Approximately 12.5 million young children are cared for in early care and education (ECE) settings at least once per week, making ECE an important setting to support nutrition, physical activity (PA), breastfeeding, and other health and wellness topics. National standards have been developed for the ECE setting, but the extent to which nutrition and PA standards are being translated to everyday policies and practices is unknown, as information has not been collected in a consistent way across states and communities. This brief report provides descriptive data from 221 ECE centers in four states in 2021 using a standardized survey called the Childcare Survey of Activity and Wellness (C-SAW). Information on the development, piloting, resulting descriptive data, and future implications for C-SAW in public health practice are presented in this brief. The C-SAW survey and all ancillary materials are freely available for use by public health professionals in states and communities to better understand ECE programs in their jurisdictions or to evaluate efforts to improve nutrition, PA, breastfeeding, and other health topics over time.

INTRODUCTION: This study examined the prevalence and correlates of 6 healthy behaviors among preschool-age children in the United States. METHODS: Data from the 2021 and 2022 National Survey of Children's Health were used to examine daily fruit consumption, daily vegetable consumption, no sugary beverage consumption in the past week, frequent outdoor play (≥2 hours/day), limited screen time (≤1 hour/weekday), and adequate sleep (≥10 hours/day) among children ages 3-5 years (N=23,123). Relationships between healthy behaviorss and child, family, community characteristics, and state of residence were examined using logistic regression modeling, accounting for the complex survey design. Analyses were conducted in 2024 using SAS-callable SUDAAN. RESULTS: Prevalence of healthy behaviors varied from 32.4% having no sugary drinks in the past week to 65.3% eating fruit daily. Only 20% engaged in all or nearly all (5-6) healthy behaviors. After adjustment, children engaging in 5-6 HBs were more likely to be younger, non-Hispanic White, have parents with higher education and income, excellent/very good parental mental health, frequent family meals, household food sufficiency, and live in safe neighborhoods, yet prevalence rose to only 30% across any characteristic. The proportion of children engaging in 5-6 healthy behaviors ranged from 6.5% in Mississippi to 46.4% in Vermont, with child, family, and community factors accounting for 43% of the variance between states. CONCLUSIONS: There is a need to increase healthy behaviors among preschool-age children and address disparities. Family and community factors associated with healthy behaviors can inform pediatric care, public policy, programmatic investments, and additional research to foster improvement.

INTRODUCTION: Federal guidelines recommend physical activity throughout the day for preschool-aged children. Time playing outdoors can support physical activity participation, health, and development. Estimates of time playing outdoors among US children aged 3-5 years have not been published. METHODS: Parent/caregiver-reported data on children aged 3-5 years from the 2021 National Survey of Children's Health were analyzed in 2022-23. Chi-square tests were used to identify differences in time playing outdoors by sociodemographic and neighborhood characteristics. Multiple logistic regression analyses were conducted with significant characteristics for weekdays and weekend days. RESULTS: Among 11,743 children aged 3-5 years, 37% played outdoors for ≤1 hour on weekdays, and 24% played outdoors for ≤1 hour on weekend days. In 9 states, ≥40% of children played outdoors for ≤1 hour on weekdays. Adjusted models for weekdays and weekend days showed a greater likelihood of ≤1 hour playing outdoors among those in all racial/ethnic groups compared to Non-Hispanic White, those who lived in metropolitan statistical areas, those who did not participate in child care, and those whose adult proxy disagreed with "we watch out for each other's children in this neighborhood." The weekday model showed additional differences by sex, with girls more likely to have ≤1 hour of time playing outdoors. CONCLUSIONS: Nearly 40% of preschool-aged children play outdoors for ≤1 hour per day on weekdays, with differences by sociodemographic and neighborhood characteristics. Further study and interventions focused on building supportive, equitable communities might increase the amount of time preschool-aged children spend playing outdoors.