Three-fourths of preschool-age children in the United States attend child care, and many are not getting enough outdoor physical activity, which may be due in part to parental and societal values about injury prevention and kindergarten readiness.

A team led by Kristen Copeland, MD, division of General and Community Pediatrics at Cincinnati Children’s Hospital Medical Center and a Robert Wood Johnson Foundation Faculty Scholar, conducted a focus-group study of 53 child care providers from 34 child care centers in Cincinnati to examine their perceptions of potential barriers to children’s physical activity in child care.

Researchers identified three main barriers to children’s physical activity: injury concerns, a focus on academics over outdoor play, and financial constraints. Because many children spend all daylight hours in care, and because some lacked a safe place to play near their home, these barriers to physical activity in child care may limit children’s only opportunity to engage in physical activity, according to Dr. Copeland.

The child care providers who were interviewed for the study said that they felt pressure from parents to make sure that their children did not get injured while playing outside and, at times, were asked to keep children from participating in vigorous activity to keep them from being injured.

Similarly, child care providers noted that recent stricter licensing codes have resulted in playgrounds being less physically challenging and interesting to children. The new play equipment that was safe according to these standards soon became boring to the children as they quickly mastered it. Teachers noted that children would then start to use equipment in unsafe ways for which it was not intended such as walking up the slide.

“Child care providers mentioned that they appreciated having state inspections of their playground equipment and strict licensing codes because it helped them feel confident about the safety of the equipment,” says Copeland. “But several of them expressed how overly strict standards had rendered some of the equipment unchallenging and uninteresting to the children, which hampered the children’s physical activity.”

Another issue discovered during the study was that care providers felt pressured by parents (both upper- income and lower-income) and early-learning state standards to prioritize academic classroom learning over outdoor and active playtime.

“Several of the care providers agreed with this goal in principle, but they also recognized that children learned through active play and that the energy release and creative stimulation of outdoor activities helped place children in a better mindset to learn and concentrate later either indoors or outdoors,” says Copeland.

“We were surprised to find such a strong focus on academics for children as young as 3 years old. At this age, most children do not know how to skip and are still learning how to share and negotiate peer relationships. Yet teachers told us that many parents wanted to know what their child ‘learned’ that day, but were not interested in whether they had gone outside or had mastered fundamental gross motor skills.”

Many of the participants also cited budgetary reasons for why their centers could not offer children optimal physical activity opportunities. Most centers had tight operating margins and could not afford equipment for the children to play on. Yet Copeland does not feel the financial barriers present an insurmountable barrier to children’s physical activity in child care.

“There are plenty of things centers can do to encourage physical activity that cost little to no money—such as putting on a dance CD, taking nature walks, running races on the playground, or learning how to skip.” Copeland and her team say that these findings show that there may be a need to reset the balance of the priorities of injury prevention and kindergarten readiness with physical activity promotion.

She says, “Given that childhood obesity is a national epidemic and a major cause of childhood morbidity and that time in child care may be the child’s only opportunity for outdoor play, licensing standards may need to explicitly promote physical activity in as much detail as is devoted to safety.

“An important message from this study is that well-intentioned policies may have unintended consequences for preschool-aged children’s physical development. Daily physical activity is essential for preschool-aged children’s development and for preventing obesity, yet parents’ and teachers’ concerns about injury and school-readiness may be keeping children from being physically active.

In essence, in ensuring that young children are smart and safe, we may also be keeping them sedentary.”

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