Parenting at Mealtime & Playtime Resource Toolkit

Please take the pre-survey before using the toolkit.

View a message from Dr. Sarah Adams, PMP Medical Director


The Parenting at Mealtime and Playtime Program (PMP) launched in 2014 with a quality improvement (QI) component. The QI project had 7 waves and trained nearly 300 primary care providers. This Quality Improvement program provided tools for physicians to enhance prevention counseling strategies, become adept at assessing “risk,” and intervene at the earliest possible stage before a child becomes overweight. The project included educational trainings, resources, and practice coaching. In 2021, PMP transitioned to an educational based training program. This will include educational training webinars (live and recorded), new and updated PMP resources, and a PMP toolkit to implement the project into individual practices. The Parenting at Mealtime and Playtime provides tools for best clinical care and health outcomes for children ages birth through 5 years old, and now through adolescence, during routine well child visits, by using developmentally-, age- and behavior- appropriate counseling strategies and handouts from the PMP resources.  There will also be a focus on best practices and practice management to help practices navigate challenges during the COVID-19 pandemic.

This toolkit is designed to:
  • Support primary care providers with well-child specific anticipatory guidance and daily structure
  • Provide anticipatory guidance messages and additional resources to make providers optimally effective at identifying young children at risk for becoming overweight and intervening with behavior change techniques core messages about healthy diet and activity
  • When providers intervene at an early age, studies have shown strong implications on the child’s weight status later in life.

    As a result of using this toolkit:
  • Providers will be able to implement PMP into their practice using the techniques, resources, and trainings provided in modules
  • Each module provides specific information relevant to providing nutrition and activity advice, as well as the well child visit as a whole.
  • The goal of the toolkit is to provide structured guidance to pediatric providers.
  • The full toolkit can be accessed here.
  • Please take the pre-survey before using the toolkit.
  • How to use this toolkit:
  • This toolkit is a resource guide to implement the components of PMP into your practice
  • Each module has different content, go through this content at your own pace, in the order that has the most benefit to you
  • Implement changes in your practice based on the suggested in each module
  • Track the changes that you make and the improvement over time
  • Checklist:
  • Complete the pre-survey
  • Become familiar with the components of PMP
  • Establish a plan to implement the content into your practice
  • Contact Alex Miller, Program Manager with questions or comments!

    Visit the PMP website for additional information!
    Ohio AAP Social Media
    Facebook: @aapohio Twitter: @OHPediatricians
    Instagram: Ohio AAP LinkedIn: Ohio AAP
    PMP Mission Statement: The Ohio Chapter, American Academy of Pediatrics (Ohio AAP) exists to promote the health, safety, and wellbeing of children and adolescents so they may reach their full potential. The Ohio AAP accomplishes this by addressing the needs of children, their families and their communities by supporting Chapters members through advocacy, education, research, service and improving systems through which they deliver pediatric care. Parenting at Mealtime and Playtime offers training, resources and strategies to aid clinicians in educating and evaluating risk of infants, children and their families as they attend well-child visits.
    • Childhood obesity in the United States continues to rise and there is a direct risk of being overweight or obese into adulthood
    • The first 1000 days (first two years of life) represent a sensitive period or “window of opportunity” for humans to learn to eat healthy, nutritious diets that, among other things, help protect against the risk of childhood obesity.- from birth to 2 years of age - are critical for childhood obesity prevention
    • A key aspect of this sensitive period is that it lays the foundation for the development of flavor preferences through life. Because humans are born with an innate taste preference for sweet, and a rejection of sour and bitter (e.g., vegetable) tastes, the first 1,000 days of life represent a very important period for facilitating the acceptance of the bitter flavors that characterize most vegetables and offering a variety of foods as well as repeated exposures helps shape their food preferences and prevent obesity
    Webinar: Why Nutrition Matters: An Introduction to PMP

    Webinar: A Fresh Perspective: How Pediatricians Can Change the Way Kids Eat

  • Review the mission statement of PMP
  • Learn more about PMP by viewing the Introduction to PMP webinars
  • This module provides tips and guidance on how to implement PMP into your practice. Checklist:
  • Review tips and guidance for implementation
  • Begin incorporating guidance into well visits
  • Have relationship focused conversations with families
  • Begin implementing your plan
  • After you download, click the “Information” logo in the upper right, and follow the directions to register an account. To receive notifications, click the “Information” logo again, select “Settings,” and then enable “Notifications.” Finally, tap “Notifications” and select your child/children’s birth year(s) and month(s). Checklist:
    • View the PMP resources available on the Ohio AAP website
    • Download the PMP mobile application
    Social media can be used to engage families in your practice! Benefits of social media include: educate/learn, connecting to patients/professionals, improving business (marketing), raising awareness, combatting misinformation, keeping up with news. The images included in this module provide quick ways to start using social media effectively. Please refer to this social media guide for more information. Checklist:
  • Determine which social media platform will work best for you
  • Develop a social media plan
  • Refer to the social media guide for more detailed information
  • Utilize the motivational readiness ruler to set SMART goals, if applicable in your practices
  • View the webinars to learn more information about motivational interviewing and SMART goals
  • Begin using motivational interviewing and setting SMART goals during well visits
  • Components that should be included in the well visit/documented in the chart:
    • Documenting if the child is underweight, healthy weight, overweight or obese
    • Reviewing the child’s growth curve
    • Assessing the growth trajectory pattern- decreased, maintained, increased
    • Assessing family history (diabetes, high blood pressure, hyper lipidemia, heart disease, stroke under 55)
    • Documentation of discussing: age-specific diet anticipatory guidance, age-specific physical activity anticipatory guidance, opportunities to improve the patient’s dietary and/or activity habits
    • Providing a PMP handout or referring to the mobile app
    • Setting a goal
    • Discussing a follow-up plan

  • Begin documenting the suggested items in the EMR system
  • Create EMR dot phrases using the examples provided
    1. Plan for implementationCreate an office flow that works best for your practice
  • Pre-visit planning that may include, well visits by age and pulling relevant handouts ahead of time
  • Review growth chart goals
  • Pre-visit documentation with dot phrases
  • Include follow-up information, if applicable
  • 2. Incorporating dot phrases into the EMR system
  • Create the dot phrases ahead of time and practice using them to become efficient in providing information for patients as well as for documentation
  • Ask your EMR help desk for information on how to create dot phrases and/or how to link the PMP resources into the after visit summary
  • 3. Incorporating/buy-in from all staff members
  • Explain the importance of the first 1000 days with your office staff and how their role as a team member has an impact on the families
  • Train staff members on the PMP educational resources and invite them to participate in the webinars and online trainings
  • Checklist:
  • Review tips for implementing PMP into your practice
  • Start small and measure success
  • Encourage others in your practice to participate
  • This module provides talking points and sample social media posts for increasing well child visits, immunizations, and the prevention of teen suicide.

    Well-child visits help parents make sure their kids and teens are:
    • On-schedule for all immunizations
    • Growing and developing properly (hearing, vision, mental health, reproductive health, etc.)
    Ohio AAP has noticed two concerning trends regarding well-child visits:
    • Many children skipped their annual well-child visit due to COVID-19 (and parents have yet to reschedule)
    • Many parents are using sports physicals in place of well-child visits (a child still needs a well-child visit, even AFTER a sport physical)

    • Pediatrician offices are still open during the #COVID19 pandemic and are taking extra safety measures. Call and schedule a well-child visit today! #SafePedsHealthyKids
    • Your pediatrician is taking extra precautions to ensure that their office is safe during #COVID19, like separating well and sick kids during different times of the day. Help your child stay healthy by scheduling a well-child visit today! #SafePedsHealthyKids
    • Did you know a sports physical includes a surface physical exam, while a well-child visit provides a thorough head-to-toe examination? Keep your little athlete healthy and schedule a well-child visit today! #SafePedsHealthyKids

    • Vaccines are down as much as 73%, largely due to the COVID-19 Pandemic
    • Vaccination helps provide immunity before children are exposed to potentially life-threatening diseases
    • With COVID-19 transmissions still remaining high, pediatricians say that it is more important than ever for everyone 6 months and older to receive a flu vaccine this flu season.

    • @AmerAcadPeds reminds you that anyone 6 months or older should receive a #flushot! Remind your friends and family to make an appointment with their pediatrician to get their children vaccinated #SafePedsHealthyKids
    • Your @AmerAcadPeds pediatrician's office is safe and ready to give flu shots during the #COVID19 pandemic. Make an appointment for your child today to fight #fluseason! #SafePedsHealthyKids
    • Vaccine rates are down as much as 73%, largely as a result of the #COVID19 pandemic. Schedule a well-child visit with your pediatrician to keep your child's vaccination record up-to-date #getvaccinated #SafePedsHealthyKids
    • In-person, routine well-child visits are still recommended for all children during #COVID19, especially children under two years of age to maintain vaccination schedules. We must all do our part to prevent vaccine-preventable disease outbreaks #SafePedsHealthyKids #VaccinateDontIsolate

    • Stay-at-home orders and online schooling have created the “perfect storm” for increased mental health issues & suicide risks in teens
    • The COVID-19 pandemic has caused severe stress and anxiety for many teens, which are risk factors for teen suicide
    • Teens spending more time at home have increased access to potentially dangerous items including firearms, medications, and alcohol

    • Suicide is the leading cause of death among Ohio teens and preteens ages 10 to 14 and the second leading cause of death among Ohioans ages 15 to 34. I’m partnering with @OHPediatricians #StoreItSafe teen suicide prevention program to reverse the trend of irreversible actions!
    • The presence of a firearm at home increases the risk of suicide even among those with no history of depression. Firearms should always be locked away when not under direct control. To learn more about safe firearm storage visit #StoreItSafe
    • 85% of suicide attempts with a firearm are fatal. Many attempts happen during a short term crisis which is why reducing access to lethal means can be effective in prevention. Join the Ohio AAP’s #StoreItSafe program and help be a part of the solution!

  • Review the topics and talking points
  • Use the messages on your social media accounts
  • While this toolkit is not meant for quality improvement, this module provides rapid changes tool and best practices to test and monitor change in your practice.
    Webinar: Office Flow. Map out your current clinical flow according to the directions on the last slide of the webinar. Taking time to do this now, will benefit you as you view the next webinar on PDSA cycles and determining tests of change. Office flow symbols can be found here.

    Webinar: PDSA Using areas identified in your office flow, complete the PDSA worksheet to test a change and improve an area relative to the project or your goals. This worksheet will allow you to evaluate implementation of PMP into your practice. You can find a copy of the PDSA Worksheet here.

  • Review the webinars on office flow and PDSA cycles
  • Create an office flow diagram
  • Create a PDSA to test a change in your practice
  • Mindful Eating- Divya Dendurli, MS, RDN, LD, IBCLC & Erin Talzzia, MS, RDN, LD
  • Social Determinants & Body Positivity- Sarah Adams, MD, FAAP
  • Power of Play- Robert Murray, MD, FAAP & Sarah Adams, MD, FAAP (CME, CNE, SW credit available)
  • Hunger and Fullness Cues- Sarah Adams, MD, FAAP
  • Eating Disorders & Perception of Food- Tyanna Snider, Psy.D & Lindsay Bailey, MS, RD, LD, CEDS
  • Interdisciplinary Training- Sarah Adams, MD, FAAP & Divya Denduluri, MS, RDN, LD, IBCLC (CME, CNE, SW credit available)
  • Alex Miller, Ohio AAP
    Dr. Sarah Adams, PMP Medical Director
    Dr. Christopher Bolling, Pediatric Associates NKY
    Dr. Alana Milton, Nationwide Children's Hospital
    Dr. Jen Valentic, Akron Children's Hospital
    Dr. Liz Zmuda, Ohio Health
    Dr. Andy Wapner, OSU Public Health
    Dr. Melissa King, Dayton Children's Hospital
    Lauren Garbacz, PhD, Nationwide Children's Hospital
    Dr. Kristen Stackpole, CCHMC
    Dr. Amrik Khalsa, Nationwide Children's Hospital
    Sarah Bidwell, Developmental Specialist, Ashtabula County
    Ohio Department of Health