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Pediatric Nutrition. Encouraging your child to drink water. Updated September 11, Fruit or vegetable juice may be served once per day during a scheduled meal or snack to children 12 months or older 1. These amounts include any juices consumed at home. Whole fruit, mashed or pureed, is recommended for infants beginning at 4 months of age or as developmentally ready 3. The facility should date and retain these menus for 6 months, unless the state regulatory agency requires a longer retention time.

The menus should be amended to reflect any and all changes in the food actually served. Any substitutions should be of equal nutrient value. When children with food allergies attend an early care and education facility, here is what should occur. A written list of the food s to which the child is allergic and instructions for steps that need to be taken to avoid that food. A detailed treatment plan to be implemented in the event of an allergic reaction, including the names, doses, and methods of administration of any medications that the child should receive in the event of a reaction.

The plan should include specific symptoms that would indicate the need to administer one or more medications. Treating allergic reactions c. The written child care plan, a mobile phone, and a list of the proper medications for appropriate treatment if the child develops an acute allergic reaction should be routinely carried on field trips or transport out of the early care and education setting.

This will usually be provided as a premeasured dose in an auto-injector, such as EpiPen or EpiPen Jr. Specific indications for administration of epinephrine should be provided in the detailed care plan. Within the context of state laws, appropriate personnel should be prepared to administer epinephrine when needed. Food sharing between children must be prevented by careful supervision and repeated instruction to children about this issue.

Exposure may also occur through contact between children or by contact with contaminated surfaces, such as a table on which the food allergen remains after eating. Some children may have an allergic reaction just from being in proximity to the offending food, without actually ingesting it. In addition, reactions may occur when a food is used as part of an art or craft project, such as the use of peanut butter to make a bird feeder or wheat to make modeling compound.

Content in this standard was modified on August 23, and November 10, All children should be monitored to prevent them from eating substances that do not provide nutrition often referred to as pica 1,2. Infants and children, including school-aged children from families practicing a vegetarian diet, can be accommodated in an early care and education environment when there is:. For older children who have more choice about what they eat and drink, effort should be made to provide accurate nutrition information so they make the wisest food choices for themselves.

Changing lifestyles and convictions and beliefs about food and religion, including what is eaten and what foods are restricted or never consumed, have some families with infants and children practicing several levels of vegetarian diets. Others label themselves lacto-ovo vegetarians, eating or drinking foods such as eggs and dairy products. Still others describe themselves as vegans who restrict themselves to ingesting only plant-based foods, avoiding all and any animal products.

Updated July 25, Meat and meat alternates: build a healthy plate with protein. Accessed September 20, The facility should keep records detailing whether an infant is breastfed or formula fed, along with the type of formula being served. Infant meals and snacks should follow the meal and snack patterns of the Child and Adult Care Food Program.

The facility should encourage breastfeeding by providing accommodations and continuous support to the breastfeeding mother. Facilities should have a designated place set aside for breastfeeding mothers who want to visit the classroom during the workday to breastfeed, as well as a private area not a bathroom with an outlet for mothers to pump their breast milk 1,2. The private area also should have access to water or hand hygiene.

Infants may need a variety of special formulas, such as soy-based formula or elemental formulas, that are easier to digest and less allergenic. Please refer to standards 4. Human milk, as an exclusive food, is best suited to meet the entire nutritional needs of an infant from birth until 6 months of age, with the exception of recommended vitamin D supplementation. In addition to nutrition, breastfeeding supports optimal health and development. Human milk is also the best source of milk for infants for at least the first 12 months of age and, thereafter, for as long as mutually desired by mother and child.

Breastfeeding protects infants from many acute and chronic diseases and has advantages for the mother, as well 3. Research overwhelmingly shows that exclusive breastfeeding for 6 months, and continued breastfeeding for at least a year or longer, dramatically improves health outcomes for children and their mothers. Healthy People outlines several objectives, including increasing the proportion of mothers who breastfeed their infants and increasing the duration of breastfeeding and exclusive breastfeeding 4.

Incidences of common childhood illnesses, such as diarrhea, respiratory disease, bacterial meningitis, botulism, urinary tract infections, sudden infant death syndrome, insulin-dependent diabetes, ulcerative colitis, and ear infections, and overall risk for childhood obesity are significantly decreased in breastfed children 5,6. Similarly, breastfeeding, when paired with other healthy parenting behaviors, has been directly related to increased cognitive development in infants 7.

Breastfeeding also has added benefits to the mother: it decreases risk of diabetes, breast and ovarian cancers, and heart disease 8. Mothers who want to supplement their breast milk with formula may do so, as the infant will continue to receive breastfeeding benefits 4,5,7. Iron-fortified infant formula is an acceptable alternative to human milk as a food for infant feeding even though it lacks any anti-infective or immunological components. Regardless of feeding preference, an adequately nourished infant is more likely to achieve healthy physical and mental development, which will have long-term positive effects on health 9.

Additional Resources. The long-term public health benefits of breastfeeding. Asia Pac J Public Health. Gibbs BG, Forste R. Breastfeeding, parenting, and early cognitive development. J Pediatr. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Furman L. Breastfeeding: what do we know, and where do we go from here? Healthy People Maternal, infant, and child health.

Total duration of breastfeeding, vitamin D supplementation, and serum levels of hydroxyvitamin D. Am J Public Health. Breastfeeding Policy and Guidance. Published July Accessed January 11 , Health inequalities and breastfeeding in the United States of America. Int J Childbirth Educ. An infant will communicate fullness by shaking the head or turning away from food 1,4,5. Responsive feeding may help prevent childhood obesity Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood.

Matern Child Nutr. Accessed November 14, Observed infant food cue responsivity: associations with maternal report of infant eating behavior, breastfeeding, and infant weight gain. Infant hunger and satiety cues. Updated October Zero to Three. How to care for infants and toddlers in groups.

Continuity of care. Published February 8, Child Obes. Guidelines for Health Professionals. Published February Question: I cannot find any information in the new CFOC as to how long a bottle of breast milk can be kept after it is fed to an infant. It states that a bottle of formula should be discarded after one hour. I would think that it should be the same, since saliva is introduced into the bottle regardless of its contents, but I want to make sure. Can you offer some guidance?

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Both re-sources state that breast milk should be discarded after it is fed to an infant. Expressed human milk should be placed in a clean and sanitary bottle with a nipple that fits tightly or into an equivalent clean and sanitary sealed container to prevent spilling during transport to home or to the facility. Only cleaned and sanitized bottles, or their equivalent, and nipples should be used in feeding. The bottle or container should immediately be stored in the refrigerator on arrival. Avoid bottles made of plastics containing bisphenol A BPA or phthalates, sometimes labeled with 3, 6, or 7 1.

Use glass bottles with a silicone sleeve a silicone bottle jacket to prevent breakage or those made with safer plastics such as polypropylene or polyethylene labeled BPA-free or plastics with a recycling code of 1, 2, 4, or 5. The filled, labeled containers of human milk should be kept refrigerated. Human milk containers with significant amount of contents remaining greater than one ounce may be returned to the mother at the end of the day as long as the child has not fed directly from the bottle. Frozen human milk may be transported and stored in single use plastic bags and placed in a freezer not a compartment within a refrigerator but either a freezer with a separate door or a standalone freezer.

Human milk should be defrosted in the refrigerator if frozen, and then heated briefly in bottle warmers or under warm running water so that the temperature does not exceed If there is insufficient time to defrost the milk in the refrigerator before warming it, then it may be defrosted in a container of running cool tap water, very gently swirling the bottle periodically to evenly distribute the temperature in the milk. After warming, bottles should be mixed gently not shaken and the temperature of the milk tested before feeding. Some children around six months to a year of age may be developmentally ready to feed themselves and may want to drink from a cup.

Two to three ounces of human milk can be placed in a clean cup and additional milk can be offered as needed. Small amounts of human milk about an ounce can be discarded. Human milk can be stored using the following guidelines from the Academy of Breastfeeding Medicine:. Guidelines for Storage of Human Milk. Containers should be covered and kept as cool as possible; covering the container with a cool towel may keep milk cooler. Keep ice packs in contact with milk containers at all times, limit opening cooler bag.

Store milk toward the back of the freezer, where temperature is most constant. Milk stored for longer durations in the ranges listed is safe, but some of the lipids in the milk undergo degradation resulting in lower quality. Clinical protocol 8: Human milk storage information for home use for healthy full term infants, revised. Breastfeeding Med From the Centers for Disease Control and Prevention Website: Proper handling and storage of human milk — Storage duration of fresh human milk for use with healthy full term infants.

If she does not know whether she has ever been tested for HIV, ask her if would she be willing to contact her primary health care provider and find out if she has been tested; and 4. Inform them that the risk of transmission of HIV is low; 3. The formula should be of the same brand that is served at home and should be of ready-to-feed strength or liquid concentrate to be diluted using cold water from a source approved by the health department.

Powdered infant formula, though it is the least expensive formula, requires special handling in mixing because it cannot be sterilized. Before opening the can, hands should be washed. The can and plastic lid should be thoroughly rinsed and dried. Also, a scoop can be contaminated with a potential allergen from another type of formula. Iron-fortified formula should be refrigerated until immediately before feeding. For bottles containing formula, any contents remaining after a feeding should be discarded.

Any prepared formula must be discarded within one hour after serving to an infant. Some infants will require specialized formula because of allergy, inability to digest certain formulas, or need for extra calories. The appropriate formula should always be available and should be fed as directed. For those infants getting supplemental calories, the formula may be prepared in a different way from the directions on the container. Formula should not be used beyond the stated shelf life period 3.

The bottles must be sanitary, properly prepared and stored, and must be the same brand in the early care and education program and at home. Avoid bottles made of plastics containing bisphenol A BPA or phthalates sometimes labeled with 3, 6, or 7. Question: Can infants who are able to sit and hold their own bottles feed themselves or should all infants through 12 months be held during feedings?

Answer: Infants should always be held for bottle feeding. Infants should always be held for bottle feeding. Bottles should never be propped. The facility should not permit infants to have bottles in the crib. The facility should not permit an infant to carry a bottle while standing, walking, or running around. Bottle feeding techniques should mimic approaches to breastfeeding: a. Initiate feeding when infant provides cues rooting, sucking, etc. Hold the infant during feedings and respond to vocalizations with eye contact and vocalizations; c.

Allow breaks during the feeding for burping; e. Allow infant to stop the feeding. Bottles should be checked to ensure they are given to the appropriate child, have human milk, infant formula, or water in them. When using a bottle for a breastfed infant, a nipple with a cylindrical teat and a wider base is usually preferable. A shorter or softer nipple may be helpful for infants with a hypersensitive gag reflex, or those who cannot get their lips well back on the wide base of the teat 1.

Question: I have concerns about the standards recommending glass and ceramic containers due to concerns about using plastic. I had a center that had a glass bottle drop and shatter in their infant room. Answer: BPA-free plastic bottles, those labeled 1, 2, 4, or 5, can be used to avoid the use of glass. For those child care and early education facilities that choose to use glass bottles, a relatively new option is to use a bottle sleeve with the glass bottle to reduce the risk of shattered glass.

Efficacy on this product is still being proven. Overall, glass is safer than plastic with BPA. Bottles and infant foods do not have to be warmed; they can be served cold from the refrigerator. Bottles should not be left in a pot of water to warm for more than 5 minutes. Infant foods should be stirred carefully to distribute the heat evenly.

Bisphenol A BPA -free plastic; plastic labeled 1, 2, 4, or 5, or. Bottles of human milk or infant formula that are warmed at room temperature or in warm water for an inappropriate period provide an ideal medium for bacteria to grow. Infants have received burns from hot water dripping from an infant bottle that was removed from a crock-pot or by pulling the crock-pot down on themselves by means of a dangling cord.

Caution should be exercised to avoid raising the water temperature above a safe level for warming infant formula or infant food. Food safety for moms to be: once baby arrives. Updated November 8, Pediatric oral burns: a ten-year review of patient characteristics, etiologies and treatment outcomes. Int J Pediatr Otorhinolaryngol. Environmental Working Group. Guide to baby-safe bottles and formula. Updated October, Bottles, bottle caps, nipples, and other equipment used for bottle-feeding should be thoroughly cleaned after each use by washing in a dishwasher or by washing with a bottlebrush, soap, and water 1.

Formula and milk promote growth of bacteria, yeast, and fungi 2. Bottles, bottle caps, and nipples that are reused should be washed and sanitized to avoid contamination from previous feedings. Excessive boiling of latex bottle nipples will damage them.

How to clean, sanitize, and store infant feeding items. Updated April 11, How to safely clean baby bottles. Published February 16, However, recommendations on the introduction of complementary foods provided to caregivers of infants should take into account:. For infants who are exclusively breastfed, the amount of certain nutrients in the body - such as iron and zinc - begins to decrease after 6 months of age. The first food introduced should be a single-ingredient food that is served in a small portion for 2 to 7 days 3.

Gradually increase variety and portion of foods, one at a time, as tolerated by the infant 4. These include sitting up with minimal support, proper head control, ability to chew well, or grabbing food from the plate. Additionally, infants will lose the tongue-thrusting reflex and begin acting hungry after formula feeding or breastfeeding 3.

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Early introduction of age-appropriate solid food and fruit juice interferes with the intake of human milk or iron-fortified formula that the infant needs for growth. Age-appropriate solid foods given before an infant is developmentally ready may be associated with allergies and digestive problems 5. Age-appropriate solid foods, such as meat and fortified cereals, are needed beginning at 6 months of age to make up for any potential losses in zinc and iron during exclusive breastfeeding 3. Typically, low levels of vitamin D are transferred to infants via breast milk, warranting the recommendation that breastfed or partially breastfed infants receive a minimum daily intake of IU of vitamin D supplementation beginning soon after birth 6.

Additionally, for infants who are exclusively formula fed or given a combination of formula and human milk, evidence for introducing complementary foods in a specific order has not been established. Chapter 5: Complementary foods. In: Infant Nutrition and Feeding. American Academy of Pediatrics. Working together: breastfeeding and solid foods.

Updated November 21, World Health Organization.

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Infant and young child feeding. Updated July Introducing solid food: age of introduction and its effect on risk of food allergy and other atopic diseases. Can Fam Physician. Vitamin D3 supplementation during pregnancy and lactation improves vitamin D status of the mother-infant dyad. J Obstet Gynecol Neonatal Nurs. BMC Public Health. All jars of baby food should be washed with soap and warm water and rinsed with clean, running warm water before opening.

All commercially packaged baby food should be served from a dish and spoon, not directly from a factory-sealed container or jar 1. A dish should be cleaned and sanitized before use to reduce the likelihood of surface contamination. If left out, all food should be discarded after 2 hours 4. The portion of the food that is touched by a utensil should be consumed or discarded.

Any food brought from home should not be served to other children.

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This will prevent cross contamination and reinforce the policy that food sent to the facility is for the designated child only. Unused portions in opened factory-sealed baby food containers or food brought in containers prepared at home should be stored in the refrigerator and discarded if not consumed after 24 hours of storage.

Feeding of age-appropriate solid foods in a bottle to a child is often associated with premature feeding ie, when the infant is not developmentally ready for solid foods 5,6. Lester J. Nutrition introducing solid foods. Published February 22, Food Safety and Inspection Service Web site. Baby food and infant formula. Publication FNS Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.

Where we stand: soy formulas. Infant feeding guide. WIC Works Web site. Modified October 31, Flavored milks contain higher amounts of added sugars and should not be served. Water should not be offered to children during mealtimes; instead, offer water throughout the day.

Early care and education settings should check with state regulators about the timing between meals. State agencies may require any institution or facility to allow a specific amount of time to elapse between meal services or require that meal services not exceed a specified duration 2. Following CACFP guidelines ensures that all children enrolled receive a greater variety of vegetables and fruits and more whole grains and less added sugar and saturated fat during their meals while in care 3.

Even during periods of slower growth, children must continue to eat nutritious foods. Picky or selective eating is common among toddlers. Over time, with consistent exposure, toddlers are more likely to accept new foods 4. The facility should serve toddlers and preschoolers small, age-appropriate portions.

The facility should permit children to have one or more additional servings of nutritious foods that are low in fat, sugar, and sodium as required to meet the caloric needs of the individual child. Young children should learn what appropriate portion size is by being served plates, bowls, and cups that are developmentally and age appropriate. Usually a reasonable amount of additional food is prepared to respond to any spills or to children requesting a second serving.

Children should continue to be exposed to new foods, textures, and tastes throughout infancy, toddlerhood, and preschool. Children should not be required or forced to eat any specific food items. A child will not eat the same amount each day because appetites vary and food jags are common 2.

Eating habits established in infancy and early childhood may contribute to optimal eating patterns later in life. The quality of snacks for young and school-aged children is especially important, and small, frequent feedings are recommended to achieve the total desired daily intake. Strong evidence supports that larger plates, bowls, and cups, when paired with sustained long-term exposure of oversized portions, promote overeating 3.

Allowing children to decide how much to eat, through family-style dining, may also help promote self-regulation in children 3. Preschool children's sensitivity to teacher-served portion size is linked to age related differences in leftovers. How to improve eating behavior during early childhood. Pediatric Gastroenterol Hepatol Nutr. An explanatory framework of teachers' perceptions of a positive mealtime environment in a preschool setting. All of which are developmentally appropriate for young children to feed themselves.

Children can also use their fingers for self-feeding. Children in group care should be provided with opportunities to serve and eat a variety of food for themselves. As children enter the second year after birth, they are interested in doing things for themselves. Self-feeding appropriately separates the responsibilities of adults and children. To allow for the proper development of motor skills and eating habits, children need to be allowed to practice feeding themselves as early as 9 months of age 3,4.

Children will continue to self-feed using their fingers even after mastering the use of a utensil. J Pediatr Gastroenterol Nutr. Williamson C, Beatty C. Weaning and childhood nutrition. Children between 12 and 24 months of age can be served whole pasteurized milk 1. Milk provides many nutrients that are essential for the growth and development of young children. The fat content in whole milk is critical for brain development as well as satiety in children 12 to 24 months of age 3.

For those children whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or early cardiovascular disease, the primary health care provider may request low-fat or nonfat milk 2. Some early care and education programs have children between the ages of 18 months and 3 years in one classroom. To avoid errors in serving inappropriate milk, programs can use individual milk pitchers clearly labeled for each type of milk being served. Prevention of cardiovascular disease in pediatric populations.

In: Bright Futures: Nutrition. Children attending facilities for 2 or more hours after school need at least 1 snack. Breakfast, or a morning snack, is recommended for all children enrolled in an early care and education facility or in school. Depending on age and length of time in care, snacks should occur 2 hours after a scheduled meal.

State agencies may require any institution or facility to allow a specific amount of time to elapse between meal services or require that meal services not exceed a specified duration 1,2. Early childhood is a time of rapid growth that increases the need for energy and essential nutrients to support optimal growth 2. Food intake may vary considerably because this is a time when children express strong food likes and dislikes.

The CACFP requirements ensure that children in child care centers for longer than 8 hours common in military child development centers, for example are given the appropriate number of meals and snacks to meet individual caloric and nutrient needs 1. Family style meal service, with the serving platters, bowls, and pitchers on the table so all present can serve themselves, should be encouraged, except for infants and very young children who require an adult to feed them. A separate utensil should be used for serving. Children should not handle foods that they will not be consuming.

The adults should encourage, but not force, the children to help themselves to all food components offered at the meal. When eating meals with children, the adult s should eat items that meet nutrition standards. The adult s should encourage social interaction and conversation, using vocabulary related to the concepts of color, shape, size, quantity, number, temperature of food, and events of the day.

Extra assistance and time should be provided for slow eaters. Eating should be an enjoyable experience at the facility and at home. Special accommodations should be made for children who cannot have the food that is being served. Children who need limited portion sizes should be taught and monitored. One adult should not feed more than one infant or three children who need adult assistance with feeding at the same time. When eating, children should be within sight of an adult at all times. Both older children and staff should be actively involved in serving food and other mealtime activities, such as setting and cleaning the table.

Staff should supervise and assist children with appropriate handwashing procedures before and after meals and sanitizing of eating surfaces and utensils to prevent cross contamination. Experiences with new foods can include tasting and swallowing but also include engagement of all senses seeing, smelling, speaking, etc. Children should be seated when eating. Children should not be allowed to continue to feed themselves or continue to be assisted with feeding themselves if they begin to fall asleep while eating.

The nutrition plan encompasses:. Potentially hazardous and perishable foods should be refrigerated and all foods should be protected against contamination. The facility should have a nutrition plan that integrates the introduction of food and feeding experiences with facility activities and home feeding.

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The plan should include opportunities for children to develop the knowledge and skills necessary to make appropriate food choices. The children should have the opportunity to feel the textures and learn the different colors, sizes, and shapes of foods and the nutritional benefits of eating healthy foods. Children should also be taught about appropriate portion sizes. The teaching should be evident at mealtimes and during curricular activities, and emphasize the pleasure of eating.

The key to identifying a qualified nutrition professional is seeking a record of training in pediatric nutrition normal nutrition, nutrition for children with special health care needs, dietary modifications and experience and competency in basic food service systems. Early care and education programs should create and implement written program plans addressing the physical, oral, mental, nutritional, and social and emotional health, physical activity, and safety aspects of each formally structured activity documented in the written curriculum.

These plans should include daily opportunities to learn health habits that prevent infection and significant injuries and health habits that support healthful eating, nutrition education, physical activity, and sleep. Awareness of healthy and safe behaviors, including good nutrition, physical activity, and sleep habits, should be an integral part of the overall program. Young children learn better through experiencing an activity and observing behavior than through didactic methods 1.

There may be a reciprocal relationship between learning and play so that play experiences are closely related to learning 2. Children can accept and follow rules, routines, and guidelines about health and safety when their personal experience helps them to understand why these rules were created. National guidelines for children birth to age 5 years encourage their engagement in daily physical activity that promotes movement, motor skills, and the foundations of health-related fitness 3.

Physical activity is important to overall health and to overweight and obesity prevention 4. Healthy sleep habits e.

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Shorter sleep duration is associated with increased risk for being overweight at ages 9 to 12 years. Bedtime in preschool-aged children and risk for adolescent obesity. Sleep duration and obesity in children: a systematic review and meta-analysis of prospective cohort studies. J Paediatr Child Health. Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis. Obes Rev. Time for bed: associations with cognitive performance in 7-year-old children: a longitudinal population-based study.

J Epidemiol Community Health. PE goal number 1 Simons-Morton, ]. Moreover, it is possible that the lack of policy, curriculum development or teacher expertise in this area contributes to the considerable variation in physical activity levels during PE Stratton, a. However, objective research evidence suggests that this is mainly due to differences in pedagogical variables [i.

Borys, ; Stratton, a ]. Furthermore, PE activity participation may be influenced by inter-individual factors. For example, activity has been reported to be lower among students with greater body mass and body fat Brooke et al. In addition, highly skilled students are generally more active than their lesser skilled peers Li and Dunham, ; Stratton, b and boys tend to engage in more PE activity than girls Stratton, b ; McKenzie et al.

Such inter-individual factors are likely to have significant implications for pedagogical practice and therefore warrant further investigation. In accordance with Simons-Morton's Simons-Morton, first proposed aim of PE, the purpose of this study was to assess English students' physical activity levels during high school PE. The data were considered in relation to recommended levels of physical activity Biddle et al.

Specific attention was paid to differences between sex and ability groups, as well as during different PE activities. One hundred and twenty-two students 62 boys and 60 girls from five state high schools in Merseyside, England participated in this study. Stage sampling was used in each school to randomly select one boys' and one girls' PE class, in each of Years 7 11—12 years , 8 12—13 years and 9 13—14 years. Three students per class were randomly selected to take part. Written informed consent was completed prior to the study commencing.

The schools taught the statutory programmes of study detailed in the NCPE, which is organized into six activity areas i. The students attended two weekly PE classes in mixed ability, single-sex groups. Girls and boys were taught by male and female specialist physical educators, respectively. Such systems measure the physiological load on the participants' cardiorespiratory systems, and allow analysis of the frequency, duration and intensity of physical activity. HR telemetry has been shown to be a valid and reliable measure of young people's physical activity Freedson and Miller, and has been used extensively in PE settings Stratton, a.

The students were fitted with the HR telemeters while changing into their PE uniforms. HR was recorded once every 5 s for the duration of the lessons. Telemeters were set to record when the teachers officially began the lessons, and stopped at the end of lessons. At the end of the lessons the telemeters were removed and data were downloaded for analyses. Resting HRs were obtained on non-PE days while the students lay in a supine position for a period of 10 min. The lowest mean value obtained over 1 min represented resting HR. Students achieved maximum HR values following completion of the Balke treadmill test to assess cardiorespiratory fitness Rowland, This data was not used in the present study, but was collated for another investigation assessing children's health and fitness status.

HRR accounts for age and gender HR differences, and is recommended when using HR to assess physical activity in children Stratton, a. This threshold represents the intensity that may stimulate improvements in cardiorespiratory fitness Morrow and Freedson, and was used to indicate the proportion of lesson time that students were active at this higher level. Sixty-six lessons were monitored over a week period, covering a variety of group and individual activities Table I.

In order to allow statistically meaningful comparisons between different types of activities, students were classified as participants in activities that shared similar characteristics. These were, team games [i. The intention was to monitor equal numbers of students during lessons in each of the four designated PE activity categories. However, timetable constraints and student absence meant that true equity was not possible, and so the number of boys and girls monitored in the different activities was unequal.

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  6. Exploratory analyses were conducted to establish whether data met parametric assumptions. Subsequent Levene's tests confirmed the data's homogeneity of variance, with the exception of VPA between the PE activities. Though much of the data violated the assumption of normality, the ANOVA is considered to be robust enough to produce valid results in this situation Vincent, Considering this, alongside the fact that the data had homogenous variability, it was decided to proceed with ANOVA for all analyses, with the exception of VPA between different PE activities.

    Post-hoc analyses were performed using Hochberg's GT2 correction procedure, which is recommended when sample sizes are unequal Field, Post-hoc Mann—Whitney U -tests determined where identified differences occurred. All data were analyzed using SPSS version The average duration of PE lessons was The high-ability students were more active than the average- and low-ability students, who took part in similar amounts of activity. These trends were apparent in boys and girls Table II.

    Boys engaged in MVPA for When expressed as absolute units of time, these data were the equivalent of Students participated in most MVPA during team games [ Individual games and individual activities provided a similar stimulus for activity, while the least MVPA was observed during movement activities Once more, team games Students produced small amounts of VPA during individual and movement activities, although this varied considerably in the latter activity Figure 2.

    This study used HR telemetry to assess physical activity levels during a range of high school PE lessons. Furthermore, the data were subject to considerable variance, which was exemplified by high standard deviation values Table II , and Figures 1 and 2. Such variation in activity levels reflects the influence of PE-specific contextual and pedagogical factors [i.

    Stratton, a ]. The superior physical activity levels of the high-ability students concurred with previous findings Li and Dunham, ; Stratton, b. While it is possible that the teachers may have inaccurately assessed the low and average students' competence, it could have been that the low-ability group displayed more effort, either because they were being monitored or because they associated effort with perceived ability Lintunen, However, these suggestions are speculative and are not supported by the data. The differences in activity levels between the ability groups lend some support to the criticism that PE teachers sometimes teach the class as one and the same rather than planning for individual differences Metzler, If this were the case then undifferentiated activities may have been beyond the capability of the lesser skilled students.

    This highlights the importance of motor competence as an enabling factor for physical activity participation. If a student is unable to perform the requisite motor skills to competently engage in a given task or activity, then their opportunities for meaningful participation become compromised Rink, Over time this has serious consequences for the likelihood of a young person being able or motivated enough to get involved in physical activity which is dependent on a degree of fundamental motor competence.

    Boys' activity levels equated to It is possible that the characteristics and aims of some of the PE activities that the girls took part in did not predispose them to engage in whole body movement as much as the boys. Specifically, the girls participated in 10 more movement lessons and eight less team games lessons than the boys. The natures of these two activities are diverse, with whole body movement at differing speeds being the emphasis during team games, compared to aesthetic awareness and control during movement activities.

    The monitored lessons reflected typical boys' and girls' PE curricula, and the fact that girls do more dance and gymnastics than boys inevitably restricts their MVPA engagement. Although unrecorded contextual factors may have contributed to this difference, it is also possible that the girls were less motivated than the boys to physically exert themselves. Moreover, there is evidence Dickenson and Sparkes, ; Goudas and Biddle, to suggest that some pupils, and girls in particular Cockburn, , may dislike overly exerting themselves during PE.

    Although physical activity is what makes PE unique from other school subjects, some girls may not see it as such an integral part of their PE experience. It is important that this perception is clearly recognized if lessons are to be seen as enjoyable and relevant, whilst at the same time contributing meaningfully to physical activity levels.

    Girls tend to be habitually less active than boys and their levels of activity participation start to decline at an earlier age Armstrong and Welsman, Therefore, the importance of PE for girls as a means of them experiencing regular health-enhancing physical activity cannot be understated. This concurs with data from previous investigations Strand and Reeder, ; Stratton, a , ; Fairclough, a. Because these activities require the use of a significant proportion of muscle mass, the heart must maintain the oxygen demand by beating faster and increasing stroke volume.

    Moreover, as team games account for the majority of PE curriculum time Fairclough and Stratton, ; Sport England, , teachers may actually be more experienced and skilled at delivering quality lessons with minimal stationary waiting and instruction time. Similarly high levels of activity were observed during individual activities. With the exception of throwing and jumping themes during athletics lessons, the other individual activities i. MVPA and VPA were lowest during movement activities, which mirrored previous research involving dance and gymnastics Stratton, ; Fairclough, a.

    Furthermore, individual games provided less opportunity for activity than team games. The characteristics of movement activities and individual games respectively emphasize aesthetic appreciation and motor skill development. This can mean that opportunities to promote cardiorespiratory health may be less than in other activities. However, dance and gymnastics can develop flexibility, and muscular strength and endurance. Thus, these activities may be valuable to assist young people in meeting the HDA's secondary physical activity recommendation, which relates to musculo-skeletal health Biddle et al.

    The question of whether PE can solely contribute to young people's cardiorespiratory fitness was clearly answered. The students engaged in small amounts of VPA 4. Combined with the limited frequency of curricular PE, these were insufficient durations for gains in cardiorespiratory fitness to occur Armstrong and Welsman, Teachers who aim to increase students' cardiorespiratory fitness may deliver lessons focused exclusively on high intensity exercise, which can effectively increase HR Baquet et al.

    Such lessons may undermine other efforts to promote physical activity participation if they are not delivered within an enjoyable, educational and developmental context. It is clear that high intensity activity is not appropriate for all pupils, and so opportunities should be provided for them to be able to work at developmentally appropriate levels. This approximates a third of the recommended daily hour Biddle et al. When PE activity is combined with other forms of physical activity support is lent to the premise that PE lessons can directly benefit young people's health status.

    Furthermore, for the very least active children who should initially aim to achieve 30 min of activity per day Biddle et al. However, a major limitation to PE's utility as a vehicle for physical activity participation is the limited time allocated to it. While some schools provide this volume of weekly PE, others are unable to achieve it Sport England, The HDA recommend that young people strive to achieve 1 hour's physical activity each day through many forms, a prominent one of which is PE.

    The apparent disparity between recommended physical activity levels and limited curriculum PE time serves to highlight the complementary role that education, along with other agencies and voluntary organizations must play in providing young people with physical activity opportunities. Notwithstanding this, increasing the amount of PE curriculum time in schools would be a positive step in enabling the subject to meet its health-related goals.

    Physical educators are key personnel to help young people achieve physical activity goals. As well as their teaching role they are well placed to encourage out of school physical activity, help students become independent participants and inform them about initiatives in the community McKenzie et al. Also, they can have a direct impact by promoting increased opportunities for physical activity within the school context. These could include activities before school Strand et al. Using time in this way would complement PE's role by providing physical activity opportunities in a less structured and pedagogically constrained manner.

    In this sense it provided a representative picture of the frequency, intensity and duration of students' physical activity engagement during curricular PE. However, some factors should be considered when interpreting the findings. First, the data were cross-sectional and collected over a relatively short time frame. Tracking students' activity levels over a number of PE activities may have allowed a more accurate account of how physical activity varies in different aspects of the curriculum.

    Second, monitoring a larger sample of students over more lessons may have enabled PE activities to be categorized into more homogenous groups. Third, monitoring lessons in schools from a wider geographical area may have enabled stronger generalization of the results. Fourth, it is possible that the PE lessons were taught differently, and that the students acted differently as a result of being monitored and having the researchers present during lessons.

    As this is impossible to determine, it is unknown how this might have affected the results. Fifth, HR telemetry does not provide any contextual information about the monitored lessons.