How are health, nutrition, and physical activity discussed in international guidelines and standards for children in care? A narrative review

Abstract

Background Children in care (CiC) have often experienced trauma and, as a result, are at high risk for poor health outcomes. It is imperative that human-service stakeholders provide trauma-informed health services and interventions. However, little is known about how health promotion is addressed in the standards and guidelines for CiC. For this scoping review, the aim was to examine and compare how nutrition and physical activity are discussed in: 1) federal standards for CiC across the United Kingdom, the United States, New Zealand, and Australia; and 2) state and territory guidance in Australia. Method The grey literature was searched for documents outlining key child-welfare standards, guidelines, or policies for the provision of care across foster, kinship, or residential care. Documents were examined for the inclusion of recommendations and/or strategies focused on primary health and the promotion of nutrition and/or physical activity. Results A total of 52 documents were included in this review: 28 outlining international federal guidance and 24 Australian documents. In the United States, New Zealand, and Australia, references to physical activity were often broad, with minimal direction, and nutrition was often neglected; the United Kingdom provided more detailed guidance to promote nutrition and physical activity among CiC. Conclusion There is a lack of consistency and specificity in guidelines supporting healthy lifestyle interventions for CiC both internationally and within Australia. It is recommended that 1) specific trauma-informed health promotion guidelines are developed for CiC; and 2) trauma-informed health promotion training is provided to carers. Doing so will ensure that care is provided in a manner in which stakeholders recognize the signs and consequences of trauma in order to determine the most appropriate health interventions to improve outcomes and prevent ongoing trauma for this population.

Child and Adult Care Food Program Participation Benefits, Barriers and Facilitators for Independent Child Care Centers in California

“…Efforts to improve nutrition in child care settings are not unique to the U.S., especially as a majority of young children in the 38 Organisation for Economic Co-operation and Development (OECD) member countries are in child care by the time they are 3 years old [ 25 ]. Two reviews of international, federal nutrition standards for child care in the United Kingdom, the U.S., New Zealand, and Australia suggest a lack of consistency in standards between countries [ 26 , 27 ]. Two studies evaluating adherence to national policy for nutrition in child care settings in England, where child care is free for all 3- and 4-year-olds, shows regional variations in the interpretation of federal policy and the implementation of voluntary federal nutrition guidelines for child care [ 28 , 29 ].…”