Standards for child and youth development programs
Out-of-School Time (CYD-OST) 11: Health
The program protects and promotes the health of children and youth.
While this core concept is largely focused on practices pertaining to physical health, COA does recognize the interconnectedness of physical and mental well-being, as well as the importance of focusing on the overall wellness of children and youth. Accordingly, it is important to note that other practices that contribute to wellness are included within other core concept standards. For example, CYD-OST 4 addresses the importance of social and emotional learning, including helping children and youth understand and manage their emotions; CYD-OST 3 and CYD-OST 4 address the importance of developing caring relationships with adults and peers; and CYD-OST 3 and CYD-OST 8 address the importance of providing the supports and opportunities that can help children and youth build skills and develop a positive self-concept.
Children and youth who participate in Out-of-School Time programs gain the personal, social, emotional, and educational assets needed to support healthy development, increase well-being, and facilitate a successful transition through childhood and adolescence, and into adulthood.
Note: See CYD-OST 12 for information regarding practices related to safety, which may at times overlap with practices related to health. See the Supplement for OST Programming: Health and Wellness (CYD-OST-HW) for additional expectations when the program is specifically designed to provide programming related to health and wellness.
Information provided to families (regarding health promotion and the types of food/drink that may be brought to the program)
Attendance guidelines that address when sick children and youth should not come to the program
Accident, injury, and illness reports
Staff training materials addressing health-related topics
Documentation that staff training on health-related topics has been provided (e.g., in training files or personnel records)
Children, youth, and families
Review files of children and youth
Observe snack and/or meal time
Observe program interactions and activities
The program promotes healthy eating and good nutrition by serving:
unsweetened beverages such as water or plain milk; and
a variety of healthful and minimally-processed foods that do not contain artificial ingredients, unhealthy fats, added sugars, or high levels of sodium (e.g., fruits, vegetables, whole grains, nuts, beans, and lean meats).
Personnel should make an effort to ensure that even celebrations for birthdays, holidays, and other special events feature or include healthy options. Further, in addition to providing the types of food and drink referenced in the standard, the program should also strive to ensure that children and youth do not have access to vending machines that offer unhealthy selections. Personnel should ideally also consider the preferences and input of children and youth when deciding what foods to offer, to the extent possible and appropriate.
Note:In some cases children and youth may have special dietary needs that require accommodation under the ADA or IDEA. See CYD-OST 1.06, 11.08, and 14.07 for more information regarding accommodating special needs.
Childhood obesity is a serious problem in the United States, and research suggests that the diets of many children and youth are poor or need improvement. Literature points to the steps programs can take to combat these trends, and encourages programs to serve nutritious foods and promote healthy eating habits. Funding for healthy snacks and meals may be available through the United States Department of Agriculture’s Child and Adult Care Food Program, National School Lunch Program, or Summer Feeding Program.
make clean and safe drinking water readily available at all times, including when children and youth are outdoors or on field trips;
provide snacks and meals at appropriate times;
provide children and youth with enough time to eat;
offer amounts of food that are appropriate for the ages and sizes of children and youth; and
support children’s and youth’s need to self-regulate the amount they eat.
Water from sinks and fountains should be tested for quality, and filtered water should be available at sites where the water quality is poor. Children and youth should also be encouraged to drink more water in hot weather.
Note:In some cases children and youth may have special dietary needs that require accommodation under the ADA or IDEA (e.g., regarding the frequency of snacks). See CYD-OST 1.06, 11.08, and 14.07 for more information regarding accommodating special needs.
Note:Regarding water quality, see CYD-AM 4.02 for more information about compliance with applicable laws, regulations, guidelines, and codes, including those related to health and safety.
The program supports and encourages the physical fitness of children and youth by:
designing the activity schedule so that children and youth do not sit for more than one hour at a time, and incorporating short physical activity breaks into sedentary activities and transition times; and
providing opportunities for children and youth to engage in physical activity for at least 30 to 60 minutes per day.
Children and youth should ideally have opportunities to engage in moderate to vigorous exercise, as well as age-appropriate bone and muscle strengthening activities. If a program operates for a relatively brief period of time each day (e.g., for an hour or two), it may not be possible for the program to engage children and youth in a full 30 to 60 minutes of physical activity, but at least 20 percent of program time should be set aside for physical activity (i.e. 12 minutes of a one-hour program).
The type of physical activity provided may vary depending on the nature of the program and the ages, abilities, and interests of participating children and youth. For example, while a program serving younger children might offer unstructured free play on the playground, a program serving older children might facilitate a variety of structured activities, from dance classes, to competitive intramural sports, to walking groups. When a program offers opportunities for physical activity beyond unstructured free play, the program should also complete the Supplement for OST Programming: Health and Wellness (CYD-OST-HW).
Note: Programs that are not designed to include opportunities for fitness should still design the activity schedule so children and youth do not sit for more than one hour at a time and incorporate physical activity into sedentary activities and transition times, and should be prepared to explain why the program’s design does not include structured time for physical activity and fitness.
As noted in the Research Note to CYD-OST 11.01, childhood obesity is a serious problem in the United States. Regular participation in physical activity can help to counteract this epidemic, and experts in the United States recommend that youth participate in at least 60 minutes of developmentally appropriate moderate to vigorous physical activity per day, as well as bone and muscle strengthening activities. Although out-of-school time programs may not be able to facilitate the full 60 minutes of activity time, they should strive to engage children in at least 30 minutes of exercise per day. Further, if program participants are not engaged in physical activity at other points in their day (e.g., in gym class, or at home), the program should strive to provide the full 60 minutes of activity time. Literature also highlights the importance of offering a wide range of physical activity options, noting that in addition to meeting different fitness needs, providing a variety of physical activities will increase the likelihood that children and youth will find activities they enjoy and will pursue throughout their lives.
The program creates an environment that supports and encourages healthy eating and physical activity by ensuring:
personnel model healthy eating and physical activity while on the job;
posters, displays, and other program materials convey positive messages about healthy eating and physical activity;
food and physical activity are not offered or withheld as a reward or punishment;
screen time is limited; and
there is adequate access to the facilities needed to support healthy eating and physical activity (e.g., kitchen, storage, and recreational facilities).
Regarding element (d), children and youth should not be permitted to watch television or movies at the program except on special occasions, and screen time that is not academic or educational should typically be limited to 30 minutes per day. When children or youth are exercising along with a video or DVD that provides physical activity instruction (e.g., an aerobics DVD), the time does not count towards the daily screen time limits.
Note: See CYD-OST 8.17 for more information regarding screen time and the use of technology at the program.
Children and youth are helped to understand the importance of developing healthy habits that support both physical and mental wellness.
Children and youth should ideally be helped to understand the importance of: (1) obtaining adequate sleep, nutrition, and exercise; (2) devising healthy strategies for coping with stress; and (3) developing reasonable expectations for themselves. It may also be helpful to explain how habits and routines in these areas may work together to impact both physical and mental well-being. For example, moderate exercise may help to improve mood and reduce stress, and adequate sleep may improve one’s ability to manage emotions. It may be especially relevant for programs to provide information regarding topics that tie into the programs’ areas of focus. For example, a program that emphasizes academic readiness might make a concerted effort to help children and youth understand how eating healthfully, and obtaining sufficient sleep, can support readiness to learn.
Note:As noted in the Interpretation to CYD-OST 11, other practices that support overall wellness are addressed in other core concept standards. For example, CYD-OST 4 addresses the importance of helping children and youth understand and regulate their emotions, and CYD-OST 8 addresses the importance of providing the opportunities and support that can help children and youth build skills and develop a positive self-concept.
In an effort to support children and youth in developing and maintaining healthy habits, the program provides families with information regarding:
the importance of a healthy lifestyle, including ways to encourage healthy habits at home; and
the types of food that may be brought to the program.
Information may be provided in a variety of ways, from communications at family events to materials sent to the home. Healthy habits to encourage include those related to eating healthfully, engaging in physical activity, obtaining adequate sleep, and supporting mental wellness. As noted in CYD-OST 11.05, it may be especially relevant for programs to provide families with information regarding topics that tie into the programs’ areas of focus. For example, a program that emphasizes academic readiness might make a concerted effort to help families understand how eating healthfully, and obtaining sufficient sleep, can support readiness to learn.
When determining the types of food that may be brought to the program, it may be appropriate to consider factors related to both nutritional content and food allergies.
Relevant health and mental health needs include, but are not limited to, needs related to: dietary restrictions, allergies, asthma, physical limitations, medication needs, and a history of trauma. Personnel should also take care to respect the confidentiality of children and youth as it relates to their health information.
Note: As noted in CYD-OST 1.05, relevant information regarding health and mental health needs should be collected from children and youth and their families during registration and enrollment. When additional needs are identified during the course of program involvement, files should be updated accordingly.
There are adequate supplies and facilities for hand washing and personnel, children, and youth are encouraged to wash hands frequently, especially before preparing food or after using the bathroom.
In addition to ensuring that soap dispensers are filled regularly, the program should also ensure that there are sanitary methods for drying hands, such as disposable paper towels or electric dryers that turn on and off automatically. Signs or pictures should also be posted to show proper hand washing techniques and remind children of the importance of hand washing.
COA recognizes that in some situations, such as field trips or outdoor activities, hand washing supplies and facilities (e.g., running water, soap) may not be available. When that is the case, hand sanitizer may be an appropriate alternative.
To protect children and youth from injuries and illnesses, the program ensures:
families are provided with attendance guidelines that address when sick children and youth should not come to the program;
procedures address when families should be notified that their children may have been exposed to an infectious disease;
health problems and injuries are promptly documented and reported to parents or legal guardians;
proper health precautions are followed when supervising children and youth who are ill or injured;
suspected child abuse and neglect is reported to prescribed authorities; and
personnel are healthy and capable of performing the essential functions of the job with reasonable accommodation.
The program should consult with a health professional, as necessary, for assistance developing procedures that cover the situations addressed in the standard. This may be especially important in regard to ensuring that the program complies with any applicable legal and regulatory requirements regarding risk of exposure to contagious and infectious disease. COA recommends that programs consult with local health authorities or a qualified professional about how to minimize the risk of contagious and infectious diseases, which may include voluntary adherence to CDC guidelines and training personnel on the use of universal precautions.
Regarding element (f), while an annual physical examination is preferred, personnel may receive a general health screening performed by a qualified medical practitioner, provided the screening addresses communicable diseases, including tuberculosis when required by relevant health authorities. See CYD-OST 11.13 for more information regarding the applicability of tuberculosis testing.
Note: See CYD-OST 12 for additional expectations regarding responding to accidents and emergencies.
The program provides an optimal learning environment that is:
well-lit, with natural light where possible;
maintained at a safe, comfortable temperature and noise level;
Systems for heating, cooling, and lighting should be functional, and the program should take additional steps to facilitate a comfortable environment, as needed. For example, floor or table lamps might be used in addition to or instead of overhead lighting, and rugs or ceiling tiles might be used to help absorb noise.
Program policy prohibits smoking anywhere on the premises, including outside entrances, outdoor play areas, and program vehicles.
The program implements a targeted tuberculosis testing program for personnel who are in direct contact with children and youth, as appropriate given the identified service population and as required by law or regulation.
Local and state public health authorities should be a program’s primary source of information when determining if there is a need to implement a targeted testing program among its staff. Local public health authorities have access to epidemiological data analysis, guidance from national authorities, and local rates of TB infection, which will help programs assess the risk for TB. Programs should consult annually with their local health department for any new information or changes in the local population that might affect the risk of TB.
NA The program does not serve high risk groups and is not required by law to conduct TB testing.
The Centers for Disease Control and Prevention discourages TB testing among individuals with a low risk for developing tuberculosis because it utilizes resources that should be maintained for populations at greater risk of infection and increases the prevalence of false positives. Mandated skin-testing programs should be avoided unless a large percentage of the program population is defined as “high risk” by local authorities.