State Regulations Promoting Infant Physical Activity in Early Care and Education

Sara E. Benjamin-Neelon, Brian Neelon, John Pearce, Elyse R. Grossman, Sarah Gonzalez-Nahm, Meghan Slining, Kiyah Duffey, Natasha Frost

Research output: Contribution to journalArticlepeer-review


Background: State policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018. Methods: We reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemar's tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period. Results: From 2013 to 2018, we observed significant improvement in one recommendation for homes - to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; p = 0.006). We did not observe any other significant difference between 2013 and 2018 regulations. Conclusions: Despite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.

Original languageEnglish (US)
Pages (from-to)368-374
Number of pages7
JournalChildhood Obesity
Issue number6
StatePublished - Aug 1 2018


  • child care
  • physical activity
  • policy
  • regulation
  • tummy time

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics


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