UNIT 5: PHYSICAL DEVELOPMENT OF

CHILDREN

TOPIC 1-INFANT GROWTH

The infant period is a time of extraordinary growth and development. In fact, infants
typically double their birth weight by four to six months of age and triple it by the time they turn
one. During their first year, infants increase their length by 50%, gaining about an inch per
month for the first six months and a 1/2 inch a month from six months to twelve months.
Immediately following birth, however, an infant normally loses about 10% of her birth weight
due to fluid loss and some tissue breakdown, according to the American Academy of Pediatrics.
Within 7 days, infants typically gain that weight back.
A child’s parents influence a child’s size. Taller parents tend to have taller children.
However, malnutrition, disease and other environmental factors can also influence a
child’s physical growth. It’s also important to note that the rate of growth of breastfed
and formula fed infants differ during the first year. Breastfed infants grow more rapidly
during the first 6 months but less rapidly during the remainder of the first year, according to the
American Academy of Pediatrics. 
Pediatricians use standardize height and weight charts to track a child’s physical
growth. There is one for boys and one for girls. Children are compared against their own
growth rate to track their growth process and with other children of the same age and
gender to track how they are growing in comparison to their peers. Ideally children follow
the same growth pattern growing at the same growth rate with their height and weight being
proportionate. 

TOPIC 2- PHYSICAL BRAIN DEVELOPMENT

An infant’s brain is about ¼ the size of an adult’s. At birth, a newborn’s head accounts for
roughly ¼ of an infant’s length. By age 3, a child’s brain will have reached at least 80% of its
full size, according to Zero to Three. 
The human brain and nervous system contain billions of neurons which form trillions of
connections and pathways. How many and how organized these connections are
influence a child’s life experience. 
Neurons multiply rapidly and before birth, the number of neurons that an individual will
have is at its highest. Throughout life, some new neurons may be produced but this is at
a far less rapid rate, according to Zero to Three. Before birth, neurons migrate to
various parts of the brain, but the connections of these neurons are incomplete and
need to be established. 
Early childhood experiences influence how a child’s brain becomes connected.  Early
sensory experiences create new synapses, or regions of the neurons where nerve
impulses are sent and received. A child’s brain becomes specialized as active synapses
are used and inactive ones are pruned. 
These connections are built rapidly during the early years of a child’s life as the child
has many new experiences. After early childhood, this process gradually slows down. 
In the brain, layers of a protein and fatty substance, called myelin, insulate the sensory
and motor neurons which make messages or impulses travel faster. This insulation
process, called myelination, continues into adolescence and enables children to
improve reaction times and coordination as they grow. 

TOPIC 3-EARLY EXPERIENCES AND THE

BRAIN
A child’s early experiences affect the development of a child’s neural pathways. While genetics
form the basic cells and general connections of brain regions, experiences fine-tune these
connections and help a child to adapt to his environment, according to Zero to
Three. Stimulation from sound and touch, as well as having needs met, enables the
neurons to branch out and develop on neural pathways. A lack of stimulation can
prevent neurons from reaching their fullest potential and children may not meet
expected milestones.
Abuse, neglect, lack of stimulation, malnourishment and exposure to drugs and toxins during
pregnancy can alter and effect brain development.  In fact, during early childhood if a child’s
needs for human interaction are not met, the development of thinking, language, social,
emotional and physical skills may not develop fully. Touch and stimulation are so critical
that even premature babies who receive it have superior growth and developmental
performance. 
 TOPIC 4-RATE OF PHYSICAL
DEVELOPMENT
While all children will develop at different rates, physical skills will develop in the same
sequence in all children. Even if a child has atypical physical development, his
development will still follow the same sequence. For example, all children will learn to
walk before they learn to run. 

TOPIC 5-PRENATAL DEVELOPMENT

The human growth direction is from the center of the body outwards to the arms, legs, finger and
toes and from the head to the feet. This outward direction of development is called
proximodistal development, proximo meaning near and distal meaning far and both
referring to center of the body, and the downward direction of development is called
cephalocaudal development, cephalo meaning head and caudal meaning tail, as in
development from head to tail. 
During the prenatal period, the brain develops first, and then the heart, lungs and internal organs
develop later. 
Growth and development also moves from general to specific and from simple to
complex. For example, at first a baby may move her arm, then move it with control, then
bend it, then bend it at the wrist, then reach and grasp for something with her hand and
then reach and grasp something with her fingers.  As she gains strength and
coordination, she can then hold a crayon for coloring, lace a string through lacing cards
and move her fingers with accuracy and precision to play an instrument.
The American College of Obstetricians and Gynecologists outlines the following stages of
prenatal development:
Weeks 1–4 of pregnancy
The dividing fertilized egg moves down the fallopian tube toward the uterus.
At about 5 days after fertilization, the cluster of dividing cells enters the uterus.
At about 8–9 days after fertilization, the cluster of cells (now called a blastocyst)
attaches to the lining of the uterus.
 
Weeks 5–8 of pregnancy
The placenta begins to form.
The brain and spinal cord begin to form.
The tissues that will form the heart begin to beat. The heartbeat can be detected during
an ultrasound exam at about 6 weeks of pregnancy.
Buds for limbs appear with paddle-like hands and feet.
The eyes, ears, and nose begin to develop. Eyelids form, but remain closed.
The genitals begin to develop.
By the end of the eighth week, all major organs and body systems have begun to
develop.
 
Weeks 9–12 of pregnancy
Buds for future teeth appear.
Fingers and toes start to form. Soft nails begin to form.
Bones and muscles begin to grow.
The intestines begin to form.
The backbone is soft and can flex.
The skin is thin and transparent.
The hands are more developed than the feet.
The arms are longer than the legs.
 
Weeks 13–16 of pregnancy
Eyebrows, eyelashes, and fingernails form.
Arms and legs can flex.
External sex organs are formed.
The placenta is fully formed.
The outer ear begins to develop.
The fetus can swallow and hear.
The neck is formed.
Kidneys are functioning and begin to produce urine.
In male fetuses, the testicles begin to descend from the abdomen.
Genitals become either male or female at week 14.
 
Weeks 17–20 of pregnancy
The sucking reflex develops. If the hand floats to the mouth, the fetus may suck his or
her thumb.
The skin is wrinkled, and the body is covered with a waxy coating (vernix) and fine hair
(lanugo).
The fetus is more active. You may be able to feel him or her move.
The fetus sleeps and wakes regularly.
Nails grow to the tips of the fingers.
The gallbladder begins producing bile, which is needed to digest nutrients.
In female fetuses, the eggs have formed in the ovaries.
It may be possible to tell the sex of the baby on an ultrasound exam.
 
Weeks 21–24 of pregnancy
Real hair begins to grow.
The brain is rapidly developing.
The eyes begin to open.
Finger and toe prints can be seen.
The lungs are fully formed but not yet functioning.
 
Weeks 25–28 of pregnancy
The eyes can open and close and sense changes in light.
Lanugo begins to disappear.
The fetus kicks and stretches.
The fetus can make grasping motions and responds to sound.
Lung cells begin to make surfactant.
 
Weeks 29–32 of pregnancy
With its major development finished, the fetus gains weight very quickly.
Bones harden, but the skull remains soft and flexible for delivery.
The different regions of the brain are forming.
Taste buds develop, and the fetus can taste sweet and sour.
The fetus may now hiccup.
 
Weeks 33–36 of pregnancy
The fetus usually stays in a head-down position in preparation for birth.
The brain continues to develop.
The skin is less wrinkled.
The lungs are maturing and getting ready to function outside the uterus.
Sleeping patterns develop.
 
Weeks 37–40 of pregnancy
The fetus drops lower into the pelvis.
More fat accumulates, especially around the elbows, knees, and shoulders.
The fetus gains about 1/2 pound per week during this last month of pregnancy.

TOPIC 6-MOTOR DEVELOPMENT

The term motor development refers to the development of a child’s muscles, bones and
ability to move around and manipulate her environment.  Motor development is broken
down into two main categories, gross motor development and fine motor development. 
Gross motor development refers to the development of the large muscles of the body.
Gross motor skills refers to movements involving the large muscles, like those in the
arms or legs, and are required for doing things like walking or jumping. 
Fine motor development refers to the development of the small muscles in the body.
Fine more skills refer to movements involving the small muscles, like those in your
hands and fingers and required for doing things like holding a crayon and coloring. 
Motor development also encompasses muscle strength and tone, or how well the
muscles work. Children have to have balanced development so that they can easily do
things like stand, sit and run. 
As children develop their motor skills, they also develop coordination. During the last few
months of the first year, an infant’s grasp changes from a palmar, whole hand grasp, to a pincer
or finger grasp. This allows older infants to point, put their fingers into openings and push
buttons on toys and real objects such as telephones and television and computer
equipment.
As children get older they may have better developed gross or fine motor skills
depending on their interests, coaching, drive and ability.
It’s important to remember that how well a child’s motor skills are developed can
influence how they experience their world. A child is better able to successfully explore
his environment if he is able to move with ease. 

TOPIC 7-MILESTONES
As children get older they not only grow in size, they grow in their ability to do more
complex things. To gauge how a child is developing, a pediatrician uses developmental
milestones to track development. These milestones are a set of age-specific skills or
tasks that most children can do during a specific age range. Each milestone involves
greater strength and coordination.
Children who are born prematurely typically hit developmental milestones based on
their corrected age. To determine a child’s corrected age, subtract the number of weeks the
child was born early from her chronological age. This correction is typically carried through the
first two to two and a half years when determining if children are meeting their developmental
milestones, according to the American Academy of Pediatrics. 
Nannies should be knowledgeable about developmental milestones and should mention
it to the parents if a child is not meeting milestones. The parents should be encouraged
to mention any possible delays to the child’s pediatrician. While children may hit
developmental milestones at different rates, if a child consistently lags in meeting
milestones, it should be discussed with the pediatrician to determine if the child is
delayed and in need of interventions. 
Parents and caregivers can use stimulating and age-appropriate activities to help
children reach developmental milestones. They should also take proper childproofing
measures to prepare for upcoming milestones, like removing breakables that are within
reach before a baby becomes mobile.

TOPIC 8-INFANT REFLEXES

A reflex is a muscle action that occurs in response to stimulation. These muscle actions
are instinctive and involuntary movements. Certain types of stimulations trigger certain
types of reflexes.
The rooting reflex is a survival reflex that presents itself when an infant turns his head
and opens mouth looking for food in response to his cheek or the area around his
mouth being lightly stroked. This reflex typically disappears around four months of age.
The swallowing reflex is another survival reflex. The swallowing reflex enables an infant to
suck and swallow milk from a breast or bottle. 
The Moro reflex presents itself when an infant flings his arms out and arches back in
response to being startled. This reflex typically disappears around two months of age.
The Babinski reflex presents itself when a baby spreads out his toes in response to the
sole of his foot being firmly stroked. This reflex disappears as children get older and
may start disappearing as early as 12 months of age; however its presence is normal up
until age two.
The stepping reflex presents when an infant lifts his feet like he’s taking steps in response
to being held in a standing position so the sole of his feet touch a firm surface. This
reflex typically disappears around two months of age.
Reflexes can be used to help determine the gestational age and neurological health of
an infant. Some reflexes, like the rooting reflex, are survival reflexes and others like the
griping and grasping reflexes will later develop into voluntary movements.
 TOPIC 9-PHYSICAL MILESTONES AT TWO
MONTHS
At two months, an infant is expected to lift his head and begin to push up when lying on his
stomach.
During this time an infant also begins to follow things with his eyes and can move his
arms and legs more smoothly. This includes having the ability to bring his hands to his
mouth.  During this period, hand and eye coordination is also developing and an infant can
focus his eyes on the faces of people near him. 
If at two months an infant is not bringing his hands to his mouth or is unable to hold his
head up when pushing up when on his stomach, nannies should mention these things
to the parents and suggest they share this information with the child’s pediatrician.

TOPIC 10-PHYSICAL MILESTONES AT FOUR

MONTHS
Around four months, an infant is expected to be able to hold his head steady, without
support, and push up to his elbows when lying on his stomach. He also may be able to
roll from his stomach to his back at this stage of development. Around four months, an
infant is also expected to push down on his feet when held in a standing position on a
hard surface and bring his hands or objects to his mouth.  At this stage of development,
you may also notice that an infant can reach or swing at dangling toys and hold and
shake small toys, like a rattle. 
If at four months an infant can’t hold his head steady without support, doesn’t push
down with his feet when held in standing position on a firm surface or doesn’t bring
things to his mouth, nannies should mention their observations to the parents and
encourage them to share this information with the child’s pediatrician. 

TOPIC 11- PHYSICAL MILESTONES AT SIX

MONTHS
Around the six month mark, an infant can usually roll over in both directions, from stomach to
back and back to stomach. Typically developing infants tend to roll from their stomachs to
their backs before they can roll from their backs to their stomachs because doing so
requires more coordination and strength. At this stage of development, infants are also
expected to begin sitting without support and to support their weight when held in a
standing position. You may even notice that an infant will bounce when held in a
standing position. During this stage of development, infants may rock back and forth
and begin to scoot backwards.
If at this stage of development an infant is unable to roll over, seems stiff with tight
muscles or seems floppy like a rag doll, nannies should mention their observations to
the parents and encourage them to share this information with the child’s pediatrician

TOPIC 12-PHYSICAL MILESTONES AT

SEVEN MONTHS
Around seven months old, a child can be expected to support his whole weight on his
legs. He is also expected to transfer an object from hand to hand and pick up objects
with a raking finger motion. At this stage of development, infants first sit with the support
of their hands, then without that support. 
If a nanny notices that an infant is unable to support his weight on his legs, sit with or
without using his hands for support, transfer an object from hand to hand or use a
raking finger motion to pick up objects, nannies should mention this to the parents and
suggest that they share the information with the child’s pediatrician. 

TOPIC 13-PHYSICAL MILESTONES AT NINE

MONTHS
Around nine months old, a child can be expected to pull up to a standing position, stand while
holding onto something for support, get into a sitting position and can sit without support.  He
can also shake and throw objects and self-feed using his fingers.
If at this stage of development, an infant is still unable to bear weight on his legs with
support, is unable to sit with support or doesn’t transfer objects from one hand to the
other, share these observations with the child’s parents and encourage them to share
this information with the child’s pediatrician
 TOPIC 14-PHYSICAL MILESTONES AT ONE
YEAR
Around one year old, a child can be expected to pull to a standing position and cruise around
while holding onto furniture. He can also be expected to sit down without help and get from a
sitting to a crawling position. Some 12 month olds may also be able to stand alone and walk a
few steps independently.
By this stage of development, if a child is not crawling, can’t stand when supported or
has lost skills he once had, share these observations with the parents and encourage
them to share this information with the child’s pediatrician. 

TOPIC 15-EXPLORATION
With infants, active learning happens through exploration that is sensory based. Infants learn
about objects by observing, listening, touching, mouthing, smelling and tasting. They
learn textures, tastes, shapes and temperatures all by putting objects in their mouths. 
Allow infants to put age-appropriate objects that are clean, sturdy, non-toxic and bigger
than the infant’s fists in his mouth. Be sure that inappropriate items are kept out of an
infant’s reach.
Encourage development by providing supervised tummy time, by placing safe objects
on the floor within reach of the infant and by giving the infant opportunities to explore
age-appropriate objects. 
Nannies should work with parents to create a safe environment where children are able
to explore. By having age-appropriate toys and activities available and by ensuring that
play areas are free from hazards, nannies can help to foster exploration, growth and
development. 
 TOPIC 16- CREATING A SAFE
ENVIRONMENT FOR INFANTS
The keys to safe exploration are injury prevention and supervision. Nannies must work
with parents to create a safe environment that encourages exploration. By being aware
of impending milestones, parents and nannies can childproof appropriately.
Nannies should get on the floor and look at the environment from a child’s perspective.
Electrical cords should be out of reach, outlets should have outlet safety covers, window
and blind cords should be tied up out of reach, furniture should be stabilized and
attached to the wall, safety gates should be placed and appropriately installed at the
tops and bottom of stairs, area rugs should have nonskid backing and bumper guards
should be placed on the corners of furniture to protect the child from sharp edges and
surfaces. 
Garbage should be stored in a tightly closed container and small items that pose a
choking hazard to the child should always be placed out of reach. Nannies should make
a habit of storing their personal items, like their purses, out of the reach and sight of the
children. 
Nannies should work with parents to identify a safe area where a child can be left
when she needs to use the bathroom or tend to other children or activities that may
require her undivided attention for a few moments. Things like helping an older sibling in
the bathroom or cleaning up a spill would require that an infant be placed in a safe
location while the nanny tends to the task at hand. A crib, play pen or play yard within
sight and hearing of a nanny can be an appropriate location. Some family pets may
need to be removed from the area during this time, depending on if they can breach the
infant’s safe area. 

TOPIC 17-WALKING
According to Dr. William Sears, 50% of  baby walking usually begins by one year, but there is a
wide normal range of when infants typically begin to walk, which is between nine and 16 months
of age. The National Institutes of Health reports that most children are walking well between
12 to 15 months of age. The path to walking typically includes infants pulling themselves
to standing, cruising between objects for support, holding onto an adult’s hand and then
walking independently. The American Academy of Pediatrics strongly urges that baby walkers
not be used as they do not help with learning to walk, they eliminate the desire to walk and they
pose a serious safety hazard as they can top over easily. Instead, nannies should encourage
parents to opt for a stationary activity center. 
Some infants go back to crawling after walking until they gain more confidence, balance
and coordination. According to the American Academy of Pediatrics, "a few children never do
crawl. Instead, they use alternative movement methods, such as scooting on their bottoms or
slithering on their stomachs." As long as the baby is learning to coordinate each side of
her body and is using each arm and leg equally, there’s no cause for concern. For babies
who crawl, they’ll typically do so around nine months. 

TOPIC 18- PHYSICAL DEVELOPMENT IN

THE TODDLER YEARS
During the toddler years, the growth rate of children slows down. Toddlers gain about
three to five pounds between ages one and two, according to the American Academy of
Pediatrics. They also tend to grow about 2 to 3 inches during this time frame.  As toddlers
become more mobile they lose their roundness.

TOPIC 19-PHYSICAL MILESTONES OF 15

MONTH OLDS
At 15 months, children can typically build a tower of three cube blocks and may start to be able
to scribble. Around this age most children can typically walk well and without help.

TOPIC 20-PHYSICAL MILESTONES OF 18

MONTH OLDS
At 18 months, children are typically able to pull toys while walking and they may also walk up
stairs and even run. At 18 months, children can also typically help undress themselves, drink
from a cup and eat from a spoon. 
Nannies should share any concerns regarding a child's development with the parents. A
child who is not walking by 18 months of age should be referred to his pediatrician for
evaluation. 

TOPIC 21- ENCOURAGING TODDLER

DEVELOPMENT
Toddlers require close supervision. They are eager to try new things, but their desire is
often more advanced than their physical abilities. 
Encourage the development of motor skills in toddlers by allowing self-feeding with a
toddler sized spoon or fork. Toddlers can also be encouraged to stack blocks, turn
pages of cloth and board books, open flaps in books, feel textures, look in an
unbreakable mirror, color with crayons and to help put their toys away bins or baskets
that are within reach. 
Nannies can help to develop self-care skills by encouraging toddlers to undress, brush
their teeth and wash and dry their hands with help.

TOPIC 22- PHYSICAL DEVELOPMENT OF 2

YEAR OLDS
Two year olds are learning to jump, run, stand on their tip toes,  put on clothing, climb, throw
overhand and kick a ball. They’re able to do these more complex and advanced physical
activities because they are gaining muscle control, balance and coordination. 

TOPIC 23-PHYSICAL DEVELOPMENT OF 3

YEAR OLDS
Three year olds are developing fine motor skills and are becoming even more
coordinated. Three year olds can be expected to stack at least four blocks, cut with scissors,
copy simple shapes and play interactive games. Encourage fine motor development by
giving the child cups, blocks and objects to build with, by doing arts and crafts and by
working on self-help skills like buttoning buttons, zipping zippers and putting on shoes. 
During the toddler years a child’s torso and legs become longer, their potbelly
disappears and they experience increased abdominal strength that lets them move
more gracefully and with ease. Toddlers are also developing more gross motor skills and by
their third birthday can be expected to ride a tricycle, climb stairs with alternating feet, run easily
and climb well.
If at age 3 a child falls down frequently, has trouble navigating stairs or is not hitting the
age-appropriate physical developmental milestones, nannies should report these
observations to the parents and encourage the parents to share this information with the
child’s pediatrician.

TOPIC 24-PHYSICAL DEVELOPMENT OF 4

YEAR OLDS
Four year olds are continuing to develop gross motor skills. Four year olds can be found
doing things like hopping or standing on one foot for up to 2 seconds, catching balls, skipping,
pouring, cutting with supervision and mashing food.
Sports give children an opportunity to improve coordination, agility and self-confidence
and many four year olds begin participating in formal sports like dance, t-ball, soccer,
swimming, skating, gymnastics and skiing. In this age group, participation in these
activities should not be forced, instruction should be age-appropriate and the focus
should be on basic skills, safety and fun. 
Four year olds also continue to develop fine motor skills. A four year old can be
expected to zip, button, fasten straps, snap easy snaps and dress independently. Four
year olds may also be able to draw a stick person with two to four body parents, write letters and
numbers, use scissors, draw a square and circle, copy letters and write their first and last
name.
Nannies should share any concerns they have regarding the child’s physical
development with the parents and encourage the parents to share this information with
the child’s pediatrician. 
 TOPIC 25- PHYSICAL DEVELOPMENT OF
ELEMENTARY SCHOOLERS
Elementary school aged children become stronger as they gain muscle tone in their
limbs, backs and shoulders. They also become more coordinated and have more
stamina so they can dance, shoot baskets in lowered hoops, play ball and ride bikes
well.
During the elementary school years, children become long and lean and their hair
typically becomes darker. According to the American Academy of Pediatrics, permanent
teeth usually begin erupting between ages 5 and 7 with the last coming in between 13
and 14 years of age. During middle childhood and the grade school years, children
typically gain on average 6.5 pounds per year and a little over 2 inches in length per
year.
Elementary school aged children continue to develop fine motor skills through writing,
tracing, copying and drawing letters, numbers and shapes. They can control a pencil
and paintbrush more as they learn to hold the utensil between their index finger, middle
finger and thumb. They can also learn to tie shoes, knots and ropes, string beads and
cook with supervision.

TOPIC 26-EARLY PUBERTY

According to KidsHealth, puberty typically begins between ages 8 and 13 in girls and 9 and 15 in
boys, however 15% of girls age 7 are showing breast development while the average
age of a girl getting her first period is age 12, according to Dr. Louise Greenspan as
quoted in an article entitled Obesity and Stress May Push Girls’ Puberty Earlier. Girls
with higher weights in early childhood have been found to start puberty earlier relative to peers
at age 9, according to a manuscript published in Pediatrics. 
The first signs of puberty in girls include breast buds, which typically appear between ages 9 or
10, though they can occur much earlier or a little later, according to the American Academy of
Pediatrics, pubic hair and a change in body shape. One and a half to three years after the
breasts begin to develop, a girl can expect to have her first period. If by age 13 a girl
shows no signs of puberty, nannies should mention this observation to parents and encourage
them discuss the information with the child’s pediatrician. 
According to the American Academy of Pediatrics, boys typically start puberty one year
later than girls. The first sign of puberty in boys is enlargement of the testes and a
thinning and reddening of the scrotum. On average, this happens around age eleven
but may occur anytime between nine to fourteen years of age. If a boy begins puberty
before age 9 or has not showed signs of starting puberty by age 14, this information
should be discussed with the child’s pediatrician. 
Nannies should discuss how to handle conversations related to puberty
with the parents. Since children may ask questions about their changing bodies to
trusted caregivers, nannies should be prepared to address questions with answers that
reflect the information the children’s parents want the nanny to share. Some parents
and nannies may be more comfortable with deferring all conversations on the topic to
the parents. If this is the case and the child asks a puberty related question, the nanny
should let the child know that she has heard the child’s question, affirm that the question
is good and important, and advise the child that she is sure it is a question that mom or
dad would really want to answer. Nannies should follow up with the parents in private to
let them know that a question has been asked and that they have directed the child to
the parent directly for a response. 

TOPIC 27-CHILDHOOD OBESITY

The Centers for Disease Control report that 1 in 6 children and adolescents in the United States
are affected by obesity.Obese children are likely to become obese adults. Children who are
obese are at a greater risk for high blood pressure, high cholesterol, breathing and joint problems,
low self-esteem and impaired social, emotional and physical functioning. Obesity can also
lead to heart disease, diabetes, metabolic syndrome and cancer. 
A child is defined as obese if he is well above the normal or healthy weight for his age
and height. Contributing factors to childhood obesity include behavior, such as dietary
patterns and medications, physical activity level, genetics, food marketing and food
promotion, according to the Centers for Disease Control.  
Nannies can combat obesity by encouraging physical activity, offering nutritious meals
and snacks and ensuring that portion sizes are appropriate. Nannies should encourage
children to get at least 60 minutes of physical activity per day and to eat a healthy diet
that emphasizes eating whole grains, fruits, vegetables, lean protein, low-fat and fat-free
dairy products and drinking water as laid out by the Dietary Guidelines and Physical
Activity guidelines for Americans. 
While obesity is a real problem, it’s important for nannies to be aware that children should
not be put on calorie restricted diets unless a physician has recommended the child be placed on
a diet, according to the American Academy of Pediatrics.