3Diploma(CACHE)‘EarlyYearsEducationandCare’

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• Level3PD/PACertificateinYoungChildren’sPhysicalDevelopment• 1st4SportLevel3CertificateSupportingthedeliveryofPEandschool

sport;aimedatEYpractitioners• Level4AdvancedPractitioner(CACHE)Unit2‘Promotehealthand

wellbeingthroughphysicalactivityandnutritioncoordinationinEY’• TwopostgraduatequalificationsfromtheCentreforResearchinEarly

Childhood(CREC)‘OutdoorPlayandLearning’and‘PhysicalActivityinEarlyChildhood’;‘standalone’oraspartofanMA

• ForSEN/PD/PApractice,TPDEducationspecialistcoursesatLevel2/3aimedatolderautisticspectrumchildren

• Trainingopportunitiesfromcommercialenterprisesinspecificdisciplinese.g.:Yoga(Yogabugs/Tatty-Bumpkins),Gymnastics(Tumbletots),Movement-play(Jabadao),Tennis(Teddy’sTennis),Football(LittleKickers).

Thefollowingglobalagreementsphysicallyaffectandprotectchildrenworldwide:

• 1989:GovernmentsworldwideadoptedTheUNConventionoftheRightsoftheChild(UNCRC).Childrenaretobetreatedas‘humanbeginswithadistinctsetofrightsinsteadofpassiveobjectsofcareandcharity.’Therightsincludewhatachildneedstosurvive,growandfulfiltheirpotential.Agenciesmustcollaboratetoprotectandensuretheirphysicalandmentalhealth

• 2000:CountriessignedtheEducationForAll(EFA)agreement;pledgingto‘expandandimprovecomprehensivecareandeducation’forallchildren

• 2010(reviewed2015)the‘GlobalStrategyforWomenandChildren’sHealth’createdtoensure‘universalaccesstoessentialhealthservicesandprovenlife-savinginterventions.’

GlobalinitiativesconcurthatEarlyChildhoodDevelopment(ECD)isimportantbutglobalinvestmentislimited;sourcedmainlyfromhealthandoreducationfoundations.Lessthan5%ofgovernmentbudgetsindevelopingcountriesareallocatedtoeducationandonly2%tohealth–onaverage0.5%offundingisdirectedatyoungchildren.FINLANDIn2005,Finlandwasoneofthefirstcountriestoproducenationalrecommendationsforphysicalactivityforundereights.In2016,theFinnishMinistryofEducationandCulturepublished‘Joy,Play,DoingTogether(MinistryofEducationandCulture2016)recommendationsforphysicalactivityinearlychildhood’inresponsetothefluidlifestylesofFinnishchildrenandfamiliesandadecreaseinthelevelsandqualityofdailyphysicalactivity.Finlandhasmanyassociations,organisationsandsportsclubssupplyingorganisedphysicalactivityforpre-schoolchildren.Activitiestargetedatchildrenunderthreearecalled‘parent-child’activitiesor‘physicalactivityforfamilies’.50%of3-6yearoldsengageinsomeorganisedPA.Eachmunicipalityhasadutytoprovidesportsservices.ThelocalauthoritymustfacilitatePAwhichisdeemeda‘basicmunicipalservice’andwhenbudgetingforearlychildhoodandcare,PAsupportismandatory.

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Thedocumentstatesthat‘municipaldecisionmakers’must:‘Makesurethatallearlychildhoodeducationandcareunitshaveanappropriateindoorfacilityforphysicalactivities,theyardatthedaycarecentreislargeenough,everydaycarecentrehasthebasicequipmentrequiredforPAandthatsufficientfundsareallocatedtorenewingtheequipmentinthebudgeteveryyear.’RecentFinnishresearchdatarecordsthatchildrenwereonly‘highlyphysicallyactive’foranaverageof47.5minutesperdaybetween8amand4pm.Theleastphysicallyactiveonlymanaged4.8minutes–themostactiveachieved163minutes.68%ofhighPAoccurredoutdoors;childrenspendonaverage91minutesdailyinoutdoorplay.Theresearchers’dataindicatedleastactivitywithteacherinvolvementandthatover70%ofchildrenaremostactiveduringpeerinteractions.Specificrecommendationsforearlyyears’teachersinFinlandarethereforetoprioritisechildren’speergroupengagement;focusingonsupplyinginvigoratingoutdooropportunitiesforPA.PAisnottechnicallypartoftheFinnishEYcurriculumbutteachersdemonstratehighcommitment;especiallynowthatthereisabeliefthat‘PAinearlychildhoodeducationandcaremustbechild-oriented,diverse,andgoal-orientedandregulartosupportthechild’sphysical,cognitive,andpsychological,emotionalandsocialdevelopment.’ThereisalsoaclearcommitmenttoCPDasthereportstates:‘Makesurethatregular,yearly,continuingeducationinphysicaleducationisavailableforthemunicipality’searlychildhoodeducationstaff–whoareentitledtoit.’Thereisaproactive,sensitivetreatmentofchildhoodobesityandthelowlevelsofPAinimmigrantchildren.Generally,Finlandexpectsagenciesinvolvedwithyoungchildren(localgovernment,families,teachersanddoctors,communities)toworkcollaborativelytosupporttheiroverallhealthandwellbeing.Ironically,although‘PhysicalDevelopment’isdesignatedasa‘PrimeArea’intheUKEYFSC;UKpractitionersreceiveminimumsupportfromcentralofficials.WerelyuponoverseasresearchtosupportfundingapplicationsbecauseUKdataisscarce.ItischallengingtoacquirefinancefortrainingandtherearenoNationalQualityStandardstosupportbestpractice.Localauthoritiesattempttoallocatefundsforchildhoodobesityprevention(includingPA)butitisrarelyobtainedforlongerthanayearwhichmakeslong-termplanningdifficult.AUSTRALIAHere(althoughallchildren’sservicescomeundertheaegisofNationalLaw)autonomyinPAprovisionisenergeticallyencouraged.Locally,agenciesworktogethertoensurethatyoungchildrenaccessabroadrangeofopportunitiesoutsideschoolandallEYsettingsareexpectedtoprovideresourcesthatsatisfyNationalGuidelinestoensurethatallchildrenarereadyandphysicallyableforformaleducation.In2009,theAustralianGovernmentpublishedablueprintforyoungchildren’shealth‘GetupandGrow’(GetupandGrow-HealthyEatingandPhysicalActivityforEarlyChildhood,AustralianGovernment:MinistryofHealthandAgeing2009).ThiscomponentofAustralia’s‘PlanforEarlyChildhood’and‘PlanforTacklingObesity’wasdesignedforuseinavarietyofsettingsbyfamily,staffandcarerstosupporta‘consistent,nationalapproachtochildhoodnutritionandphysicalactivity.’Theemphasisistoembed

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positivehabitsandbehaviourstowardsPAfrombirthasthemosteffectiveformofobesitypreventionwithagoalofensuringchildren’ssmoothoveralldevelopment.Arangeofphysicaldevelopmentsupportingopportunitiesaresupplied;activeunstructuredphysicalplay(freeplayinsandpits/playgrounds/dancingtomusic/imaginativeplay)orstructuredactivity(creativemovement/dancing/actiongames/organisedactivitiesandgames)includingactivetransport(lessbuggytime,increasedwalking/scootertransport)andeverydayphysicaltasks(gardening/tidyingandactivityatmealtimes).Outdoorplayinallweathersisadvocatedbecause‘itprovideschildrenwithmorespaceandopportunitiestouselargermusclegroupsandexperiencemovinginawholerangeofdifferentshapes,speedsanddirections.Outdoorplayalsoallowschildrentobemessyandnoisy’.Centralgovernmentstatesthat:‘Earlychildhoodsettingsaretheidealplacetodevelopgoodphysicalactivityhabitsandinfluencethebehaviouroffamilies.Parents,staffandcarerscanworktogethertosharetheresponsibilityofmakingphysicalactivityaprioritybothinsideandoutsidethehomes.’‘Thebenefitsofactiveplaygobeyondjustthephysicalandincludethedevelopmentofsocial,languageandintellectualskills.’TheStateofVictoriarespondedbydevelopingtheir‘Goforyourlife-HealthPromotionPlanningTool’(StateofVictoria,Australia2010)withthesupportofPrimaryCarePartnershipsandhealthpromotionagencies.Theprogrammeprovidesearlychildhoodserviceswithacomprehensiveguideto‘creatinghealthierenvironmentsthatpromotehealthyeatingandphysicalactivity’.70%ofAustralian3-4yearoldsattendpre-schoolsfor‘longstay’care.The‘Kidsgoforyourlife’initiative(HealthPromotionPlanningTool:StateofVictoria,Australia2010)isafreeservicefundedbytheVictoriangovernmentandavailabletoallcommunities.Thereisanawardstructurethatmaybeappliedtoallearlychildhoodservicesrequiringthecompletionofasetof7-9criteria;includingthedevelopmentsofpolicyandchangestotheenvironmentandpracticetopromoteandfacilitatepositivehealthyeatingandPAbehaviour.Thethreeclearmessagesare:

1. TurnOff–SwitchtoPlay–aimstoreducechildren’sscreentime.SettingsareencouragedtoexcludeorlimitscreentimeandencouragePAwithmanagedequipmentduringbreaks

2. StrideandRide–encouragestheuseofactivetransport-decreasesbususe–creates‘walkingbuses’andencouragesscooterusagewhengoingtoschool

3. Move-Play-Go–encouragesactiveoutdoorplay.Practitionersmustprovidedailyfreeandstructuredphysicalactivitiesasasignificantcomponentoftheprogrammeplan.

In2017,aUniversityofWollongingteamproposedare-thinkofissuesimpactingonyoungchildren’shealthandwellbeing.Their‘24hourMovementGuidelines’includethreeclearlydefinedelements:

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‘Topromotehealthygrowthanddevelopment,infants,toddlersandpre-schoolersshouldachievetherecommendedbalanceofphysicalactivity,highqualitysedentarybehaviourandsufficientsleep.’TheyhavemainlykeptthePAguidelines(30minutesdaily‘tummytime’forinfants-180minutesaccumulativedailyPAfortoddlers(1-2years)andpre-schoolers(3-schoolentry)–buthaveincluded‘highqualitysedentarybehaviourandsleep’withintheremit.Byaddingtheseelements,theresponsibilityforchildren’soverallhealthandwellbeing(notjustphysicalhealth)maynowbeeffectivelyspreadbetweenallagencies;home,settings,healthcareprofessionals.Theguidancealsoadvocatespositivesedentarypursuitssuchasreadingandstorytellingwithacaregiverandtherecognitionoftheimportanceofsleepisalsoverywelcome.Asyettheseguidelinesarenotgenerallyavailable,butitishopedthatintimea‘progressiveadjustment’willfacilitatetheirimplementationinternationally.NEWZEALANDTheMinistryofHealthhasrecentlyproduced‘SitLess,MoveMore,SleepWell–ActivePlayGuidelinesforUnder-fives’,(WellingtonMinistryofHealth,NewZealand2017)to‘supporttheworkofhealthpractitioners,regionalsportstrusts,earlychildhoodeducationcentresandotherswhoprovidePAadvicetothepublic’.NewZealand’s‘physicalliteracy’approachrecognisesthatyoungchildren‘requirephysicalmovementineverydaylifeenvironments(includingnature)toencouragecreativity,imaginationandexploration’.Auniqueemphasisstressesthat‘spiritualgrowth’isenhancedbymovementactivities,influencedbyaMaoriholisticviewofhealthandwellbeing.Incomparisonwiththethreecountriesdescribedabove,theUKiswaybehindintermsofsupportingchildren’sphysicaldevelopmentthroughphysicalactivity.Our‘frameworks’arenotbackedby‘fitforpurpose’mechanisms;ourassessmentproceduresareinsufficientandsincetherevisedcurriculumdidnotembedtheCMO/PAguidelines,wenolongerhavetheoptionofengagingproactivelywithOfsted.Thereismuchdebateaboutthedesirabilityofa‘PhysicalLiteracy’approachandasyet,noconsensusaboutwhatthisactuallymeans.EY/PDPAisinurgentneedofreconsiderationandpolicyreformulationtoaffordallyoungchildrenintheUKthebestopportunitiesbothinsettings,thecommunityandintheirhomes.Recommendations5.1 ReviewthePDcomponentoftheEYFStoreflectthedemandsoftheCMO

guidelinesandensureafocusongross-motorskillsinbothindoorandoutdoorenvironments

5.2 OfstedinspectionprocesstobeadaptedtoaccountforlevelsofPAandprovisionforchildreninindoor/outdoorsettings

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

practitioners’understandingsoftheimportanceofphysicalskills/playand

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tobuilduponexistingknowledgetodesignanddeliversafeandeffectiveactivesessions

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/PAtaskforcetoinformanddrivepolicyandpracticeinthisfield.

6. SOCIOECONOMICISSUSES,ETHNICDIVERSITYANDCULTURALPRACTICEANDTHEPLANNINGSYSTEM(INBOTHRURALANDURBANCONTEXTS)ASTHEYIMPACTUPONEARLYCHILDOODANDACTIVITYPATTERNS

ApolicypaperfromTheCentreforMarketandPublicOrganisation‘TheSocioeconomicGradientinPhysicalActivityinEngland’(July2013WorkingPaperno.13/311)considersphysicalinactivitytobeanimportantcomponentinchronicillhealthandidentifiestheimportanceofsocioeconomicpositionasakeycontributoryfactor.DataanalysisgatheredfromoveronemillionindividualsinEnglandfromtheActivePeopleSurvey(APS)followsthegroundbreakingworkofTheMarmotReview(Marmotetal2010:FairSociety,HealthyLives)thathaslinkedsocioeconomicinequalitiesinextricablytohealthdisparities;advocatingearlychildhoodasatimeofespecialsignificanceandpotentiallyabedrockforlaterhealthandwellbeing.Thereareacknowledgedinconsistenciesrelatingtophysicalinactivitywithincommunities(Veitch,J,Hume.Salmon,Crawford,DandBall,K,2011‘Whathelpschildrentobemoreactiveandlesssedentary?Perceptionsofmotherslivingindisadvantagedneighbourhoods’,Child:Care,HealthandDevelopment,39(1):94-102)andacomplexmixofmacrofactors(socioeconomicbackground,ethnicity,culturalpracticeandgeographicalcontext)thatimpactnegativelyuponyoungchildren’sparticipationinphysicalactivity.Physicalactivityispartiallyrelatedtolivingarea.Low-incomefamiliestendtobesituatednexttoeachotherandtheareasthemselvesmayhavelowtaxbaseswithwhichtofundrecreationandotheractivitiestostimulatephysicalactivity(MooreL,DiezRouxA,EvensonK,McGinnA,BrinesS,‘Availabilityofrecreationalresourcesinminorityandlowsocioeconomicstatusareas’.AmericanJournalofPreventiveMedicine,2008,34:16-22.PowellLM,SlaterS,ChaloupkaFJ,‘Therelationshipbetweencommunityphysicalactivitysettingsandrace,ethnicityandsocioeconomicstatus’.EvidenceBasedPreventiveMedicine,2044,1(2):135-144).Childrenfrompoorbackgroundsarelesslikelytoaccessaprivategardencomparedtotheirmoreaffluentpeers,withthePovertyandSocialExclusion(PSE)studyintheUKrevealingthat92%ofpeopleintheirsampleconsideredagarden/safeplacetoplay

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essentialforallchildren(GordonD.etal2013:TheImpoverishmentoftheUK:LivingStandardsintheUK(PovertyandSocialExclusionResearchProject):http://www.poverty.ac.uk/pse-research/pse-uk-reportsHowever,thenatureoftheenvironmentisequallyimportant.Poorerfamilieswithgardensmaystillkeeptheirchildrenindoorsbecausetheycannotaffordtomaintaintheupkeepoffencing,thispotentiallyjeopardisingsecurityinareasthatmayhavehighercrimerates.Similarly,thoselivingindisadvantagedcommunitiesarelikelytofindthattheirphysicalactivityrecreationalopportunitiesarelimitedbyfinancialcost(McKenzieTL,MoodyJS,CarlsonJA,LopezLVandElderJP.2013:‘Neighbourhoodincomematters:disparitiesincommunityrecreationfacilities,amenitiesandprogrammesJournalofParkandRecreationAdministration’,31(4):12-22),leavingoutofschoolpublicplayspaceslikegreenspacesandparksastheprimesitesinwhichfamiliescanengageinphysicalactivity.However,apoorqualitybuiltenvironmentcombinedwithlivinginadisadvantagedareaimpactsnegativelyuponchildren’soutdoorphysicalactivity.Crimeratios,dogfouling,shabby,poorlymaintainedequipment,drugabuse,anti-socialbehaviourandheavytraffic,increaseparents’reluctancetoallowtheirchildrentoplayoutdoors;particularlyinpoorerurbanareas.Parentalperceptionandreceivedwisdomisalsoimportant(TeedonP,GillespieM,LindsayKandBakerK2014:‘Parentalperceptionsoftheimpactsthebuiltenvironmenthasonyoungchildren’shealth:AqualitativeexaminationandlayassessmentamongstresidentsinfourScottishcommunities’,HealthandPlace,28:50-57).Parentsaretheirchildren’s‘gatekeepers’totheoutsideworld;children’sperceptionofsafetymaywelldiffer,butadultjudgementsarelikelytoprevailwherethesafetyofyoungchildrenisconcerned.Thesameistrueofdecisionsbasedonclimate(BelonAP,NieuwendykLM,ValliantosHandNykiforukCIJ,2014:‘Howcommunityenvironmentshapesphysicalactivity:perceptionsrevealedthroughthePhotoVoicemethod,SocialScienceandMedicine’,116:1-9)andfromapracticalperspective,poorerfamiliesmaybeunabletoaffordwarmwinterclothingforoutdoorplay(GordonD.etal2013:‘TheImpoverishmentoftheUK;LivingStandardsintheUK(PovertyandSocialExclusionResearchProject)’:http://www.poverty.ac.uk/pse-research/pse-uk-reportsRuralareascanbemoreconducivetophysicalactivitythanurbansettlementsandmothersintheVeitchstudy(asabove,2011)havepointedtoaruralcommunitycultureofphysicalactivityandsport.Thechoicesavailableforolderchildreninurbanareas(shopping/goingtofast-foodoutlets)includedawiderrangeofactivitiesdeemed‘sedentary.’Unlikemanyurbanareas,ruralareasmayhavepoortransportlinkstorecreationcentres,whichmayimpactuponyoungchildrenandtheirfamilies’engagementinactivitysuchasswimming.Children’sparticipationinphysicalactivityisalsoinfluencedbythedegreetowhichthelocalcommunityengagesinphysicalactivity.Thisrelatesbothtothephysicalenvironmentofagivenlocalityandtoperceptionsofneighbourhoodsociality:thedegreetowhichpeopleknowandtrustoneanother.Thisisparticularlythecaseforimmigrantfamilieswhoarenewtoacountry(BrewerMandKimbroRT,2014:‘Neighbourhoodcontextimmigrantchildren’sphysicalactivity,SocialScienceandMedicine’,116:10-21)butalsomoregenerallyforBlackandMinorityEthnic(BAME)

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families(Belowasabove).Somestudies(BrewerandKimbroasabove)intheUShaveshownBAMEchildrenengaginglessinphysicalactivitythantheirWhitecounterpartsandthisissupportedbysomeUKresearch(TrigwellJ,MurphyRC,CableNT,StrattonGandWatsonPM,2015:‘Parentalviewsofchildren’sphysicalactivity:aqualitativestudywithparentsfrommulti-ethnicbackgroundslivinginEngland’,BMCPublicHealth,15:1-11)butthereisroomformuchmoreinvestigationhere.Trigwellfoundthattosomeextent,culturaldeterminantslinkwithissuesofethnicityinpromotingchildren’sphysicalactivity.ParentsfromAsian,Bangladeshi,ChineseandYemenibackgroundsvaluedtraditionalacademicattainmentovertheirchildrenbeingphysicallyactive.ThestudyalsorecordedanintersectionwithgenderandreligionassomeMuslimfamiliessurveyedconsideredthattherewasalackofsuitablephysicalactivityopportunitiesforoldergirlsandthatsomeactivities(forexample,football)wereactuallyantitheticaltotraditionalculturalandreligiousvaluesforgirlsandwomen.Culturalimperativesshouldalsobeconsideredinconnectionwithalterationstospecificchildren’scultureovertime.SomeoftheTrigwellBAMEparentsstatedthattheiroffspringpreferredsedentarypursuits(screentime)buttheparentalactivityrolemodelisstillextremelyinfluential.However,thedegreetowhichfamiliespromoteacultureofbeingphysicallyactiveisimpactedbysocioeconomicissuessuchasunemploymentandtheMarmotReview(asabove)doesnotunderestimateorunderplaytheresultantpsychosocialstressors.Itisalsovitalthattheimportanceofphysicalactivityisknownandunderstood.TheTrigwellsurveydemonstratedthatBAMEparentsthoughtthatchildrenenjoyedahighdegreeofphysicalactivityduringtheschooldayandsodidnotconsiderittobenecessarytosupplementthiswithphysicalactivityathome.Theydisplayedapatchyknowledgeoftherecommendedphysicalactivityguidelinesforyoungchildrenandotherstudies(RawlinsE,BakerG,MaynardM,HardingS,2013:‘Perceptionsofhealthyeatingandphysicalactivityinanethnicallydiversesampleofyoungchildrenandtheirparents:theDEALpreventionofobesitystudy’,JournalofHumanNutritionandDietetics,32:132-144)haverevealedasimilarlyunevenknowledgeofphysicalactivityneedswhencomparedtodietaryintake.Irwinetal(IrwinLG,JohnsonJL,HendersonA,DahintenVSandHertzmanC,2006:‘Examininghowcontextsshapeyoungchildren’sperspectivesofhealth’,Child:Care,HealthandDevelopment,3394):353-359)offerausefulperspectiveonthethinkingofyoungchildrenthemselves.Somehadrestrictedopportunitiestoplayandbephysicallyactivebecausetheydidnotknowmanyotherchildrenlivinglocally.Evenveryyoungchildren(5-7years)wereawareoftheimportanceofphysicalactivitybutwerenotallowedtoplayoutdoorsbecauseofthephysicalandsociallimitationsoftheirneighbourhoods.AsMarmothasargued,thephysicalandsocialcharacteristicsofacommunitywillnecessarilyimpactuponhealth.Theoverallpicturethatemergesfromtheaboveinformationiscomplex;demonstrativeofdisparitybetweendifferentgroupsintermsofchildren’sphysicalactivity.Choiceofactivitywithinrecreationalspacesindoorsandoutdoorsisimportantbecauseitseemstoincreasephysicalactivityratesandyetitisevidentthatpoorerfamilieshavelesschoiceopentothem.Itwouldseemthatrecreationcentres,greenandparkspacesaswellasnurseriesandschoolsarepivotalinimpactinguponthedisparitiesbetween

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income-richandpoorfamilies’physicalactivity.However,itisthesocialaswellasphysicalcharacteristicsofalocalitywhichaffectphysicalactivityrates.Withtheeffectofphysicalactivityuponhealthoutcomesinlaterlife,currenttrendspredicatealargefuturehealthproblemfortheUKandonethatisheavilysociallygradedonalargerangeofsocioeconomicdimensions.Priceisimportantandefforttoreducepricebarriersmighthelptoreducedisparities.Yeteducationandethnicityarealsodeterminantsofphysicalactivityandunlesstheseissuesareaddressedalongsidethoseoffinance,disparitieswillexistandcontinuetoflourish.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.

7. THEROLEOFADVERTISING,TRADITIONALANDSOCIALMEDIAANDTECHNOLOGY(INCLUDINGTHEUSEOFAPPS)ASSTIMULANTANDPROMOTEROFEARLYCHILDHOODPHYSICALACTIVITY

Socialmarketing,advertisinganddigitaltechnologiesaremethodsofreachingvariedaudiencesquicklyandcreatively.Theyarefrequentlypositionedasimpactingunfavourablyonphysicalactivitylevelsinearlychildhoodandthroughoutthelifecourse.AstudybytheUniversityofUlsterconsistingofanonlinesurveyof350studentsmeasuringsocialnetworkingactivityandlevelsofphysicalactivity(‘DoesSocialNetworkingLimitPhysicalActivity?’UniversityofUlster:https://psychcentral.com/news/2012/09/11/does-social-networking-limit-physical-activity/44412.htmlfoundthatsocialnetworkingtimecameattheexpenseofotheractivities.Althoughonequarterofrespondentsallegedthattheyengagedinteamsports,analysisoftheresultsconfirmedthattheamountoftimespentonsocialnetworkwebsitescorrelatednegativelywiththerespondents’activitylevelsinthepreviousweek.Facebookfollowerswerelesslikelytopartakeinteamsports.However,theseperceptionsofsocialmediaandphysicalactivityareoneaspectofawiderpicture.Downingetal(DowningKL,SalmonJ,HinkleyT,HnatiukJAandHeskethKD,2017:‘Amobiletechnologyinterventiontoreducesedentarybehaviourin2-4yearoldchildren(MiniMovers);studyprotocolforarandomisedcontrolledtrial’,Trials,ppl-8.DOI10.1186/s13063-017-1841-7)havecompletedanAustraliantrialinwhichmobiletechnologiesareharnessedtodeliveraninterventionprogrammewiththeaimofreducingsedentarybehavioursinchildrenaged2-4years,knownas‘MiniMovers.’Parentsreceiveapackofinterventionmaterialsandtherearepersonalisedtext

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messagesforfamiliescontainingideastostimulatephysicalactivitywiththeirchildren.ThestudysuggeststhathealthpromotersaredevisinginnovativeideasusingSmartphonetechnologiesasadeliverysystemforpublichealth.TheEnglishChange4Life(C4L)campaignworkswithfamiliesofchildrenaged5-11topromotehealthyeatingandexercisewithaviewtocombatingobesity.ItisthemarketingcomponentoftheGovernment’sresponsetotheriseinobesityandusestelevision,socialmediaandpartnershipwithlike-mindedorganisationstooffereasydietandexerciseswaps.Itaimstosupportfamiliessothattheyarelikeliertomakethenecessarychangestoachieveahealthierlifestyle.Withinitsfirstyear,Change4Life’sreportonitsownperformanceclaimedthattheprogrammehadreached99%ofmothersofchildrenaged11andunder;alsostatingthat‘Accordingtoourtrackingstudy,over1millionmumsarealreadyclaimingtohavemadechangestotheirchildren’sdietoractivitylevelsasaresultofChange4Life’,(Change4LifeOneYearOn,DepartmentofHealth,16thFebruary2010).AC4LgeneratedappcontainsideasforoutdoorandindooractivityforchildrenandtheDoHhasalsolaunchedStart4Life,asisterbrandaimedmorespecificallyatpregnantwomenandnewmothers:http://www.huffingtonpost.co.uk/2010/12/27/start4life-the-latest-addition-to-the-department-of-health-s-campaign_n_7399218.htmlbSimilarcampaignsdirectedatchildhoodactivitylevelshavealsobeenlaunchedinCanada:http://activeforlife.com/about/andtheUSA:http://letsmove.obamawhitehouse.archives.gov/TheaimsofChange4Lifearecertainlylaudable;however,onreview(CrokerH,LucasRandWardleJ,2012:‘Cluster-randomisedtrialtoevaluatethe“ChangeforLife”massmedia/socialmarketingcampaignintheUK’,BMCPublicHealth,12(404):1-14):http://www.biomedcentral.com/1471-2458/12/404thereseemedtobelittleimpactonattitudesandonchangingbehaviourssignificantlytowardssomethingmorephysicallyactiveandinvolvingtheconsumptionofahealthierdiet.Socialmediacanunitegroupsofpeoplewithsimilaractivitygoals,althoughtheevidencefortheireffectivenessislimited.NICEguidancestressestheimportanceofmarketingphysicalactivitytoyoungpeople.Socialmarketingandnewtechnologyhaspotentialwiththisgroupalthoughtheareaisnotasyetwell-evaluated.PossibleexamplesmightincludelinkingpeoplewithsimilaractivitygoalsonsocialmediasitesortheuseofGP-enabledappstotrackwalkingandotheractivitiestoshare(VandelanotteC,KirwanM,RebarA,AlleyS,ShortC,FallonL,BuzzaG,SchoeppeS,MaherC,DuncanMJ.IntsJBehavNutrPhysAct.2014Aug17:11(1):105,‘Examiningtheuseofevidence-basedandsocialmediasupportedtoolsinfreelyaccessiblephysicalactivityinterventionwebsites’).Itisalsoessentialthattechnologyisoperatedsafely.TheNSPCCandO2havesetuparangeoffreeclassroomresourcesforschoolsandteachersthatcanbeusedintheclassroomtohelpchildren(NSPCC):https://www.nspcc.org.uk/preventing-abuse/keeping-children-safe/online-safety/Change4Life,FunGeneratorApp:http://www.nhs.uk/change4life/pages/fun-generator-mobile.aspx

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Afamily-basedapproachbenefitseverybodyinthefamilyunitandcanactasabondingmechanism.InNewham,theWellbeingandNutritionteamofferanAssociationforNutritioncertifiedPhysicalActivitytrainingmoduletosupportstaffinconveyingtheimportanceofachievingthephysicalactivityguidelines.Practicaltoolssupportcommunicationwithfamiliesandenablestafftoactaspositiverolemodelsforchildren.Thishasbeenshowntobeaneffectivecommunicationmethod,usingdisplayboards,informationleaflets,tipssheetsandsharingusefulappswithfamilies(WellbeingandNutritionTeam,PhysicalActivityTrainingmodule):https://www.earlystartgroup.com/wellbeing&nutrition/training/pagMytimeActivehasembracedsocialmediaandtechnology(whilstalsobeingalerttotheneedtomonitorlocalFacebookgroupsinareasofprovisioninordertoaddressandmonitornegativefeedback).Theorganisationhasproducedsongsandhomegamevideosandmadethemfreelyavailableonline.Thesongsaccompanyingthevideoscombinewell-knownnurseryrhymestuneswithcatchynewlyricstocommunicatekeyhealthybehaviours,includingbeingactive,tryingnewfoods,drinkingwater,beingmobileasafamily,goodoralhealthhabitsandeffectivebedtimeroutines.Thehomegamesequipfamilieswithnewactivityideasthatcanbeplayedanywhereandatnocost.Familiesaresignpostedtothevideosviasocialmedia,groupsessions,familyworkshopsandhand-outsthatchildrenattendingprogrammestakehomeeachweek.However,workingwithfamilieswhohaveyoungchildreninordertoimpactonphysicalactivityischallengingandthisisnotpurelyanissuerelatingtohealthpromotion.Earlychildeducationresearchhasshownsubstantialdifferences;inparticularengagingwithfamiliesdeemed‘hardtoreach’(OsgoodJ,AlbonD,AllenKandHollingsworthS,2012:‘EngagingHardtoReachFamiliesinEarlyYearsMusicMaking’.London:YouthMusic).Reasonsforlackofengagement(inC4Linparticular)maybethatprogrammestargetnumerousareasasopposedtohavingaspecificfocussothattheylackacleardirectionfortheintervention.Manyprogrammestargetparents.Giventhatyoungchildrenareknowntoengagewitharangeofdigitaltechnologiesfromanearlyageanddemonstratecompetenciesindoingso(LivingstoneS,MarshJ,PlowmanL,OttovordemgentshcenfeldeSandFletcher-WatsonB,2014:‘YoungChildren(0-8)andDigitalTechnology:AQualitativeExploratoryStudy–NationalReport–UK’.JointResearchCentre,EuropeanCommission:Luxembourg)itmaybeadvisabletoutilisetechnologiesverydirectlywithchildrenthemselvesasopposedtousingthemediumoftheirparents.Theroleofadvertisinginthequesttoimprovechildren’sphysicalactivitylevelsisamatterofongoingconcern.Therehasbeenopencriticismofsportandenergydrinksbeingmarketedtochildrenforawidevarietyofinappropriateuseswithanemphasisonhealthymovement.Thesheerscaleofthemarketingisastonishinginitself.Thetrendistoblendpsychologicalandbehaviouralinsightsand‘priming’occurswherethetwoitemsarelinked(e.g.abrandtoanathlete)orfollowinquicksuccession(e.g.Coca-ColaandtheOlympicTorchRelay).‘Familiarity’worksinthatthemoreweseeorhearofabrandthelikelierwearetorememberit,thusinfluencingpurchases.Finally,subliminalmessagesarethosewherebysponsors’logosandbrandingareflashedbeforethespectators’eyesattheactivityeventitself(Children’sFoodCampaign2012:‘TheObesityGames–junkfoodsponsorshipoftheLondon2012OlympicGames’,26thJulySustain.London).Thesepracticesarepotentfactors;influencingyoungchildrenand

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impactingupontheirviewofphysicalactivity.CommentsfromparentsmadeduringtheUKOlympicTorchRelayareinstructivehere:‘TherewasgreatexcitementhereinCornwall.NotsureCoca-ColagivingbottlestotoddlerswastheirgreatestPRstint!ItwasregularCoke…andtheyweregivingthemtoallagesfromtoddlersupwards.’‘SeeingminiCoca-Colabottlesbeinghandedouttochildrenbyadultsintracksuitsmademeangry’,(TheObesityGamesasabove).Socialmediaisusedrelentlesslytopromotesugarydrinkstochildren.TheHappyMealtoysaboutexerciseandactivityareviewedbymanyasatokenisticgesture.CurrentlyMcDonaldsisusingacharacterinitsHappyMealspromotiontoencouragechildrentobecomeactivebutthisappearstobemerelyacolouringsheet.Manyschoolshavebannedfoodindustrysponsoredvendingmachinesbutthisdoesnotapplytosportscentresornearbyplayingfields.Retailersareusingsportshallsinadrivetoproduct-placethesportsdrinknearwaterandjuices.Manyofthesportsdrinkcompaniesdenythattheyaremainlytargetingtheyoungpopulationwhenadvertisingbutstatistics,reportsandstudiesindicateotherwise.Fastfoodoutlets,ice-creamandburgervansoutsideschoolgatesareproblematic.Nurturingahealthyandactivelifestylebothforphysicalactivityandnutritionisessentialbut,astheRoyalSocietyforPublicHealthhasreported(2015December,Londonwww.rsph.org.uk)oneinfouryoungpeopleclaimtohaveorderedafastfoodtakeawaytotheirschoolviatheirmobilephone.Afterexercisetheyare‘starving’andmaketheorderinthisway,notevenbotheringtowalktotheshop.Youngchildrenaresubjectedtounacceptablemarketingpractices.TheWHOreportrecommendsthatpolicymustaddresstherealityofanobesechildhood,turningattentiontothejunkfoodanddrinkenvironment.Thefoodandbeverageindustryisassiduousincontributingtoprogrammespromotingphysicalactivity;forexample,theUKNationalTrustjoinedupwithCadburyduringEaster2017forchildrentoundertakearelativelysmallamountofexerciseat250venues;toberewardedwithachocolateegg.Therewasmuchcriticismoftheomissionoftheword‘Easter’inpublicity,butnomentionofthepromotionofphysicalactivitybeingrewardedbyacalorie-ladensnack!Coca-Cola‘sHappyPlaytimeinitiativehasbeenintroducedto700schoolsin19ChinesecitiesandfoodmanufacturerssponsorIt’sfuntobefitinthePhilippinesandMovimientoBienstarProgrammesinLatinAmerica(FrancoSassi,2012,‘ObesityandtheEconomicsofPrevention.FitnotFat’.EdwardElgarPublishingLtdUSA).Whatremainscertainisthatwithinthecontextofpromotingphysicalactivityforyoungchildren,thereisnopurposein‘turningbacktheclock.’Apps,socialmediaandadvertisingarefirmlyheretostaybutitisuptopublicpressureandpolicymakerstoensurethattheirinfluenceisbenignandpositiveratherthannegative,evendetrimentaltothecauseofhealthandwellbeing.Heretheactionsofthefoodanddrinkindustryandthepromotionalandsponsorshipconcernssurroundingelite,publicandlocalsportingeventsareasimportantasinitiativesfromhealthandeducationalexpertsandgovernmenthasaclearresponsibilitytofacilitatedialogueandjointwaysofworking.AsoutlinedinTheLancetin2010(‘Useofmassmediacampaignstochangehealth

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behaviour’,ProfMelanieAWakefieldPhDa,ProfBarbaraLokenPhDb,ProfRobertChornikPhDc,TheLancet,Volume376,issue9748,9-15October2010,Pages1261-1271):‘Weconcludethatmassmediacampaignscanproducepositivechangesorpreventnegativechangesinhealth-relatedbehaviouracrosslargepopulations’.Thisshouldberegardedbothinthelightofanaim–andasachallenge.Recommendations7.1 GovernmenttoreviewChange4LifeandStart4Lifeintermsoftake-upand

effectinglastingbehaviourchangewithaviewtoupdateordevisingnewandcoreresponsiveschemesinlinewithcurrentneed

7.2 LocalGovernmentAssociationtoworkinconjunctionwithpioneerorganisations(suchastheLondonBoroughofNewhamandMytimeActive)toproduceareadilyavailable‘directory’ofsocialmediaprogrammesandrelatedappsforuseinactivityplansforfamilieswithyoungchildren

7.3 DepartmentsofHealth,EducationandCulture,MediaandSporttoconveneapolicyforumwiththeadvertising,sportspromotionandfoodanddrinkindustriestochartapositivewayforwardforthepromotionofchildhealthandwellbeingviaphysicalactivity

7.4 Socialmediapromotionalmaterialrephysicalactivitytoincludegamesandappstargetedforaccessbyyoungchildrenaswellasseparatematerialsdirectedatadults.

8. THERELATIONOFPHYSICALACTIVITYTOCOGNITIVEANDACADEMICPROGRESS

Physicalactivitycontributestoneurologicaldevelopment(NeilsonCA,2000:Theneurobiologicalbasesofearlyintervention.InJPShonkoff,&SJMeisels(Eds)Handbookofearlychildhoodintervention(pp.2014-227)2nded,Cambridge:CambridgeUniversityPress),triggeringbiologicalresponseswithinmusclesandorganstomodifyandregulatethestructureandfunctionsofthebrain.‘Untilthebrainreachesabouttheageof7,thebrainisprimarilyasensoryprocessingmachine.Thismeansthatitsensesthingsandgetsmeaningdirectlyfromsensations.Ayoungchilddoesn’thavemanyabstractthoughtsorideasaboutthings;heisconcernedmainlywithsensingthemandmovinghisbodyinrelationtothosesensations.Hisadaptiveresponsesaremoremuscularormotorthanmental.Thusthefirst7yearsoflifearecalledtheyearsofsensorimotordevelopment.’(Ayres,AJ.2005:‘Sensoryintegrationandthechild:understandinghiddensensorychallenges’,25thanniversaryedition,LosAngeles,CA;WesternPsychologicalServices).Thekeyobjectiveofearlyyears’educationandphysicalactivitiesmustbetoencouragechildrentoachievegoodmultisensoryintegrationtoprogresstothenextstageintheirdevelopment–thisisacomponentofhumandevelopmentoverall.Thesearefoundationskillsforliteracyandnumeracyandifabsent,willrestrictaccesstoequallifeopportunities.Frombirthto8yearsofage,humansdevelopmotorsensoryintegration;

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thefoundationforallhigherlevelskilldevelopment.Learninguntilsevenoreightyearsofageisprimarilygroundedinactionandexperienceandchildrenneedtoutiliseallmotorskillsandsenseseachdayandtoreachapointwheretheyareproperlyintegrated.Theyandtheirparentsshouldbesupportedwithclearadviceonwhatspecificdevelopmentalrequirementsarenecessaryforchildrenandhowtoachievethem.Allstakeholdersshouldfocusonthesefundamentalgoalsandfoundationskillsdevelopmentshouldnotbecompromisedbyarushtoachievecomplex,higherskills.Evenmovementinveryyoungchildrenisimportantfromacognitiveperspective.Researchintoinfantactivity(upuntiltwoyearsold)hasconsideredtheirexploratorylocomotiveskillsandfindingssuggestthattheneedtoconstantlychangespeed,directionand/orcopewithcomplexsurroundingsmakesthemadaptive.Asaresult,theyacquirecognitiveflexibility(Adolph,KE.2006:‘Learningtolearninthedevelopmentofaction’.ReiserJJ,LockmanJJ,NelsonCA,editors.‘Actionasanorganizeroflearninganddevelopment’.Vol.Vol33.Mahway,NJ:LawrenceErlbaumAssociates;p.91-122;BergerSE,AdolphKE,2003:‘Infantsusehandrailsastoolsinalocomotortask’.DevelopmentalPsychology.39:594-605.{PubMed:12760526}).Executivefunction(ahigherordercognitiveskill)islinkedtothepre-frontalcortexwhichdoesnotmatureuntillateadolescence.Ithasbeensuggested(Best,JR2010:‘EffectsofPhysicalActivityonChildren’sExecutiveFunction:ContributionsofExperimentalResearchonAerobicExerciseDevelopmentalReview’,30(4):331-551)thatphysicalmovementdrivescognitivedevelopmentinpartbyrequiringchildrentouseflexibleandadaptivethoughtprocesses.Thereisarelativelackofcontemporaryresearchintophysicalactivityandcognitioninyoungerchildren(birth-sevenyears)despitethefactthatatthistime,thebrainisexperiencingmajordevelopment.Themajorityofstudiesfocusonchildrenagednineandabovebutthereissomevaluablework,includingbyFisher,BoyleandPaton(‘2011:Effectsofaphysicaleducationinterventiononcognitivefunctioninyoungchildren:arandomizedcontrolledpilotstudy’.BMCPediatrics,Vol.11,No.97)demonstratingthatintensivephysicaleducationimpactedpositivelyonspatialworkingmemory,spanandaccuracyderivedfromapilotstudyofsixyearoldboys.Inonehistoricallongitudinalstudy(ShephardRJ,VolleM,LavalleeH,LaBarreR,JequierJC,RajicM.1984:‘Requiredphysicalactivityandacademicgrades:acontrolledlongitudinalstudy’.ChildrenandSport,Ed:IImarinenJ,Valimakil,Berlin:SpringerVerlag,58-63)researchersfoundthatacohortofchildrentakingfivehoursofphysicaleducationinaweekwerehigherachieversacademicallythanacontrolgroupofchildrenwhoonlyreceived40minutesofPAperweek.Moreover,someoftheextratimeforphysicaleducationwastakenfromthemathematicsclassallocationandyetthechildrenintheexperimentalgroupreturnedhigherscoresinmaths.AfurtherstudyofyoungerchildrenthathashighlightedthebenefitsofphysicalactivityistheEarlyYears’SwimmingResearchProject(JorgensonR,2012,‘EarlyYears’Swimming:AddingCapitaltoYoungAustralians-InterimReport’.GriffithsInstituteforEducationalResearch,MtGravattCampus,GriffithsUniversity).Inthisstudy,three-fiveyearoldswhoregularlyattendedearlyyears’swimmingschoolwereassessedforphysical,cognitiveandlanguagedevelopmentagainstnonswimmers.Theswimming

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groupperformedmarkedlybetterinteststhanthecontrols,evenaftercontrollingforsocioeconomicstatus.MytimeActiveconsidersphysicallyactivelearningtobea‘goldenthread’runningthroughalltheirsuccessfulMENDprogrammes.Whetherlightphysicalactivitysuchasstandingupandmovingaroundaroominaworkshop,orundertakingsomethingmoremoderatetovigorousduringpracticalphysicalactivitysessions,theMENDapproachfullyembracesactivelearning.ItissupportedbyaUKstudypublishedbytheDepartmentofEducation(GutmanLandVorhausJ201:‘TheImpactofPupilBehaviourandWellbeingonEducationalOutcomes’,London:DfE)findingthatpupilwellbeingpredictedtheirlateracademicprogressionandengagementinschool.Forexample,pupilswithbetteremotionalwellbeingagedsevenhadavalue-addedKeyStage2score2.46pointshigher(equivalenttooneterm’sprogress)thanpupilswithpooreremotionalwellbeing.AdvocatesoftheDailyMileinitiativemakesimilarclaims;citingasdirectoutcomes,improvedconcentrationintheclassroomandbettermoodandsocialrelationshipsresultingintransformationalchangeinthephysical,mentalandemotionalhealthandwellbeingofallparticipants.ThisisendorsedbyDrKayBrennan,SportsandExerciseMedicineDoctor,GPandPhysicalActivityClinicalChampionforPublicHealthEngland:‘Thelinkbetweenphysicalinactivityandobesityinchildreniswellestablished.Oneintenchildrenisobesewhentheystartprimaryschoolandonly21%ofboysand15%ofgirlsaged5-15inEnglandtakethephysicalactivitytheyneedforgooddevelopment.Beingphysicallyactivewill…improveachild’sselfesteem,bodyconfidence,sleepandconcentration.Wealsoknowfromlargestudiesthatthereisastronglinkbetweenbeingphysicallyactiveandimprovedacademicachievement.’Whenfreephysicalmovementandopportunityblossoms,unfetteredbytheinterruptionsofwell-meaningadults,anindependenceoflearning(fuelledbyselfmotivationandconfidence)developswherebychallengesthatarewellmatchedtochildren’sindividualinterestsandabilitiesareestablished.Aswellasmakingessentialconnectionswithinlearning,integratededucationalenvironmentsencompassingindoorandoutdooropportunitiesarevitalasincludedwithintheEarlyYearFoundationStageFramework.Correlationbetweenphysicalactivityandacademicachievementisevidencedinolderchildren(thechildrenintheDwyer,Sallis,Blizzardetal.studyareaged10-11yearsandtheCalifornianDepartmentofEducationreportconsiderschildrenfromthatagegroupupwards)throughmanymulti-nationallongitudinalstudies:

• Dwyeretalnotedacorrelationbetweenscholasticachievementandphysicalfitnessandgeneralactivitymeasureswhenlookingat8,000Australianchildren(DwyerT,SallisJ,BlizzardL,LazarusR,&DeanK,2001:‘Relationofacademicperformancetophysicalactivityandfitnessinchildren’,PediatricExerciseScience,13,225-237)

• Theevaluationofover1millionCalifornianchildren’sscoresofphysicalfitnessandlanguageartsandmathematicsproficiency(CalifornianDepartmentofEducation2005)foundsignificantpositiveassociationsbetweenscholasticachievementandphysicalfitnessandgeneralactivitymeasures

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• TheThreeRiversProjectinQuebecanalysedtheacademicgradesof546childrentorevealthatthosewhowereactiveperformedbetterthancontrolgroupchildren(Shephardetalasabove).

Systematicreviewsofsedentarybehaviourandhealthindicatorsintheearlyyearsdonotshowthatscreentimebenefitseithercognitivedevelopmentorpsychosocialhealth.Instead,itisflaggedupratherasacopingstrategy(CarsonV,ClarkM,BerryT,2014:‘AqualitativeexaminationoftheperceptionsofparentsontheCanadianSedentaryBehaviourGuidelinesfortheearlyyears’,IntJBehavNutrPhysAct2014;11:65.doi:10.1186/1479-5868-11-65)withstressedparentslesslikelytotime-limitscreenviewing.Asmostresearchconcursthatitisvolumeratherthancontentthatismorelinkedtothemultiplehealth,psychosocialanddevelopmentaladverseeffectsofinappropriatescreentime,alternativestrategiespromotingthepotentialgaintofamiliesofexchangingthescreenformoreactivepursuitsmustbeoffered.Thereisalsoasubstantiallackofresearchwithyoungerchildren(upto7-8)inthematterofcorrelationbetweenphysicalactivityandscholasticachievement.Sedentary-reliantbehaviours,enhancedwithexcessivescreenuse,beginataveryyoungage(WuX,TaoS,RutayisireE,ChenY,HuangKandTaoF.2017:‘Therelationshipbetweenscreentime,night-timesleepduration,andbehaviouralproblemsinpreschoolchildreninChina’,EuropeanChild&AdolescentPsychiatry,Volume26,Issue5,pp541-548.doi:10.1007/s00787-016-0912.8)andtranslateintoadultissueslateron(HancoxRJ,MilneBJandPoultonR.2004:‘Associationbetweenchildandadolescenttelevisionviewingandadulthealth;alongitudinalbirthcohortstudy’,Lancet364(9430):257-262.doi:10.1016/S0140-6736(04)16675-0).ArecentChinesestudy(above)consideringtheconnectionbetweenscreentimeandbehaviouralproblemsevaluatedtheactionsof8900childrenagedbetweenthree–sixyearsold.Afteradjustmentforpotentialvariants,thosewithtwoormorehoursofscreentimeperdayexhibitedasignificantriskofemotionaldifficulties,conductproblems,hyperactivity,peerandprosocialproblemsaswellassomesymptomsontheautismspectrum.WhilstevidencehasbeenusedtoinformmultinationalguidelinesthroughoutAustralia,CanadaandtheAcademyofPediatrics(AAP),advocatingthatchildrenyoungerthantwoshouldengageinnorecreationalscreenuse-andthoseagedthree-fiveyearsofageshouldparticipateinonehourorlessperday(AustralianDepartmentofHealthandAging2006;Tremblayetal,2012;AAPCommitteeonPublicEducation,2001)nosuchguidelinesexistintheUK.Therefore,parentsarelikelytobelievethattheirownchildren,unlikethoseoftheirfriendsandacquaintances,donothaveexcessivescreentimehabits.Guidelinesalonewillnotsolvetheproblemofchildren’sexcessivescreenusagebutcombinedwithwellresearchedandsupportedrecommendationscouldmakeadifference.However,theyshouldbetargetedatspecificaudiencesandsettingsandaccompaniedbyrealisticresourcingandinfrastructure.Whatiscertaininthisscenarioisthatnoguidelineswhatsoeverisapoorstartingpointandthisshouldberemediedbygovernmentattheearliestopportunity.Ifwearetorealisethepotentialofphysicalactivityasacontributortochildren’sneural,motor,cognitiveandsocialdevelopment,actionmustbeginearly.Studiesofolderchildren(typicallyseven-fifteenyearsofage)arevaluable,butmuchmoreresearchisneededintopatternsofthepre-schoolchild.Recognisingtherelativelackofevidencein

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thisarea,Cliff,McNeil;etal(‘ThePreschoolActivity,Technology,Health,Adiposity,BehaviourandCognition’,(PATH-ABC0cohortstudy:rationaleanddesign,BMCPeidatrics,17:95.doi10.1186/s12887-017-0846-4)haveinitiatedanewstudywithchildrenagedthree-five.Takingasitsbackground,internationalestimatesofphysicalactivity(andincreasingsedentarybehaviour)andlevelsofscreen-basedentertainment(television,computer,tablet,phone)inpre-schoolchildren,thePATH-ABCstudyseekstodiscoverhowthesefactorsindependentlyinfluencehealthoutcomesandpsychosocialandcognitivedevelopment.Thestudyaimstotrackbehaviourandoutcomesin430childrenwithphysicalactivitybeingmonitoredperiodically,whilescreen-basedentertainmentwillrelyonparentalreporting,withoutcomestobeprovidedviaanumberofcognitiveandhealthmeasures.Withevenyoungchildrenappearingtobecomemoresedentary,suchresearchcouldhaveimportantconsequencesinprovidingtheinformationthatparents,educatorsandhealthprofessionalsneed,toencourageandsupportchildrentobecomephysicallyactiveandtochooseappropriateenjoyableactivitiesthatsuitthem.Physicalactivitybenefitsthewholechildandthencethewholeperson.Itisthencrucialthatitisembeddedintothehabitualprocessesofearlylifesothatitbecomesawayoflifefromtheoutsetandremainssothroughoutthelifespan.Recommendations:8.1 ANationalCurriculumframeworkthatendorsesoutdoorplayand

learningandaninspectionsystem(Ofsted)thatchallengesitsineffectivedelivery

8.2 TheNationalCurriculumtoincludeexamplesofhowphysicalactivitycontentcanbeincludedwithintheclassroomaspartoftraditionallearningfromearlyyears’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/PHYSICALDISABILITY

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Physicalactivityisrelevanttoallchildrenwhethertheyhaveastatementofneedornot.Theyallrequiresupportandopportunitytodevelopmotorskillsandembodiedcognitionatthehighestlevel;ideallyallshouldbeabletoachievemotorsensoryintegrationandcontinuedevelopingfullybeyondthat.Forafewchildrenwithfundamentaleducationalanddevelopmentalblocksthiswillnotbepossible,buttheyshouldbeabletoaccessphysicalactivitiestomaximiselifelongcognitiveandphysicalskills.Toofrequently,childrenwithlearningdifficultiesaresidelined-programmesofdevelopmentallyappropriatedailyphysicalactivitiesshouldbeeveryone’sright.Engagementinphysicalactivityduringchildhoodisnecessaryforhealth,qualityoflifeandwellbeingforall,whethertheyhaveadisabilityornot(SportEngland,‘TowardsanActiveNation’,2016).Intheearlyyears,PAaffordsopportunitiesforwhole-childgrowthincludingahealthyweight,braindevelopment,improvedsleep,relationshipformation,movementco-ordinationandbone/musclestrength(SportEngland,2011StartActive,StayActive:‘Areportofphysicalactivityforhealthfromthefourhomecountries’,ChiefMedicalOfficers)andispartofachild’seducationalprocesses.6%ofUKchildrenhaveadisability,wherebythereisaphysicalormentalimpairmentthathasasustained,long-termadverseeffectontheircapacitytoperformnormaldailytasks.TheWorldHealthOrganisation(WHO)(InternationalClassificationofFunctioning,DisabilityandHealth(ICF)Geneva:2001)regardsdisabilityasthreedimensional;eachcomponentcontributingtolimitedPA,eitherdirectly,viaskeletalfunctionsorsocialandenvironmentalfactors:

1. Impairmentinaperson’sbodystructureorfunction,ormentalfunctioning;examplesofimpairmentsincludelimbloss,visionlossorlossofmemory

2. Activitylimitation,suchasdifficultyinseeing,hearing,walking,orproblemsolving

3. Participationrestrictioninnormaldailyactivities,suchaswalking,engaginginsocialandrecreationalactivities,andobtaininghealthcareandpreventiveservices.

TheUKfollowsglobalrecommendationforPA;broadlyalignedbytwodevelopmentalstagesforearlychildhood.TheNHSpromotesthefollowing:http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-young-people.aspx

• 0-5years:Childrenshouldpartakeinaminimumof3hoursofphysicalactivityperdaywithminimalperiodsofinactivity

• 5-7years:Fiveyearoldsshouldbeactivefor60minutesdaily.Withintheserecommendations,nospecificguidelinesaregivenforchildrenwithdisabilitiesasthecomplexityofphysicalandmentalimpairmentsmakesgeneralisationdifficultalthoughthebroadconsensusisthatanyPAisbetterthannone.CurrentadviceisforpeoplewithadisabilitytofollowbroadPAguidance,withappropriateadaptationsmadeaccordingtoneedandcapacity(StartActive,StayActive:‘Areportonphysicalactivityforthefourhomecountries’ChiefMedicalOfficers,2011).

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‘Wheneverpossible,childrenandyouthwithdisabilitiesshouldmeettheserecommendations.However,theyshouldworkwiththeirhealthcareprovidertounderstandthetypesandamountsofphysicalactivitythatareappropriateforthemconsideringtheirdisability’,(WHO2010GlobalRecommendationsonPhysicalActivityforHealth).IntheUK,thereisnoroutinediagnosisbyeliminationforchildrenwithphysicaland/ormentaldisabilities.Neitheristhereidentificationoftherootcausesoftheirdifficultiesandtherefore,distinctionbetweenproblemsthatcouldbecorrectedthroughtherapy,i.e.improvementstotheenvironment(Learning,AssessmentandNeurocareCentrelimited,2017):http://www.lanc.org.uk/educational-psychology-assessment-adhd-asd/andthosethatarenotcapableofchangebecausetheyaretheresultoffundamentalneurologicalorphysicaldifferences.Thecurrentpositionisthat:

• Therearenospecificgoalsformotorskillsdevelopment• Therearenoroutinechecksofbinocularvisionorvisualprocessing• Therearenoroutinechecksofsoundprocessing,eveninchildrenwithspeech

andlanguagedelays• ThereisnoPhysicalEducationcurriculumforallchildrenlinkedindetailtothe

developmentalneedsofthechildandhowthatinturnlinkstocognitivedevelopment.

Healthworkersandteachersarenotdefinitivelytrainedinthechainofchilddevelopment.Thereisnosharedrecognitionthatmotorsensoryintegrationshouldbeachievedinorderforapersontoaccesshigherlevelcognitiveskills.15.4%ofpupilsinEnglishschoolshaveidentifiedspecialeducationalneeds(equatingto1,301,445pupils).Thishasbeendecreasingsince2010(21%)representingafallof205%since2016.ThedeclineisduetoadecreaseinSENwithoutastatementorEducation,HealthandCare(EHC)plan.2.8%ofschoolpupilsinEnglandhaveSENstatementsoranEHCplan(equatingto236,165pupils).Thefigurehasremainedat2.8%since2007(DfESpecialeducationalneedsinEngland:January2015).EducationHealthCarePlanscanbeprocess-adversarial;oftenrequiringparentswithstaminaandotherresourcestopursuetheirchild’sinterests:https://www.mumsnet.com/onlinechats/sen-legislation-changes-jane-mcconnellandthesystemhasworsenedasfinancialcutshavereducedfundingallocationstochildrenwithidentifiedneeds.IfstatementedbyanEducationalPsychologist,achildmaybereferredtoanOccupationalTherapist,aSpeechandLanguageTherapistandor/variousotherprofessionals,possiblyincludingvisiontherapy.SoundtherapyisrareintheUKandaholisticunderstandingoftheneedsofthechildismissing;howtheyinter-relateandSMARTtargetsforimprovement.5yearsoldsarebeingmedicatedfor‘behavioural’problems;theywillstillhaveentirelycorrectabledifficultieswithmotorskills,soundprocessingandvisionwhichnobodywillbesystematicallyaddressing:‘TherewasamarkedincreaseinADHDdruguseamongstchildrenintheUKfrom1992untilaround2008,withstablelevelsofusesincethen.UKchildrenshowrelativelylong

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persistenceoftreatmentwithADHDmedicationscomparedtoothercountries’,(RaphaelleBeau-Lejdstrom,IanDouglas,StephenJWEvans,LiamSmeeth:‘LatesttrendsinADHDdrugprescribingpatternsintheUK:prevalence,incidenceandpersistence’,EpidemiologyResearch,BMJOpenAccess;June2016–Volume6Issue6).Childrenwhoarelookedafterexperiencehighlevelsoflearningandbehaviouraldifficulties:‘In2016,57.3%ofchildrenlookedafterhadaspecialeducationalneed,comparedto46.7%ofchildreninneedand14.4%ofallchildren’,(‘DfEoutcomesforchildrenlookedafterbylocalauthoritiesinEngland’,31stMarch2016SFR12/2017).ThereisnoprogrammetoensurethatallchildreninCareorinneedcanaccessgoodmotorskillcontrol,soundprocessingorstereopsisofvision.TrendsacrosschildhoodasawholeindicateapatterntowardsinactivityratherthanmovementwithUKchildrenbeingtheleastactivegenerationtodate,placingyoungpeopleatincreasedriskofexperiencingphysical,mental,andsocialandhealthchallengesthroughoutthelifecourse.Youngdisabledchildrenarepresentedwithvariousadditionaldailychallengesconcerningaccessibility(Natalie,Camejo,Asfour,Unlhorn,DelamaterandMessiah2017:‘PromotingHealthyWeightAmongChildrenWithDevelopmentalDelays:JournalofEarlyintervention’).ArecentsystematicreviewintoPAparticipationfordisabledchildren(Ross,Bogart,Logan,Case,FineandThompson2016:‘PhysicalActivityParticipationofDisabledChildren:ASystematicReviewofConceptualandMethodologicalApproachestoHealth,FrontiersinPublicHealth’)recognisedthattraditionalviewshavebeenviewedthrougha‘medicalmodel’prismwiththe‘health’ofanindividualbasedontheabsenceofillnessandbodilyimpairments.ApurelymedicalapproachtoPAmakestheinherentassumptionthatitisphysiologicalorfunctionaldeficitsalonethatpreventchildrenfrombeingactiveparticipants.SuchviewsaboutthevalueofPAforyoungdisabledpeoplecanleadtoareducedexposuretowiderphysical,socialandpersonalexperiences.Aglobalchangeinthinkingisrequiredtounderstanddisabilityfrombeyondamedicalperspective,recognisingthewidefinancialandcommunity,socialandpsychologicalbarriersthatinhibityoungdisabledpeoplefrombecomingmoreactive.Whatresearchconsistentlyshowsisthatchildrenwithspecialhealthcareneedsandpsychiatricdisordershavehigherratesofhealthrelatedfactorssuchasobesity,versusthosewhodonot;indicatingthattheneedforincreasedlevelsofPAishigheramongstthispopulationthanforchildrenwhoarenon-disabled.Inparticular,theimportantplaceofPAhasbeenhighlightedforchildrenwithautismspectrumdisorder,attentiondeficithyperactivitydisorderandlearningdisabilities(Chen,Kim,Houtrow&Newacheck,2010‘PrevalenceofObesityamongChildrenwithChronicConditions’,Obesity).Themostcommonofallchildhooddisabilities,CerebralPalsy(CP)alone,presentsextremelycomplexchallengesforthoseparticipatinginPA.ACPregisterreviewidentifiedthatforchildrendiagnosedwiththeconditionatage5,3in4wereinpain;1in3couldnotwalk;1in3hadhipdisplacement;1in4couldnottalk,1in4hadepilepsy;1in4hadabehaviourdisorder;1in4hadbladdercontrolproblems;1in5hadasleepdisorder;1in5dribbled;1in10wereblind;1in15were

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tube-fedand1in25weredeaf.ItislikelythatchildrenwithCPwillexperiencetheirconditiondeterioratingwithageandmanywillencounterotherhealthchangesovertime(Novak,Hines,GoldsmithandBailey2012:‘ClinicalPrognostic:MessagesfromasystematicreviewonCerebralPalsy’.AmericanAcademyofPediatrics).AsPAlevelsamongstthegeneralpopulationdecreasewithage,embeddinggoodhabitsfromearlychildhoodisessential.Theprojectionforyoungdisabledpeopleastheymovetowardsadulthoodisworryingbecausethenumberofimpairmentsapersonhasisdirectlylinkedtooverallinactivityovertime.Additionally,aGovernmentreportidentifiedthatthosepeoplewithadisabilityarelesslikelytoengageinsportorculturalactivitiescomparedwithnon-disabledgroups(HMGovernment,‘SportingFuture:ANewStrategyforanActiveNation’,2015).IntheUK,only36%ofadultswiththreeormoreimpairmentsareactivecomparedwith65%whoarenon-disabled.Afurthercomplicationisthelikelihoodthatyoungpeoplewithexistingunderlyinghealthissuesanddisabilitiesarealsofromlowsocioeconomicbackgroundsorliveinpoverty(‘MovingtheGoalPosts:PovertyandAccesstoSportforYoungPeople’,2015;StartActive,StayActive,2011)meaningthataccess,affordability,opportunityandsafespacesinwhichtoplayformextrabarrierstoachievingahealthyandactivelifestyle.USPAguidelinesandSportEnglandsuggestthataunifiedapproachtoPAacrossthehomeandwidercommunitycanassistpeoplewithdisabilitiesbyimprovingthecapacitytocarryoutdailylivingactivitiesandboostingindependence.ThiscanleadtoimprovedautonomyandsocialinteractioninadulthoodaswellasreducingriskofchronichealthconditionslikeCoronaryHeartDisease,Cancer,MentalHealthDisordersandDiabetesinadditiontopre-existinghealthconditions:https://www.cdc.gov/features/physical-activity-disabilities/index.htmlInterventionsforPAandmotordevelopmentwithinearlychildhoodhavedemonstratedapositiveoutcomeonchildren’sphysicalexperiences.Theschoolenvironmentcanofferspecialistinterventionsforchildren,focusingontargetedmotordevelopmentprogrammesleadingtoincreasedmotorcontrol,participationandconfidence(BlackandDavies199:‘AnActivity-BasedApproachtoPhysicalEducationforPreschoolChildrenwithDisabilities:AdaptedPhysicalActivityQuarterly’).Since2014,TheYouthSportTrusthaveestablishedanetworkof60leadinclusionschoolstosupporttheprofessionaldevelopmentofteachersinhelpingyoungpeoplewithspecialeducationalneedsanddisabilities(SEN/D)inandthroughPEandschoolsport.YSThasalsodesigned‘ProjectAbility’toimproveandadvanceschoolprovisionforSEN/Dpupilstoparticipateinsportthroughintraandinterschoolcompetition.HoweverinarecentreportexaminingtrainingofprimaryteachersinEngland(Randall,Richardson,SwaithesandAdams,2016GenerationNext:‘Thepreparationofpre-serviceteachersinPrimaryPhysicalEducation’)itwasidentifiedthatmanynewteachersfeelneitherconfidentnorcompetenttosupportchildrenwithcomplexphysical,healthorlearningneedsduringcurriculumtime.ThereportrecommendedthattheteachingofinclusivePEshouldbecomepartofcorecontentcurriculumteachertrainingforallprimaryteachersandthemostrecentlyrevisedOfstedITTtraininghandbookhassaidthatallprimaryteachersduringtheirtrainingshould:‘Teachphysicaleducationanddemonstrategoodsubjectknowledgeandteachingstrategies,includingforpupils/learnerswithspecialeducationalneeds’,(2015).

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ThePrimaryPEcurriculuminEnglandhasmovedtowardsoutsourcingprovisionwherebyalargenumberofexternalcompanieswithoutqualifiedteacherstatusandwithminimumexperienceofworkingwithyoungpeoplewhohavecomplexhealthanddisabilityissuesaredeliveringstatutorylessons.Youngpeople’searlyexperiencesofPA,PEandschoolsportcanhavelastingeffectonlaterattitudestowardsbeingphysicallyactiveadolescentsandadults.Thereforetheschoolsandwidercommunitiesresponsibleforchildcareandeducationforearlyyear’schildrenrequireahighlyskilledandqualifiedworkforce,capableofsupportingarangeofthosewithdisabilitiestoaccessdailyPA.Physicalactivityforyoungpeoplemustbeaddressedinthebroadestsenseofengagementandparticipation,recognisingthatthebreadthofindividualinvolvementcanrangefromandembracemotorskilldevelopment,play,physicalindependence,games,sportandPE.Recommendations: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. THELEGISLATIVEWAYFORWARDINTHEPROMOTIONANDEXPANSIONOFPHYSICALACTIVITYPROGRAMMESANDTAKE-UPFORALLCHILDRENINTHEUK

Childhealthandwellbeingiskeytoanynation’sfutureandmustbeprioritisedbyallstakeholders;primarilygovernment.Policyandinitiativesmustberealisticallyresourcedandshouldalsobeholisticandcapableofwidespreadapplicationand

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adaptation.Withthisinmind,itisusefultodescribetheprogressto‘mainstreamthinking’ofoneidea,TheDailyMile,describedearlierinthisreport.TheDailyMileFoundationhasheldtalkswithUKMinistersaboutestablishingTheDailyMileasanintegralpartofhealthandwellbeinginitiativesinnurseriesandprimaryschools.InAugust2016,itbecametheonlyschemeofitskindtoberecommendedintheGovernment’sChildhoodObesityStrategy.ThisledtoconsiderationoftheinclusionofTheDailyMileaspartofa‘healthyratingtoolkit’forusebyheadteachersinEngland.ThoughthasalsobeengivenastohowsomeoftheadditionalPrimaryPEandSportPremiummightbespenton,forexample,installingall-weatherDailyMileroutesinschools.TheDailyMilehasbeenvariouslyintroducedintoEnglishschools;includingviaCountySportsPartnerships(CSPs),LocalAuthoritiesandtheNHSClinicalCommissioningGroups(NHSCCGs).ThetendencyhasbeenforEducationandHealthtoagreejointimplementationandforPE/sporttoprovidedirectsupporttoschools.InEssex,CheshireWestandSurrey,theCSPsActiveEssex,ActiveCheshireandActiveSurreyhavebeenpivotalinthedeliveryandqualitycontroloftheprogramme.Examplesofsuccessfulregionalimplementationinclude:

• TheNHS(ClinicalCommissioningGroup),PublicHealth(LocalAuthority)andActiveCheshire(CountySportPartnership)arealsoworkingincooperationtoboosthealthandwellbeinginnurseryandprimaryagedchildrenintheCheshireWestregion.ActiveCheshirehasleadonschoolengagement,thesupportfordeliveryandthequalitycontrolofthatprogramme

• WiganCouncilprovidesanexcellentexampleoffullcollaborationbetweentheDirectorsofEducation,PublicHealthandLeisureServicesresultinginschoolsandnurseriesrunningTheDailyMileincreasingfrom4-53inamatterofmonths

• NHSManchesterandGreaterSportaredevisingahealthplanfortheCityof(andGreater)Manchesterregion,inwhichTheDailyMilehasbeenincludedasakeycomponentofnurseryandprimarystrategy

• HertfordshireCountyCouncilaimstorolloutTheDailyMiletoallprimaryschoolsacrossthecounty.32schoolshavealreadysignedupwith25morepledgedtolaunchsoon.

ThispartnershipapproachhasledtoeveryLondonBoroughhavingatleastoneschooladoptingTheDailyMileandmanywithmorethanoneschool.SomeofthepoorerBoroughshavefoundthatitallieswellwithattemptstoofferinclusivehealthsolutionstoeverychild.LewishamPublicHealthhasincorporatedTheDailyMileasanintegralcomponentofstrategytotacklechildoverweightandobesityandtoencouragephysicalactivity.TheDailyMilecontinuestoengagewiththeGovernmenttoexplorewaysofsupportingitscontinuedgrowthacrosstheUK.Atthedevolvedlevel,TheDailyMileFoundationhasworkedwithpolicyleadersinHealthandEducationtoassistwithregionaleffortstoimplementitinprimaryandnurseryschoolsUK-wide.InMarch2017,TheDailyMileWales(Cymru)waslaunchedandtheFoundationhassubsequentlyworkedwiththeWelshGovernmentandPublicHealthWalestorollouttheschemeviatheHealthySchoolsNetwork.InJanuary2017,

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theWelshGovernmentwrotetoallprimaryheadsinWalesencouragingthemtoconsiderinnovativeandsimpleapproachestoimprovethehealthandwellbeingofchildrenduringtheschoolday-includingadoptingTheDailyMile.InsupportofthenewWelshcurriculum,thisprogrammesupportsprimaryschoolstoincreasechildren’sphysicalactivitylevelsandhelptosafeguardpupilwellbeingwhilstworkingtowardscurriculumimplementation.Alarge-scaleroll-outofaninitiativelikethisrequiresastrongcommunicationsstrategy.TheDailyMileFoundationmonitorsandgrowsitsfollowingofDailyMileschoolsprincipallyviaawebsite:www.thedailymile.co.ukandsocialmedia(Facebook/Twitter).ThesedigitalplatformscontaininformationandresourcesthatarefrequentlydevelopedandupdatedbytheFoundation,toprovideguidanceforschoolsandteachersonhowbesttoimplementandsustaintheprogramme.Further‘bestpractice’issharedacrossthenetworkofDailyMileschools,andinformationisprovidedabouthowtheinitiativebenefitschildren’sphysical,mental,socialandemotionalhealthandwellbeing.ManycountriesinScandinaviaandEasternEuropehaveestablishedearlyyears’programmes,specificallyaimedatmaximisingchildren’sphysicalandemotionaldevelopment(EuropeanParliament,QualityinEarlyChildhoodEducationandCare,2013.PolicyDepartmentStructuralandCohesionPolicies).FormulationofsuchdetaileddevelopedpolicyisneedintheUKwherechildrenshouldallhavetheopportunitytoachievemotor-sensoryintegration,inorderthattheycanprogresstoachievehigherlevelskills(Dionne-Dostrietal,Multisensory‘IntegrationandChildNeurodevelopment’,BrainSciences2015Mar:5(1):32;Gorietal,‘YoungChildrendonotintegratevisualandhapticforminformation’,CurrBiol,2008;18(9):694-8;Nardinietal,‘DevelopmentofCueIntegrationinHumanNavigation’,CurrBiol.200818:689-693).Motorsensoryintegrationisdependentuponadailyactiveeducationforallchildrenwherevertheylivewithopportunitytodeveloptheirmotorskillsthroughawell-structuredPhysicalEducationprogrammewithemphasisuponthefollowing:

• Posture• Grossmotorskillcontrol;developmentofprimaryreflexes• Finemotorskillcontrolincludinguseofhands,feetandfacialmuscles• Learningtouseeyesefficientlyatallpoints• Activitiestopromotemotorsensoryintegrationincludingmusic,movement,

dance,buildingandundertakingobstaclecourses.Awellintegratedprogrammetoboostmotorsensoryintegrationshouldalsoincludeactiveparticipationinmusicalactivity,artanddesign,aerobicexercise,speech,drama,tryingaforeignlanguageforthedifferinglinguisticmovements,self–calmingactivities,cookingandnutritionandhavingaccesstoawidevarietyofplaygroundopportunities.Allchildrenshouldbeformallyassessedat7yearsofageformotorskills,motorsensoryintegration,soundprocessingandbinocularvisionwithmeasuresinplaceforreassessmentifprogressinanyoftheseareasiscauseforconcern.GovernmentshouldalsoensurethatthisassessmentprocessisappliedtochildreninCare,needandtheyouthoffendingsystemandphysicalactivitypatternsofbehaviourbothathomeandin

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institutionsshouldbepromoted(TheDailyTelegraph,3rdMarch2017):http://www.telegraph.co.uk/news/2017/03/03/people-learning-disability-treated-second-class-citizens-has/Policymakersshouldbealerttothetrainingneedsofteachersandhealthprofessionals(toincludetheirownmotorsensoryeducation)andalsothedesignofbuildingsandequipmentthatwillpromote,ratherthaninhibit,physicalactivityandbodilyconfidence.Allpeopleinvolvedasprofessionalswithanyaspectofchildren’slivesrequirededicatedtrainingsothattheyunderstandthekeystagesinchilddevelopmentandhowtheythemselvescancontributetochildren’scognitiveandemotionalprogressionwitheffortsmadetoboostdevelopmentthroughregularphysicalexercisesandactivities.Inconjunctionwiththis,physicaldevelopmentchecksshouldformpartofanygeneralassessmentofachild’smentalorphysicalhealthandchildrenshouldnotbemedicatedforbehaviouralproblemsbeforeallotherissueshavebeeneliminated.Stakeholdersandteacherswhoareinvolvedinthedesignandlayoutofclassroomsrequiretraininginhowthebuildingandfurnituredesigncanimpactuponachild’sdevelopingphysiology.Inaddition,allpolicymodificationshouldembedsupportthatparentsandcarerscanaccesssothattheycanensurethattheirchildren,whatevertheirfamilyandlivingcircumstances,candeveloptheirpotentialtothefull.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:GOODPRACTICECASESTUDIESLackofphysicalactivityisbi-directionallylinkedwithobesityandasingle‘catch-all’approachsimplyencouragingmoreactivitywillnotofitselfpreventchildrencarryingandmaintainingtoomuchweight(NHSChoices2014Obesity-causes):http://www.nhs.uk/Conditions/Obesity/Pages/Causes.aspxSustainedinterventionsareneededatallsocietylevels,fromcommunitiesthroughtogovernments,privateorganisationsandnon-governmentalbodies.Obesity-relatedrisk

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factorsareembeddedinsociety’sframework,influencedbymanyareasofnationalpolicy.Ifchildrenaretobemorephysicallyactive,thepromotionofsocialchangeisnecessaryandanimportantleverisstrongevidence-basedcommunicationgeneratinghealthiercommunities(RobertWoodJohnsonFoundation2009:‘BattlingchildhoodobesityintheUS:AninterviewwithRobertWoodJohnson’sCEO’.March).ItisdisturbingthatyoungchildrencanspendoversixhourswatchingTV,videogamesandusingmobilephonesandtheMillenniumCohortStudyfoundthatmorethanhalfofthe12,556childrensampledhadatelevisionintheirbedroomatageseven.Theywerealsomorelikelytobeoverweight(TheTimes2017:‘BedroomTVincreasestheRiskofChildObesity’,3rdJune).Moreevidencemustbegatheredandwellevaluatedtoestablishhowtogetchildrenmovingandoffthesofa.However,cautionhasbeenraisedaboutself-reportedstatisticsonphysicalactivitywhichcanoverestimatetheamountofmovement.Thequalityandreliabilityoftheactivityalsodemandsclosescrutiny.Concernshavebeenraisedrecentlywithregardtothefundingofsuchresearchandwhetherthereisevidenceofvestedinterests.Thisisconsideredtobeagrowingproblembyacademia.However,noneofthisdetractsfromthekeymessage;childrenaremeanttomoveandatpresent,theyarenotmovingenough.Whentheyleaveprimaryschool,athirdofUKchildrenareoverweight,andwearegradually‘normalising’obesityandforgettingwhatahealthychildlookslike.Parentscomparetheirownchildrentothechildrenoftheirfriendsandrelativesandifextremecasesofobesityarethereferencepoint,noactiononfoodintakeorphysicalactivityistaken.DrAngelaJonesofNewcastleUniversityhasdevelopedawebinterventiontoshowparentshowtheirchildrenwithhighBodyMassIndexwouldlookasadults;tappingtherebyintoparentalconcerns.Manywereshockedandtookremedialactiononfoodandactivity.However,otherparentsholdtheopinionthat‘obesityisarealproblem–forothers,’(TheTimes2017:‘VirtualImagesofFatChildrenShockParents’).Ahigherpriorityshouldbegiventoactivitylevelsoutsidetheschoolgates.ProfessorNickWarehamhasclaimedthatmuchphysicalactivitydeclineoccursoutofschoolhoursandatweekends.Itissignificantthat30%ofchildrenlivingwithin2kmoftheschoolaredriventhereeveryday.DrWilliamBirdhashighlightedPrimaryCare:‘..theGPsparticularlyneedtohavetheirknowledgeincreased.Physicalactivityshouldbepartofbeingagooddoctor.Itisnotquitethereyet.Theevidenceistherebutitneedstobeputintheheartsandmindsofdoctors,’(HouseofCommonsHealthCommittee2015‘ImpactofPhysicalActivityandDietonHealth’,SixthReportofSession2015-15.TheHouseofCommons:TheStationaryOffice,London).Amulti-stakeholderapproachisrequiredforeffectiveinterventionsinordertomodifyinteractionsbetweenindividualhealth-relatedbehavioursandtherangeofdeterminantsthatcontributetotheobesityepidemicinUKyoungchildren.AccordingtoJaneLandonoftheUKHealthForum:‘Wehavethetoolsavailabletous;wehavedietaryguidelines;wehavephysicalactivityguidelines.Weareonlyreallyusingthemwhenwetalktotheindividualwhentheseshould

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beguidingpolicydecisionsacrossGovernmentdepartments.Weneedtoreframesomeofthediscussions’,(HoCHealthCommittee2015asabove).Afterprotractedinertiaformanyyears,theseissuesarefinallybeingchallengedandthereisnotimetowaste.YoungchildrenintheUKhavearighttohealth:‘Thenutritionalpatternslaidoutintheearlyyearscandefineachild’shealthforlife.Weareindangerofdestroyingthehealthofawholegenerationofchildren…weneedtoensureeverychildhasahealthyandvarieddietandregularexercise.’(Pryke2006:‘WeightMattersforChildren-Acompleteguidetoweight,eatingandfitness’.Oxford).Whatfollowsisacompendiumofprogrammeswithawholechildapproachtophysicalactivity.ThebeneficentinfluenceofTheDailyMileintheUKhasbeendescribedearlier.

1. Nationallyandinternationally,positiveusecanbemadeoffreeWiFitopromotehealthyactivitiesinyoungpeopleandfamilies.ManygointofastfoodrestaurantstousefreeWiFiandaspartofsignup,restaurantscouldadvertisehealthyphysicalactivitiesinthegeographicalarea,supportedbyalocalauthoritydrive.MorefreeWifFicouldsimilarlybeofferedinparksandleisurecentres

2. ‘Exercisebreak’cuescouldbecomepartofchildren’stelevisionprogrammeexperience(DeborahCohen2014:‘ABigFatCrisis-TheHiddenForcesbehindtheObesityEpidemic-andHowWeCanEndIt’,NationalBooks.NewYork)

3. Kirklees,WestYorkshirehasanexcellentPhysicalActivityandSportsPlan2015-20;EverybodyActive.TheKirkleesvisionistogeteverybodyphysicallyactivethroughwork,play,sport,travelorleisureby2020.ItislinkedtotheirjointHealthandWellbeingStrategy,KirkleesEconomicStrategy,KirkleesFoodPlanandtheKirkleesSaferStrongerCommunitiesPartnership.KirkleesalsofollowstheGreenInfrastructureDeliveryPlan,ChildrenandYoungPeople

4. Iceland:‘EverythingAffectsUsEspeciallyOurselves’wasstartedin2005in25municipalitiestopromotehealthylifestylesforchildrenandfamiliesbyemphasisingincreasedphysicalactivityandimproveddiet(FrancoSassi2010:‘ObesityandtheEconomicsofPrevention.FitnotFat.’,EdwardElgarPublishingLtd.ISA)

5. Japan:byalertingurbandesign,theyhavemanagedtheirtransportnetworksmakingmasstransitconvenient.TheJapanesepeopleeatlessandwalkconsiderablymore

6. USA-ActivatetheParks:theseprogrammesyieldmultiplebenefitsbeyondphysicalactivity.Theparksaresaferandfamiliesaretherebymoreconfidentaboutinteracting(DeborahCohenasabove)

7. BogataColumbia:theirstreetsareaclosedtocars(Ciclovias).InBogataColumbia,themainstreetscloseeverySundayandtwomillionpedestriansandcyclistscomeouttoenjoytheuninterruptedpeaceandexercise(DeborahCohenasabove)

8. NewYorkUSA:in2005CentralParkNewYorkCityinstalled‘TheGates’,atemporaryartexhibitionofbrightorangebannersover23milesofwalkwayswhichattracted4millionvisitors(94timestheusualnumber).Thisconceptofartinstallationtoimprovephysicalactivityrequiresmoreinvestigation(DeborahCohenasabove).

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9. Finland:hasfocusedforover30yearsonincreasingphysicalactivity.Muchattentionhasbeenpaidtotheconstructionandmaintenanceofsportsfacilities.Thereisonephysicalactivitysiteforevery176Finnsandtheseareusedby90%ofthepopulation.Thereisonepublicswimmingpoolforevery18,000citizensandtheyareusedby70%ofthepopulation.FewFinnsreportbarrierstoexerciselikedistanceorlackofmoney(DeborahCohenasabove)

10. Sweden:daycareschoolsofferactivitiesforyoungerchildrenduringandafterschoolhours

11. Hungary:schoolsopentheplaygroundsforfamiliestoengageinsportsactivitiestogether

12. ColumbusOhioUSA:Walkwithadoc–justawalkinthepark.DrDavidSabir,acardiologistinitiatedthisactivitywithaweeklywalkforonehoureverySaturday.Itwasagrassrootsleveleffortbasedonsustainabilityandsimplicity.Onhisfirstwalk,100peoplearrivedanditisnowtakingplaceallovertheUSandisnationallyrecognised.Allfamilymembersincludingyoungchildrenareencouragedtoparticipate:www.walkwithadoc.org

13. USA:StepitUp!FamilyGroupsWalksinOttawaCounty,Michigantomotivateresidents.Thewholefamilywalkstogether,promotingwalkingandwalkablecommunities.TheprogrammeisrecognisedbytheUSSurgeonGeneral.

Recommendations:11.1 LocalAuthorities,HealthandEducationalconcernsinvitedtosubmit

PAcommunityschemesforcentralevaluationbyGovernmentTaskForcewiththeaimofestablishingasetofrecommendedpilotsfornationalrollout.Goodpracticefrominternationalsources(asabove)toinformthiswork

11.2 Agreateruseofqualitativeresearchdata;merelyfillinginquestionnaireswillnotnecessarilyrevealthetruepictureoftheamountofcurrentactivityandthencethebasefromwhichimprovementsmustbemade.

12. ANIN-DEPTHANALYSISOFTHEIMPORTANTROLETHATBABYANDINFANTSWIMMINGHASTOPLAYINHELPINGTOACHIEVEPHYSICAL,COGNITIVEANDEMOTIONALGOALS

Thisreportconcludesbymakingthecaseforrecognitionofbabyandinfantswimminginallprogrammestoenhancethehealthandfitnessofyoungchildren.Itcomesatatimewhenarecentstudy:http://www.sportsmanagement.co.uk/Sports-news/latest/Swimming-UK-Education-Policy-/333260?source=searchhashighlightedthefactthatathirdofschoolpupilsaged11willfinishYear6unabletoswimdespiteanationalrequirementthateveryYear6leaverbecapableofunaidedswimmingover25metres:‘usearangeofstrokeseffectivelyandbeabletoperformself-rescuetechniquesinvariouswater-basedsituations.’

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Thereporthighlightsafailureof53%ofprimaryschoolstoprovideanycurriculumguidedswimminglessons,areluctanceto‘disrupt’thenormalschoolday,alackofformaltrainingforteachersdirectingswimmingclassesandtheprohibitivecostoftransporttoswimmingpools.Reportcommissioners,SwimEnglandhavecalledforadditionalresourcesfordeliveringschoolswimminglessonsandanewnationaltop-upprogrammeforschoolscurrentlyrecordingthelowestswimmingattainmentlevels.TheobservationshavereceivedqualifiedsupportfromRobertGoodwill,MinisterofStateforChildrenandfamilieswhohassaid:‘Swimmingisavitallifeskillandschoolshaveadutytoteachchildrenhowtoswimandlearnaboutwatersafetyatprimaryschool.Thesefindingsshowthatmoreneedstobedonetoensureallschoolsfeelconfidentteachingswimmingtostudents,whichiswhywewillcontinuetoworkcloselywithSwimEnglandtoreviewtherecommendationswithinthisreport.’Anyrecognitionofthebenefitofswimmingiswelcome,butswimminglessonsatschoolaresomewayremovedfromanapproachthatwouldcredittheactivitywithitspositioninthewholedevelopmentofthechild;intheproperlyphysical,social,linguistic,intellectual,emotionalandcreativetermsinwhichPAhasbeenexaminedelsewhereinthisreport.ScientificsurveysattheGermanSportsCollegeCologneshowthatearlyswimmingforyoungchildrenacceleratedtheirdevelopmentphysicallyemotionallyandintellectuallyincomparisonwithacontrolgroupthatdidnottakeyear-roundlessons.Thestudiesshowedthat:

• Childrenwhoswamconsistentlyfrominfancywerestrongerandbetterco-ordinated

• Childrenwhoswamscoredhigherforintelligenceandproblemsolving;continuingtosuccessinacademictasks

• Swimmershadmoreself-discipline,self-controlandanincreaseddesiretosucceed

• Swimmershadhigherselfesteemandweremoreindependentandcomfortablesociallythanthecontrolgroups

(GermanSportsCollegeCologne:‘BabySwimmingAdvanceIndependenceandDevelopmentofIntelligence’.WorldAquaticBabiesandChildrenNetwork).Aquatictherapyisinclusiveandwaterhasprovedtobeanexcellentenvironmentinwhichtosupportthedevelopmentofchildrenwitharangeofdisabilitiesincludingthoseontheautisticspectrumwhohaverecordedthebenefitsofimprovedmotorperformance,(Mortimer,Privopoulos&Kumar2014;VonderHullsetal,2006)greaterattention,breathingskillsandfamilybonding(Huettig&Darden-Melton2004).WhilstaquatictherapymaynotsuitallASDchildren,ithashadsuccessinachievingadecreaseinnegativesocialbehaviourstogetherwithanincreaseinsocialisation(Mortimer,Privopoulos&KumarandVodnerHullsasabove).Neonatalswimminghasbeenanalysed,(Zhao,etal.,2005)thestudyfindingthatimplementingsuchaprogrammecanaccelerateinfantgrowthanddevelopment.WaterBabies’swimmingprogrammeprovidesspecialisthydrotherapyopportunitiesforvery

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smallandprematurebabiestoexperiencethebenefitsofwateranditspropertiestostimulategrowthanddevelopment.Hyptoniarelievesthejointsofweightwhilstsupportingmuscledevelopment.Lungdevelopmentandstaminacanalsobenefit.Also,astructuredbabyswimmingprogrammecanassistthewholefamily.WaterBabiesincludeparentsandcarersintotheirlessonsascentraltohelpingbabiesintheactivities.In15yearsofteachingbabyandtoddlerswimming,WaterBabieshaveobservedthatmotherswithpostnataldepressioncanbenefitfromaweeklyswimminglessonviafocusandstructureplusthechancetosocialisewithpeers,sharingexperiencesandbondingopportunities.The‘oneonone’parent-childtimealsofurtherspositiveparent/childactivityinteraction,includingunderstandingandinterpretingachild’snon-verbalcommunicationandskintoskincontactalongsidetouching,talkingandsingingtoababy(ukactiveResearchintopre-schoolphysicalactivityforWaterBabies).WaterBabies’programmesareopentoallfamilymembersandcarers,sevendaysaweekwithresultantadvantageouspatternsthatcanbeseeninbothchildandadultactivityandhealth.Theaquaticenvironmentitselfisauniquearenainwhichbothbabiesandtoddlerscanflourish.Physicalbenefitsinclude:

• Chest-deepwaterprovidingresistancetostrengthenthediaphragm;influentialinbreathingforspeech

• Supporttothetrunk,headandneck,affordinggoodpositioningforjawandtongue;promotingincreasedfeedingskillsandmoreintelligiblearticulation

• Bettermuscletone;easeofmovementandtherebyapositiveandstimulatingenvironmentforlearninganddevelopment.

StudiesconductedattheNorwegianUniversityofScienceandTechnology(SigmundssonH,HopkinsB:‘BabySwimming,ExploringtheeffectsofEarlyinterventiononSubsequentMotorAbilities’.Child,care,healthanddevelopment,Sciencedaily210,36(3);2010)foundthatbabyswimmershadbetterbalance,movementandgraspingtechniquesthannon-swimmers.Thedifferencepersistedevenwhenthechildrenwerefiveyearsold.Anumberofresearchstudies(ZealazoPR,WeissMJ:‘InfantSwimmingBehaviours;cognitivecontrolandinfluenceofexperience’:Journalofcognitivedevelopment7(1)2006pp1-5;DraganskiB,GaserC:’ChangesintheGraymatterinducedbytraining’,Nature4272004pp311-312;Jorgensonetal,‘EarlyYearsSwimmingResearchProject’atGriffithUniversity,Splashmagazine,2001;HealthmadeMagazine,‘TheBenefitsofSwimmingEspeciallyforChildren–theFunctiontoteachSwimmingtoinfants’,2011)havealsopinpointedthefollowingadvantages:

• Waterbuoyancyasaboosttoinfantmotordevelopment• Swimmingtoysstimulatingmotorskillsandhand-eyecoordination• Finemotorskillshoned;improvedeyesightandfocus• Spatialdevelopment;afreedomtomovethatcanalsobelinkedtocognitiveand

kinaestheticdevelopmentmusclestrengtheningduetohighwaterresistance.WaterBabiesreportthattheirswimmingprogrammesstimulateinfantcognitivedevelopmentandtoddlersareissuedinstructionsduringthecourseofthelessons

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containingsomesimpleskillstofollowandaction.Theseincludesongs,teachingrecognitionofbodypartsandtheenvironmentandavarietyoftoysintroducingconceptsoffloatingandsinking.Afouryearprojectbegunin2009byGriffithsUniversityandcoveringtheUS,AustraliaandNewZealand(EarlyYearsSwimmingResearchProjectwith45swimschools)hasreleasedpreliminaryfindingsshowingthatunderfivestakingswimminglessonsaremoreadvancedincognitiveandphysicaldevelopmentthannon-swimmers.Theswimmerswere11monthsaheadinoralexpressionandsixandahalfmonthsaheadinmathematicalreasoning.SimilarresultswererecordedbyresearchersinMelbournein2011,academicsfromtheUniversityofEssexandUniversityCollegeLondonanda1979study(asabove)fromtheGermanSportsCollegeCologne.Duringswimming,achildexperiencestactilebodystimulationfromwaterresistanceandthisencouragesneurologicaldevelopment.Themovementinvolvedinswimmingactivatesbothcerebralhemispheresandallfourlobesofthebrainsimultaneouslywhichcanencourageheightenedcognitionandlearningcapacity.Goodcommunicationinthecerebralhemispheresleadstoanoverallefficiencyinbrainprocesses;inparticularencouraginglanguagedevelopment.Swimmingforbabiesandinfantscanalsohelpemotionaldevelopment;affordingchildrensignificantopportunitiestosharespacewithpeersandexploremovementtogether(ConnellG,ToddA,‘ReferenceManualforEarlyChildhoodinWater’.Auckland,NewZealand2007).GroupparticipationcontributestosocialdevelopmentandtheWaterBabiesswimmingprogrammeincorporatesopportunitiesforsharing,takingturns,watchingindividuals,wholegroupinvolvementandcelebratingsuccessandgoalachievement.Itusesactionsongstodevelopselfcontrol,includingtheabilitytostop,waitandlisten.Therearealsoopportunitiestorecogniseconceptssuchasbeginning,ending,tidyingtoysandworkingcollaborativelywithothers.Theearlyyearscurriculumsupports‘waterplay’andtheswimmingenvironmentfostersemotionaldevelopmentaswellasunderstandingwhyandhowthingshappen;learningaboutpropertiessuchas‘warm’‘wet’and‘cold’andwhyandhowobjectsfloatandsink.WaterBabies’carefullydesignedsongsandgamesarealsoideallyplacedtoteachchildrenaboutweather,numbers,colourandbodyparts–helpingthemtobecome‘schoolready’,withacapacitytoenjoylearningandtoformandsustainpositiverelationshipswithpeergroupfriendsandadultmentors.Successivegovernmentshavestressedtheimportanceofswimmingfromasafetyperspectiveandacase-controlledstudyconductedbyRuthBrennerandcolleagueshasfoundthatparticipationinformal,structuredswimmingclassescanreducetheriskofdrowningby88%amongchildrenagedbetweenone–fouryears(BrennerRR,GitanjaliST,HaynieDL,Trumble,AC,Quian,C,KlingerRM,KlebanoffMA:‘AssociationbetweenSwimmingLessonsandDrowninginChildhood-Acasecontrolstudy’,ArchivesofPaediatricsandAdolescentMedicine2009163(3)203-210).However,theuniversaldesiretoreduceinfantdeathsbydrowninghasbeenmisguidedlyabusedbytheUKintroduction(since2016)oflessonstargetingparentsofyoungchildrenwithso-called‘drown-proofing’methodologiesthatupuntilthispointhaveonlyhadapresenceintheUSAandAustralia.Thecredibilityoftheselessonsasofferinglifesavingskillsforveryyoungchildrenrequireseriousandurgentreviewbecauseatbesttheyrepresentanill-conceivedapproachandatworstareindeed,tantamounttochildabusewithnoevidentialpositiveeffectuponinfantdrowningrates

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andcausinginfantstressthatriskslongtermharmtoachild’sbraindevelopment.InJuly2017,SwimEngland,STA(SwimmingTeachersAssociation)RLSS(RoyalLifeSavingSociety)andprominentUKswimschoolswereunitedinvocallydiscreditingthesetechniquesashighlightedinTheDailyMail:http://www.dailymail.co.uk/news/article-4669568/Grieving-mother-criticised-baby-swim-survival-lessons.htmlandTheTimes:https://www.thetimes.co.uk/edition/news/backlash-over-self-rescue-swimming-classes-for-toddlers-mthlb67x2TheWaterBabiesorganisation(supportedbyfifteenyears’provensuccessfulandinnovativeexperienceindeliveringswimmingprogrammesforbabies,toddlers,children,theirparentsandcarers)isunequivocalinitsoutrightoppositiontothesemethodologies.Itstronglyrejectstheirdeploymentineachandeverysetting,hasneverpractisedthemnoradvocatedtheirusagebyWaterBabies’personnelorothersandwouldneverdoso.Roundlycriticisingtheterminology‘InfantSelfRescue’forthemethodologiesmentionedabove,WaterBabies’ManagingDirector,SteveFrankshasbrandedthetechniquesasbeing‘adangerousthreattothedevelopmentandwellbeingofyoungchildren’andwarmlywelcomesalleffortstodissuadewell-meaningparentsandcarersfromjoininganyprogrammesfollowingsuchinstruction.Theso-called‘InfantSelfRescuelessons’havealsobeenroundlycriticisedbyDrFrancoiseFreedman(‘SinkorSwim?:Drown-proofingmethodologies’,June2017)Thereisanurgentneed,aspractisedandadvocatedbyWaterBabies,todevelopsafetytechniquesinlinewithababy’sphysicalandemotionaldevelopment.TheISRmodelignoresdevelopmentalmilestonesandYouTubeclipsofISRtechniquesandlessonsarbitrarilysubjectingbabiestorigid‘flipandfloat’methods(whilstignoringtheclearlyaudiblecriesandprotestsoftheinfants)servetodistressandconfusebabieswhilstoperatingontheerroneouspremisethataninfantfallingintodeepwater,if‘taught’inthisway,willrotatethemselvesroundandfloatuntilrescued.Allsafetymethodsadvocatedmustbebaseduponcurrentscientificresearchratherthantheviewsofself-appointed‘parentingexperts’whoarenotrecognisedspecialists.Freedmanalsopointsouttheveryrealdangerstobraindevelopmentofthesetechniques:‘Inthelightofbothresearchshowingthatviolentconditioningisdetrimentaltoearlybraindevelopment,potentiallycausingtraumatosensitiveinfants,andtheunprovenoutcomesofdrown-proofingmethodsinstatisticallyreducingdrowningfatalitiesamongthe0-4yearoldchildrenpopulation,forcefullytraininglargenumbersofinfantstorolloverandbackfloatisthereforenotsociallycommendable.….theonlytruewaytoensureachildispreventedfromdrowningis100%supervisionfromaresponsibleadult.’(Freedman2017asabove).ThesepointsaresupportedbySueGerhardtinherbook‘LoveMatters’(2004)asshearguesthatinfantsneedasupportivelearningenvironmenttoprosper.Theambivalenceitselfofdrown-proofingisoneofthestrongestargumentsagainstit:‘Whileparentsentrusttheirinfantstotrainerswithlovingintent,theexperienceofenforcedconditioningdoesnotmatchthislovingintentforthechild.Thecontradictions

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inherentinreceivingpraiseandrewardsatthecostofinflictedpainareknowntothosewhostudychildabuse.Forayoungchild,beingthrownintowaterandstrugglingtokeepafloatunderthelovinggazeofhisparentssimplydoesnotamounttotheperceptionoftheworldasasafeplace.Howmuchviolencehasbeeninflictedonbabiesunderthepretextthatitisfortheirgood?’Awell-developed,nurturingchild-centredearlyyears’swimmingprogrammeshoulddeliversafetyskillsandincreasedparentalawarenessandco-operationthatwillsavechildren’slives.Inthewidestsense,itistimefortheover-neglectedareaofbabyandinfantswimmingtobeaffordeditsproperroleaspartofanational,government–promotedandsupportedstrategytoboostphysicalactivityforchildreninearlylife,thusprovidingthebeststartforwhole-childdevelopmentincludingphysicalfitness,emotionalwellbeing,heightenedcognitiveskillsandahealthyweightthatwillprovidethestrongestfoundationforadultprosperity.‘Teachingchildrentolove,respectandgainconfidenceinthewatershouldbeattheveryheartofagoodoverallpre-schoolstrategy’.(SusanFreedman2017asabove).Nowisagoodtimetobegin.Recommendations:

12.1 Widespreadoverhaulandreviewoftheearlyyears’andprimarycurriculumsastheyaffectbaby/infantswimmingwithguidelinesandpolicydevelopedthatconcernwhole-childdevelopment

12.2 SwimmingteachingandtrainingtoformpartofallearlyyearsandprimaryprofessionaltrainingwithregularupdateaspartofCPD

12.3 Antenatalcare/postnatalproviderstosignpostparentstoswimmingandwatertherapyclassesandforthesetoformpartofantenatalandpostnatalmaternalhealthprogrammes

12.4 Allchildswimmingproposedsafetytechniques/teachingpackagestobesubjectedtogovernmentresearchandscientificproofingbeforebeinglicensedforuseinUKswimmingandteachingfacilities.Currentmethodsthathavenotbeenexaminedtoundergothetestingprocedurebeforebeinglicensedtocontinue

12.5. Grants/SportsPremiumfinancetobemadeavailablefortransportationcostsforschool-basedinfantswimmingopportunities.