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Health Promotion in Nursery Schools and Child Day-care Centres

Antje Richter-Kornweitz

(last update 08 June 2015)

Health promotion in day-care facilities starts in routine. It is designed to take into account the living and working conditions in the establishment and teach a positive concept of health. The focus here is not just on promoting attitudes and behaviors relevant to health, but also on developing the necessary general conditions. Health promotion in day-care facilities includes services and activities for all those who regularly spend time there as well as collaboration with the relevant institutions and individuals in the facility’s social environment. The goal is to turn the entire day-care facility into a healthy living environment.

Despite an overall positive assessment of child health in Germany, around twenty percent of girls and boys still exhibit problematic features relating to their health. Among children of kindergarten and preschool age, this includes developmental abnormalities in the areas of language, motor skills, nutrition and behavior. Particular risks exist for children if their families face multiple stress factors such as low income and/or unemployment, a large number of children, social isolation, a migration background, a difficult living environment. The resulting living conditions can have a negative impact on their further physical, psychological and social development.

It is in childhood that the course is largely set for the further development of good physical and mental health. Children’s abilities and opportunities to exploit health potentials throughout their further life or to avoid risks are largely dependent on what competencies and orientations they were taught during the early phases of their life. Measures to improve the health opportunities of girls and boys should therefore start as early as possible in life. Day-care centers are a suitable setting.

Health-related activities in the areas of promoting physical activity, hygiene and nutrition are among the daily routines in many day-care facilities. Further measures in the sphere of child health - such as preventing addiction and violence, promoting language development etc. - are often delivered to the facilities from the outside as individual, successive and separate projects. That way, day-care facilities become access points for health-promotion measures and services delivered by outside organizations. Project providers can turn to individual day-care facilities, work with schools and other institutions or bring many day-care centers together in a larger project. The project ‘Leibeslust - Lebenslust’ from Schleswig-Holstein, which is about the prevention of eating disorders, run in kindergarten and primary school, or the pilot project ‘gesunde kitas - starke kinder’ run by “Plattform Bewegung und Ernährung”, in which 50 day-care centers participated, are good examples of this (see ‘internet addresses’). Success doesn’t just depend on the quality of the concepts or the qualifications of the individuals conducting the programs; it is also decided by the framework conditions in the day-care facilities (the size of the institution, staff resources, spatial conditions, social conditions in the neighborhood, the institution providing the funding, the methodical approach etc.). Therefore a thorough analysis of the general conditions and project characteristics should take place before the start of the project.

Above and beyond this function as project recipients, day-care facilities could also become sources of inspiration and the starting point for comprehensive activities to promote health, as long as they choose a systematic approach based on the Setting Approach. Settings are social systems that exert a strong influence on health and in which the conditions for health can be shaped and influenced. The goals of health promotion in the day-care setting include:

  • shaping the entire living and working environment in the day-care center so that it promotes health
  • strengthening the health resources and competencies of the staff, children and parents and to teach them a positive concept of health.

Setting-oriented health promotion is anchored in the day-care living environment and requires comprehensive participation. Its goal is to involve everyone present in day-care facilities, and to trigger a positive process of change from which the entire facility and all the people involved will benefit. In addition to the children, this includes all those employed in the educational and non-educational sphere as well as the parents. A further important sphere of action is the facility’s ‘social environment’ with all the activities for co-operation and networking with partners such as the public health service, children’s and youth welfare institutions (incl. the Early Help facilities), therapeutic and advisory/counselling institutions, doctors, family education and schools.

When health as an organizational goal is anchored in all the regularly recurring everyday routines and educational services, this process can not only contribute to health promotion but also to an increase in the quality of the children’s education and upbringing.  

Figure 1. The four spheres of action in health promotion in day-care facilities (source: Richter-Kornweitz and Altgeld 2010).

Figure 1. The four spheres of action in health promotion in day-care facilities (source: Richter-Kornweitz and Altgeld 2010)

Health promotion in the day-care setting is not an abstract goal. It is delivered and maintained in these facilities’ everyday routine. It is not exclusively aimed at children; rather, it also includes everyone else in the day-care center, i.e. staff and parents, taking the social context into account (see Figure 1).

The example of ‘Bewegungskindergärten’ (kindergartens with a strong focus on physical activity) demonstrates what can also be applied to other areas. Institutions can conduct physical-activity programs in co-operation with local sports clubs, or they can develop their own concepts. Kindergarten teachers can acquire an exercise instructor license while the day-care facility organizes parent-and-child exercise sessions. In some day-care centers parents get involved in transforming the outside space into an area conducive to physical activity. Major funders of day-care centers also organize in-house exercise services for the staff.

All of the day-care center’s space, including a garden if one is available, can be used to encourage physical exercise. If there is not much available space, the solution is to equip the facility with materials that can be used in a multitude of ways to make it more exercise-friendly and to use the open space in the surrounding area.

Setting-oriented health promotion also incorporates the work-related health situation of the staff (Health Promotion in the Workplace). The employees’ working days are shaped by a large number of cumulative stress factors, but also by specific health potentials. Much of this is connected in a structural and organizational manner with the framework conditions of the day-care centers (e.g., how the work is organized and the space available). In addition, the employees suffer typical stress factors of noise, unfavorable postures and the carrying and lifting of heavy loads, as well as psychological and emotional stress factors. As a result, employees are particularly likely to suffer from back pain, headaches, being generally overwhelmed by nervous tension and circulatory problems. On the other hand, day-care staff say that their positive resources include their high level of identification with their work, a great potential for creativity in the work process and in independent planning, a high level of solidarity with colleagues, and good opportunities for gaining further professional qualifications.

Concepts to promote health in the day-care setting pick up on this situation. Using participatory methods, suggestions for improvement are developed together with the employees, and implemented with their involvement.

A further sphere of action is work with parents. Their participation is incredibly important, since children can be supported both directly and via support given to their parents. In addition, the effects can be more long-lasting if there is a transfer of knowledge and competencies from the day-care facility to the family. The principles of this work are participation and empowerment as the fundamental attitudes towards parents, as well as the implementation of a trusting and open dialogue to determine the needs of families. The curriculum ‘Gesund aufwachsen in der Kita - Zusammenarbeit mit Eltern stärken’ (Growing up healthy in day-care - strengthening collaboration with parents) published by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung) is a good example of this (see references).

In addition to the three spheres of action already mentioned, health promotion in the day-care setting is also focused on networking and co-operation in the social environment, in other words, with nearby institutions and those with a related professional orientation, and, in the best case, through collaboration in a chain of prevention. One important goal would then be the exchange of competencies, services and experiences that could supplement the expert profile of the day-care center.
In addition to the collaboration with the above-mentioned institutions and individuals, it is also conceivable that there could be co-operation with sports clubs, cultural institutions, advice centers and/or neighborhood centers. This is where the social component of health and wellbeing is located as the World Health Organization (WHO) understands it, meaning the health-promoting effect of social integration in a community, where day-care centers can take on a central and coordinating role.

Alice-Salomon-Hochschule Berlin, STEGE final report. Strukturqualität und Erzieher_innengesundheit in Kindertageseinrichtungen, Berlin 2013.
Retrieved from
Bundeszentale für gesundheitliche Aufklärung, Gesund aufwachsen in der Kita - Zusammenarbeit mit Eltern stärken. Curriculum zur Zusammenarbeit mit Eltern in der Gesundheitsförderung, Cologne 2014.
Retrieved from
Freistaat Sachsen - Staatsministerium für Soziales, Gesund aufwachsen in Sachsen: Handbuch für Erzieherinnen und Erzieher, Dresden 2008.
Retrieved from
Kliche T et al, Prävention und Gesundheitsförderung in Kindertagesstätten, Juventa Verlag, Weinheim 2008;
Richter-Kornweitz A/Altgeld T, Gesunde Kita für alle! Leitfaden zur Gesundheitsförderung im Setting Kindertagesstätte. Broschüre. Gefördert durch das Bundesministerium für Gesundheit im Rahmen des nationalen Aktionsplans “IN FORM - Deutschlands Initiative für gesunde Ernährung und mehr Bewegung“, Hanover, Berlin 2010.
Retrieved from
Werkbuch Präventionskette. Herausforderungen und Chancen beim Aufbau von Präventionsketten in Kommunen. Landesvereinigung für Gesundheit und Bundeszentrale für gesundheitliche Aufklärung, Hanover 2013.
Retrieved from

Internet addresses:
http://www.gesunde-kita.net/Startseite.334.0.html (”Netzwerk Gesunde Kita Brandenburg“)
http://www.gesundheit-nds.de/index.php/netzwerke/111-netzwerk-kita-und-gesundheit-niedersachsen (”Netzwerk Kita und Gesundheit Niedersachsen“)
http://lvgfsh.de/gesundheitsfoerderung/arbeitsschwerpunkte/servicebuero-kita-und-schule/lebenslust.php (Projekt Lebenslust-Leibeslust)
www.ernaehrung-und-bewegung.de/ (”gesunde kitas - starke kinder“)

Links: Setting Approach

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Federal Centre for Health Education (BZgA) / Maarweg 149-161 / 50825 Köln / Tel +49 221 8992-0 / Fax +49 221 8992-300 /
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The Federal Centre for Health Education (BZgA) is a specialist authority within the portfolio of the Federal Ministry of Health.