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Systematic Review

Health Education in Early Childhood Education: A Systematic Review of the Literature

by
Anabel Ramos-Pla
1,* and
Laura Fornons Casol
2
1
Education Sciences Department, University of Lleida, 25001 Lleida, Spain
2
Department of Psychology, Sociology and Social Work, University of Lleida, 25001 Lleida, Spain
*
Author to whom correspondence should be addressed.
Societies 2025, 15(4), 106; https://doi.org/10.3390/soc15040106
Submission received: 6 February 2025 / Revised: 14 April 2025 / Accepted: 15 April 2025 / Published: 18 April 2025
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Abstract

:
Addressing Health Education (HE) in Early Childhood Education is essential for shaping future responsible citizens who are aware about the importance of caring for their health. The aim of the present article was to conduct a systematic review of the scientific literature on Health Education in the Early Childhood Education stage. Through an exhaustive analysis of 21 articles published in the internationally-renowned database Web of Science in a period of 10 years (2014–2024), the text is structured around three dimensions: article data and main areas and topics covered, pertinence and relevance of Health Education in Early Childhood Education, and lastly, the impact of Health Education in child development. The results show an increase in scientific production, although limitations persist, such as the predominance of quantitative approaches, gaps in mixed designs, a fragmented focus on educational actors, and the lack of interdisciplinary integration. It is concluded that HE in Early Childhood Education is fundamental for promoting healthy habits, for the comprehensive development of students, and community well-being, underlining the importance of interdisciplinary approaches, teachers’ training, and health literacy to guarantee its efficacy and sustainability.

1. Introduction

Health Education (HE) is a planned and systematic teaching–learning process that seeks to improve individual and community health [1,2]. Its main objective is to facilitate the acquisition, selection, and maintenance of healthy practices, as well as to modify unhealthy behaviors. As [1,3,4] state, one of its main characteristics is that it is a fundamental tool for promoting health. In addition, it is practiced in diverse settings (health, education, and community), and combines different learning experiences to improve the health of people and communities. Lastly, it seeks to develop independence and criteria based on scientific evidence for making health-related decisions.
Another study [5] also suggest that key elements of effective Health Education are skill development and relevance for students. The main aims of HE include the following [2,6,7]:
  • Modify negative behaviors and promote new positive behaviors.
  • Change harmful environments for healthier ones.
  • Enable individuals to maintain an active attitude with respect to their own health and the health of others.
  • Improve health literacy, including knowledge and personal skills.
In this sense, teachers are essential for the development of a culture of health in society, acting as catalyzers for the promotion of health and facilitating access to information and necessary resources to maintain and improve the health of the population [8,9,10].
In addition, addressing HE in education centers is of vital importance for many reasons. In first place, health and education are closely related. Healthy children and young people have higher probabilities for learning more effectively [11,12,13]. A school environment that promotes health can directly improve the health of students, favor learning, and contribute to the development of healthy and productive adults. In second place, HE is committed to the comprehensive education of students, preparing them to become independent adults who are responsible for caring for their health [13,14,15]. Lastly, it seeks to develop knowledge, attitudes, and healthy lifestyle habits in students [16]. In third place, school is considered, by different organizations [2,17,18], as the most effective means for promoting healthy lifestyles in children and young people [12,19,20,21]. Education centers have access to a large section of the children and young people population, which allows for the implementation of healthy programs in an efficient and sustainable manner [17,22]. It should be noted that the Health Promoting Schools initiative also carries out important tasks to implement HE in schools. This initiative consists of educational centers that integrate health promotion into their educational project, creating healthy environments to live, learn, and work. This initiative, promoted by the WHO and UNESCO, is implemented through national and regional networks such as the SHE Network (Schools for Health in Europe) [8]. Some of its main characteristics are the comprehensive approach that combines HE in the classroom with measures in the school environment; the development of life skills and emotional well-being; and the active participation of the entire educational community.
  • In addition, it must be pointed out that addressing HE in the Early Childhood Education stage is vital for many reasons [1,2,22]: The Early Childhood Education stage is a crucial moment for establishing healthy habits and behaviors that can last a lifetime. During this period, children are especially malleable and receptive to the learning of new behaviors. Instilling healthy behaviors from an early age can have a significant impact on the future well-being of the students.
  • There is strong evidence that children who are raised since early childhood in environments that care about health obtain better education results. A school environment that promotes health can directly improve the health of its students, favor learning, and contribute towards the development of healthier adults.
  • HE in the Early Childhood Education stage contributes to the comprehensive training of the child, encompassing aspects such as personal hygiene, healthy diets, physical activity and play, emotional and mental health, and the prevention of risks and accidents. These elements are fundamental for the holistic development of children, and lay the foundations for a healthy life.
  • Early Childhood Education provides a unique opportunity for establishing a close collaboration between families and schools in health matters. Parents are more open to changes in attitude and are anxious for useful information during this stage, which eases the implementation of healthy habits at both home and school.
Addressing HE at school must have a comprehensive approach, considering the following [5,21,22]: the inclusion of health content in the curriculum; Health Education in the classroom; the promotion of healthy and sustainable education environments; and the participation of the community.
It must also be noted that Health Education programs contribute to the improvement of health literacy; that is, the ability of people to understand and access information and services related to health [5,20,23,24].
However, to address HE at schools, it must be integrated into the school curriculum. To perform this effectively, the following strategies can be implemented [16,19,22,25,26]:
  • The key for introducing Health Education continuously is to include it in the Center’s Education Project. This allows for the promotion of health to be an integral part of the school’s educational approach.
  • Having a comprehensive and contextualized approach, where health is promoted globally, by combining the inclusion of health content according to the curriculum, HE in the classroom, the promotion of healthy, sustainable, and participative educational settings, and, lastly, be open to the community.
  • Health Education must be integrated sequentially and progressively in the curriculum of basic education, so that it is not reduced to a set of one-time activities.
  • The integration must favor the harmonious growth of the knowledge of the students, by developing an educational process that includes the development of competencies, participation in social initiatives, and taking part in coherent experiences with health.
  • The information and activities must be adapted to the students as a function of age, education stage, and possible physical or psychological limitations.
  • The inter-sectorial work between the health and education sectors is indispensable to make advances in the promotion of health at schools.
The implementation of these strategies can lead to the effective integration of Health Education in the school curriculum, thus promoting a comprehensive education that empowers students with knowledge and healthy habits for the rest of their lives [15,16,22,25,26,27].
The present study is centered on performing a systematic review of the literature available in the Web of Science (WOS) Core Collection Database on Health Education in Early Childhood Education, in order to identify and analyze previous studies. For this, the following research questions are posed: What approaches and content related to Health Education have been addressed in empirical research published between 2014 and 2022 in the field of Early Childhood Education? What are the main trends and gaps in research on Health Education in Early Childhood Education? What are the main areas and topics covered in the scientific literature? What is the pertinence and relevance of Health Education in Early Childhood Education?
Through this systematic review, we seek to provide a more comprehensive view of the advances and the areas to be developed in Health Education in Early Childhood Education, thereby contributing to the consolidation of a more comprehensive and holistic education of children.

2. Materials and Methods

The general objective of the present study was to perform a systematic and critical analysis of the existing literature on Health Education (HE) in the Early Childhood Education stage. The main research question, as mentioned above, is: what approaches and content related to Health Education have been addressed in empirical research published between 2012 and 2022 in the field of Early Childhood Education? This analysis seeks to provide a comprehensive view of the didactic approaches and early care strategies in this field. To meet this general objective, the following specific objectives were defined:
  • Identify the main trends and gaps in the research performed on Health Education in Early Childhood Education.
  • Analyze the main areas and topic addressed in the literature.
  • Discover the pertinence and relevance of Health Education in Early Childhood Education.
To meet these specific objectives, an exhaustive search was performed in the Web of Science (WOS) database, which is internationally recognized due to its prestige and for encompassing a broad range of important scientific publications. The search ended on 24 December 2024. The protocol’s registration was registered on PROSPERO (CRD420251000899). Two researchers carried out the document selection process and the discrepancies were resolved with the help of a third reviewer.
The systematic review process was performed according to the guidelines from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol [28], which guaranteed a rigorous and transparent methodological approach for the identification, selection, and analysis of the pertinent literature. For this search, a specific equation was designed: [TOPIC (“health education”)] AND [TOPIC (“early childhood education” OR “preschool education” OR “kindergarten” OR “early education”)].
The selection process was based on clearly-defined eligibility criteria. First, a total of 395 references was obtained, which were then screened (see Figure 1). Data restrictions were applied, with the inclusion of studies published between 2014 and 2024. Then, the search was restricted specifically to scientific articles found in the Web of Science Core Collection. In addition, other studies were also included that were not part of the “Education and Educational Research” area of knowledge, and documents written in languages other than Spanish or English were ignored.
The preliminary screening, based on the review of the titles and abstracts, resulted in 35 potentially useful articles. After a detailed analysis of the complete texts, through the application of the exclusion criteria (non-open access, non-relevant topic, or an approach not directed to Early Childhood Education teachers or students), a total of 21 studies were finally selected.
From each of these 21 articles, information was extracted on the variables object of analysis, to create a large matrix table that was analyzed quantitatively (descriptive analyses) and qualitatively (categorization).
There were 3 dimensions to the objects studied, taking into account the theoretical framework set out in the Introduction section (established by the principal investigators and with a third judge analyzing the discrepancies), and they were subdivided into nine variables:
  • Dimension 1: Article data. Variables: (1) article authorship, (2) year of publication, (3) methodology, and (4) type of sample.
  • Dimension 2: Main areas and topics covered. Variables: (1) discipline/area from which the study starts, and (2) main topics investigated.
  • Dimension 3: Pertinence and relevance of Health Education in Early Childhood Education. Variables: (1) impact of HE on child development, (2) its influence on the educational community, and (3) connection with the curriculum or other areas of education.
The coding procedure was carried out in two phases. Initially, a deductive approach was used based on pre-established categories derived from relevant theoretical frameworks in Early Childhood Education, which allowed us to identify the main thematic axes in the literature analyzed. Subsequently, an inductive analysis was adopted to facilitate the emergence and systematization of new emerging sub-themes. To ensure the rigor and reliability of this process, all studies were independently coded by two researchers and the results were then compared and, in case of disagreement, differences were discussed until a consensus was reached.
All the articles analyzed are found in the references section [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49].

3. Results

3.1. Article Data

3.1.1. Authorship and Publication Year

The analysis of the 21 scientific articles reviewed reveals that, under the established criteria, each author has only one publication on Health Education in Early Childhood Education. This pattern of contributions raises questions about the development and research approach in this field, as it reflects a low concentration of publications based on the authors. Therefore, it does not seem to be a common line of research among the re-searchers.
With respect to the year of publication, during the 2014 to 2024 period, it can be observed that the 2019–2024 period had the highest scientific production on the subject under study, with a total of 22 published articles (see Figure 2). In this sense, although the growth was variable and fluctuated over time, the year 2023 is notable (N = 6), followed by 2021 (N = 5), and 2019 (N = 4). In this sense, it can be observed that there is a growing interest in this area among researchers.

3.1.2. Methodological Approaches and Sample Characteristics

As for the research methodology of the 21 articles analyzed, it was classified into four categories: qualitative, quantitative, mixed, and systematic review of the literature. In this sense, most of the studies were quantitative (N = 10) [29,32,33,34,35,37,42,43,48,49], 7 were qualitative [36,38,39,40,45,46,47], 3 were mixed [31,41,44], and 1 was a systematic review of the literature [30]. The methodological distribution of the studies analyzed reflect a clear preference for quantitative studies. This finding suggests an academic interest for establishing empirical and contrasting bases about the efficacy and efficiency of the application of HE in Early Childhood Education schools. However, although this could entail the generalization of the results, a limitation could be found in not knowing the different realities in detail.
Lastly, with regard to the type of sample used in the studies analyzed, a predominance of Early Childhood Education students was observed (N = 8) [29,31,33,35,39,42,46,49], followed by active Early Childhood Education teachers (N = 4) [32,34,40,43], Early Childhood Education degree students (N = 3) [37,38,44] and the documental analysis of curricula and education policies (N = 3) [30,45,47]. On the other hand, the least utilized samples were those that jointly used teachers and Early Childhood Education students (N = 2) [41,48] and followed by school principals (N = 1) [36].

3.2. Main Areas and Topics Covered

The analysis of the studies on Health Education (HE) in the Early Childhood Education stage, corresponding to the 2014–2024 period, showed a notable diversity of thematic areas that reflected the predominant priorities and approaches in current research. This review allows us to not only identify clear trends, but also points to significant gaps that require more attention from the scientific community.

3.2.1. Education

In first place, most of the research studies reviewed were focused on the area of education (N = 12) [29,30,32,34,37,38,39,40,41,44,45,46], underlining the importance of integrating HE in both early childhood school programs, and the training of future teachers (see Table 1). This approach highlights the central role of schools as a privileged space for promoting health, not only through the curricular content, but also as a key scenario for the construction of habits and values.
Within this discipline, the critical analysis of the recurring topics revealed that 5 studies addressed the initial training and the professional development of teachers as the main topic [37,38,39,44,45]. These works analyzed the inclusion of HE in the curricula, as well as the practices and preparation in higher education to promote health. These also explored the perception and motivation of university students with respect to its relevance and efficacy, especially due to the impact of the COVID-19 pandemic.
However, the exploration of innovative and adaptive pedagogic approaches for implementing HE in Early Childhood Education was limited. Three researchers [34,40,41] were grouped into a single category that addressed didactic strategies oriented towards comprehensive learning, such as education in kindergartens, and interdisciplinary methods to promote a safe and healthy school coexistence, starting with the evaluation of preventive interventions in educational settings, particularly the prevention of accidents.
Two additional studies within the field of education [29,30] were centered on the promotion of healthy habits, such as personal hygiene and physical activity. These works highlighted these practices as key tools for improving health literacy and promoting positive habits in early childhood. Another two studies [32,46] analyzed sociocultural factors and their influence on HE. This latter group of research studies underlined how external and cultural factors condition the transmission of health knowledge, as well as the relational dynamics in education communities.

3.2.2. Medicine and Nursing

The area of medicine and nursing is highlighted, represented by a smaller number of studies (N = 4) [31,33,42,43]. These works addressed, from a clinical perspective, the promotion of health and the prevention of diseases, with special emphasis on the children population and the factors that have an influence on their well-being.
A predominant thematic line includes research on healthy lifestyles and preventive health during childhood (N = 3). One study examined the behaviors that promote comprehensive health from the early years, encompassing aspects such as a balanced diet, physical activity, the understanding of the workings of the human body, and the management of emotions [42]. Another study was centered on the use of gamification as a tool for teaching essential hygiene practices to small children [31], while a third study analyzed the role of digital literacy on the health and well-being of Early Childhood Education teachers, evidencing its impact in an educational environment [43].
A thematic category was identified related to socioeconomic and family-related factors in childhood obesity (N = 1) [33]. This study investigated the underlying dynamics on the prevalence of childhood obesity, considering individual, family, and structural factors, as well as social inequalities that affect the health of children. Its findings provide valuable evidence for the design of public policies and educational programs that seek to mitigate these disparities.
Although these studies provide an enriching perspective about the links between medical care and HE, a certain disconnection was observed with respect to the educational context. In addition, they lack a truly interdisciplinary focus that effectively integrates educators, families, and health professionals, thereby limiting their applicability in real-life education scenarios.

3.2.3. Public Health and Nutrition

Another emerging area was public health and nutrition (N = 4) [35,36,47,49]. These studies specifically analyzed the influence of nutrition on child development, as well as its intersection with education and healthy food environments, organizational factors, and early obesity prevention programs. Two main themes emerged within this area: diet and organizational factors. The first thematic block includes two studies (N = 2) that were centered on the implementation of structured diet education programs in early childhood [35] and the development of education policies related with nutrition [36]. These studies highlighted the importance of establishing pedagogic programs that promote healthy food habits starting in the early stages of life, by integrating educational and practical elements that involve not only children, but their caregivers and educators.
The second block is composed by two studies (N = 2) that addressed organizational factors that condition the efficacy in the implementation of policies related with physical activity and the prevention of childhood obesity. One of the studies underlined the relevance of the organization’s preparedness, and fidelity in policy implementation, underlining the need to align them with local needs and contexts [47]. Another work was focused on the evaluation of comprehensive prevention programs, considering variables such as height, weight, levels of physical activity, sedentary behaviors, duration of sleep, time spent with screens, gross motor development, dietary intake, and food and activity preferences [49].
These studies shared a focus on the determinant factors of child health, emphasizing the importance of designing programs and policies that are comprehensively culturally and structurally adapted. In addition, they described the synergies between food education and health policies, at the same time that they pointed to critical areas that require a more multidisciplinary approach focused on cultural, social, and economic aspects of the children to maximize their impact on health and well-being from an early age.

3.2.4. Psychology

Lastly, the area of psychology was represented by a single study (N = 1) [49], which revealed the relevance of emotional well-being and psychological factors in the promotion of children’s health. This approach is fundamental, as it underlines the interrelationship between socioemotional development and the acquisition of healthy habits, which are essential aspects for the comprehensive understanding of health during early childhood. However, the scarce representation of this topic in the literature reviewed reveals a significant gap in HE research and a promising potential for enriching intervention strategies and strengthening the multidisciplinary approach in this field (see Table 2).

3.3. Pertinence and Relevance of Health Education in Early Childhood Education

In this section of the results, the pertinence and relevance of HE in Early Childhood Education is examined from different perspectives: its impact on child development, its influence on the educational community, and its connection with the curriculum or other educational area (see Figure 3).

3.3.1. Impact on Child Development

From the start, the analysis of the 21 studies selected offers a comprehensive view of the contributions of the literature on the impact of HE in child development. The findings highlight the potential of HE for promoting the well-being and the comprehensive development of children, at the same time that they identify key areas to improve both the research and the application of these initiatives. However, four studies [32,44,45,48] did not present relevant results within the first thematic framework proposed.
  • A significant category (N = 7) underlined the importance of HE as a promoter of healthy habits and comprehensive well-being in the long-term, key elements for sustainable personal growth [35,36,38,40,43,46,49]. This approach includes fundamental dimensions such as nutrition, personal hygiene, and the development of responsible attitudes. Likewise, it underlines the strengthening of health competencies by the educators, who act as multiplying agents in the educational setting. The literature supports this perspective, when evidencing multiple benefits derived from HE during childhood. These include a higher consumption of fruits and vegetables, the adoption of hygiene practices that increase quality of life, and the early health literacy concepts. These findings underline the importance of providing specialized support to educators with regard to health topics, with the aim of optimizing the quality and effectiveness of the interventions in diverse contexts.
  • In the second thematic block (N = 5), the pertinence of HE is based on their preventive and protective role against diseases [31,33,34,39,41]. This group of studies explores the ability of educators to manage emergencies, promote safe practices, and transmit essential knowledge about first aid in the school context. In addition, it emphasizes the relevance of health practices during Early Childhood Education, a critical period in physical and cognitive development that is a determining factor in adult life.
  • Lastly, a third block (N = 4) addressed HE from the perspective of the creation of a healthy and active school environment [29,37,42,47]. The findings showed significant improvements in fundamental motor skills, a higher motivation, and participation in physical activities, as well as an increase in the frequency and effectiveness of personal hygiene practices. These results reinforce the idea that the school setting not only represents a model for a healthy life, but also a privileged space for promoting the comprehensive development of children.

3.3.2. Influence on the Educational Community

The analysis of the influence of Health Education (HE) on the educational community provides evidence on the notable lack of studies that explicitly address this thematic framework (N = 9), as the articles identified demonstrate [31,32,33,37,38,42,43,44,48]. This absence reflects a significant gap in the literature, which limits the comprehensive understanding of the potential impacts of HE in this area.
  • In contrast, a set of studies that did explore this relationship (N = 5) underlined that HE can strengthen the collaboration and cohesion within the educational setting, fomenting the creation of support networks and synergies between the different actors that shape it. These works emphasized the relevance of an integrative approach that actively involve institutions, administrators, educators, and families, in the promotion of holistic child development [40,47] In addition, they underlined the transformative potential of HE in institutional dynamics and the relationships in school communities, promoting a greater cohesion between education agents and a collaborative environment [29,39,49].
  • On the other hand, a group of researchers (N = 3) focused their attention on the strengthening the competencies, the knowledge, and the confidence of teachers to implement effective HE programs in the school context. These studies [29,30,34] highlighted that these improvements have a positive impact on the quality of the educational interactions, promoting responsible and healthy behaviors among the students, and consolidate the role of teachers as agents of change.
  • Simultaneously, three articles delved into the ability of HE to transcend the school setting, directly influencing families and homes. An argument was made that HE promotes healthy habits and creates communities that are increasingly aware and responsible with respect to their comprehensive well-being [36], involving families in the process of education [35], and highlighting the crucial role of the social and family environment in the learning and shaping of healthy identities [46].
  • Lastly, a smaller block of research studies (N = 2) addressed the role of HE as a tool for reducing inequalities and promoting social values in the educational community. These studies underlined that HE promotes the ability of teachers to face inequalities and promote social justice [45], aside from contributing to the resolution of school conflicts and the improvement of coexistence [41]. From this perspective, HE is presented not only as a means to improve the physical health of students, but also as an engine for the construction of a school environment that is equitable, inclusive, and favorable for learning.

3.3.3. Curricular Integration and Interdisciplinary Connections

To conclude this results section, with respect to the pertinence of developing HE in the Early Childhood Education stage, a favorable perspective is identified, due to its link with the curriculum and other areas of education. Nevertheless, eight studies from the sample analyzed did not address this aspect on their approach [31,32,33,34,39,43,48,49]. The remaining set of studies examined the education curricula from different approaches.
  • A set of seven studies (N = 7) underlined the unequal and limited integration of HE in the curricula, which has an effect on its practical application in schools. This group underlined the importance of considering HE as a cross-cutting topic that permeates different areas of education [35,36,37,38,45,46,47].
  • Likewise, a second group (N = 4) adopted an interdisciplinary approach, arguing that HE can be effectively integrated into different areas of the curriculum, thus meeting multiple educational objectives [29,30,40,41].
  • Lastly, two research studies (N = 2) proposed specific interventions or an expansion of the curricula in the area of higher education, with optional courses [42,44].

4. Discussion

The results of the present systematic review reveal certain structural and dynamic limitations in the field of HE in Early Childhood Education. The recent increase in the scientific production (2019–2024), particularly in the 2023 peak, coincides with the trends observed in the general literature on Health Education, perhaps driven by the effects of the COVID-19 pandemic and its impact on the awareness on public health in school settings [38]. However, this peak does not guarantee a long-term sustainability; it is necessary to analyze if this trend reflects a sustained commitment or an ephemeral interest from the scientific community.
The prevalence of quantitative studies (N = 10), as compared to qualitative or mixed approaches, underlines a certain inclination towards the generation of results that can be generalized and contrasted. Although this approach provides a solid empirical base to assess the efficacy of the interventions, more attention must be given to cultural, contextual, and institutional specificities inherent to educational settings [40]. Some studies [50] have highlighted the relevance of mixed designs as essential tools for understanding the complexity and the involvement of HE in natural contexts, by integrating the strengths of quantitative and qualitative methods for a deeper analysis and the effective implementation of intervention programs.
Likewise, the predominant approach in the sampling of students (N = 8) is understandable, given the nature of HE. However, the limited attention given to teachers, principals, and curricular policies reflects a fragmented approach that does not consider HE as a comprehensive system. Previous studies have pointed that the participation of all the educational actors is key for the success of the interventions [37]. In addition, recent studies on school leadership [51,52] emphasize that principals play a crucial role in the implementation of educational changes, an aspect that has been scarcely explored in HE. The scarcity of documental analyses on education curricula and policies is a critical gap that limits the ability of the literature to provide guidance for effective educational practices [53].
In line with international evidence, a systematic review [54] reveals that most of the studies have predominantly concentrated on physical activity and nutrition, addressing key issues such as sedentary behavior, obesity, and sustainability. This emphasis is justified given that establishing healthy dietary habits and an active lifestyle during early childhood is crucial for long-term well-being according to World Health Organization guidelines [55]. However, the review also highlights a significant gap, pointing to the necessity of expanding the focus to include more holistic approaches, specifically interventions that incorporate mental and social health aspects, as well as risk behavior management, which have so far been only marginally addressed.
The HE literature has consistently argued that its integration in the training curricula of teachers is indispensable [56,57]. In addition, although most of the studies were concentrated in the area of education (N = 12), the disconnection between medicine, public health, and psychology is evident, which underlines the need for more collaborative and holistic approaches. This includes the incorporation of health professionals as strategic allies in health-promotion school programs [58].
In addition, the limited exploration of innovative and adaptive pedagogic approaches was identified, as well as the influence of family and community dynamics on the adoption of healthy habits, especially in vulnerable socioeconomic contexts [29]. These areas represent significant opportunities for future studies and practical development.
In general terms, the results from the present review highlight the importance of HE as an essential component in Early Childhood Education, with multidimensional positive effects that encompass child development, the education community, and curricular integration. HE not only acts as a catalyzer for the adoption of healthy habits, but also foments the collaboration and social transformation in the first years of life. Nevertheless, limitations persist in the preparation of teachers for the effective implementation of programs, which underlines the need for more specific and contextualized training [59,60].
These results must be considered with caution, as this article has some limitations, such as the small number of publications on the subject and the exclusion of relevant studies due to the restricted access to the Web of Science database, as well as the language criteria. However, it contributes towards the enrichment of the scientific literature in this field, by the identification of key areas for future development.
In future studies, it is suggested to expand the analysis to other databases, such as Scopus, and to explore other levels of education, such as Primary and Higher Education. HE requires the diversification of its approaches, the strengthening of its theoretical and practical foundations, and addressing socioeconomic and cultural inequalities to maximize its impact in diverse contexts. This will allow us to position it as a priority in education policies, fomenting more inclusive and interdisciplinary practices that are sustainable in the long term.

5. Conclusions

The analysis performed allowed us to identify the main trends and gaps in research on Health Education (HE) in the Early Childhood Education stage, especially in the last few years, which reflects the recognition of its importance in the training of healthy habits from early ages. However, some significant gaps persist, such as the limited attention given to vulnerable contexts and the scarce incorporation of mixed methods designs that allow for a more comprehensive and contextualized understanding of the different school realities.
With respect to the areas and topics addressed, the literature has predominantly been centered on food and nutrition education, personal hygiene, and the promotion of physical activity. In addition, significant gaps were identified in the application of interdisciplinary, multi-dimensional, and innovative approaches that effectively associate HE with the practice of education.
Likewise, the pertinence and relevance of HE in this stage of education was confirmed, not only as a key tool for fomenting healthy habits from early childhood, but also as a fundamental pillar for the comprehensive development of students, at the same time benefiting family and community environments. In addition, the importance of teachers’ training and health literacy was underlined, as decisive factors for guaranteeing the efficacy of education initiatives. The adequate preparation of the educators and their ability to transmit knowledge and values related with health are essential for maximizing the reach and sustainability of these strategies in the school setting.
Some proposals for HE intervention in Early Childhood Education can be the design of interdisciplinary and contextualized programs, integrating key areas such as food, hygiene, physical activity, and emotional health. These programs must be adapted to the socioeconomic, cultural, and psychological characteristics of students and their communities. In this sense, it is very important to involve various disciplines, such as psychology, nutrition, pedagogy, and medicine, to create a multidimensional approach that encompasses not only knowledge, but also the change of attitudes and behaviors. Another proposal may be related to the participation of families. Activities and workshops can be organized that involve families, especially in vulnerable contexts, so that education on healthy habits transcends the school and reaches homes, promoting healthy habits in a comprehensive way.
It should be added that, in view of this context, it is very important to promote physical activity and healthy eating. Playful and participatory activities can be established in the school curriculum that promote physical activity from an early age, integrating games that stimulate both fine and gross motor skills. Healthy cooking workshops and awareness-raising activities on the importance of nutrition, adapted to children, can also be carried out to teach them how to prepare healthy snacks in a simple and fun way.
In addition, it is necessary to incorporate emotional health programs in Early Childhood Education. In this way, Emotional Education content can be incorporated into HE programs, with activities that teach children to recognize, express, and manage their emotions in a healthy way.
Taking into account all of the above, continuous training for teachers is essential. In this line, training can be carried out related to health, nutrition, child psychology, and innovative pedagogical approaches that allow them to transmit not only knowledge, but also values and healthy behaviors. In addition, health literacy training programs can be developed for teachers, so that they can effectively incorporate health knowledge into their daily practices and be active agents in promoting healthy habits. It is also essential to integrate HE into the initial training of Early Childhood Education teachers, with the aim of integrating Health Education (HE) in an effective, contextualized, and innovative way in their future teaching practices. In this way, HE should be incorporated in a transversal way in the training curriculum of teachers, integrating HE contents in the core and optional subjects of the degree in Early Childhood Education. Health literacy for teachers should also be developed, including content that enables future teachers to develop health literacy competencies, so that they can interpret, evaluate, and communicate health-related information appropriately. In this sense, it is essential to promote collaborative work with professionals in the health, nutritional, psychological, and social fields as part of the training process.
Based on the results obtained in this study, some practical implications are proposed to promote the development of HE in Early Childhood Education. Firstly, to ensure the integration of HE into the school curriculum and that it is present in all areas of the curriculum and is not limited only to specific subjects. This implies training educators to integrate this approach naturally into their math, science, and language classes, among others. Secondly, encouraging the involvement of the school community (parents, health personnel, local authorities) is key to the success of HE programs. The active participation of families in workshops and activities will reinforce healthy habits at home and in the community. Third, to implement evaluation mechanisms that allow measuring not only the knowledge acquired by students, but also the change in their attitudes and behaviors related to health. Evaluations must be adapted to the age of the children and carried out in a playful and participatory way.
In conclusion, Health Education (HE) is an essential strategy for the promotion of health and the prevention of diseases, as it seeks to have a positive influence on the physical and psychological well-being of people. In addition, addressing HE in education centers is fundamental for shaping citizens who are able to care for their health, prevent diseases, and adopt healthy lifestyles, a fact that has a positive impact at both the individual and collective levels.
Some future lines of research may be the realization of longitudinal studies that evaluate the impact of interdisciplinary HE programs on the integral development of children, and in particular, their influence on the adoption of healthy habits over time. Studies applying mixed methodological designs could also be developed to investigate how combinations of qualitative and quantitative approaches can enrich the understanding of health interventions and their effectiveness in diverse educational contexts. Finally, research can be proposed on how continuing Health Education for teachers influences the quality and effectiveness of HE programs in classrooms, and how these programs can be adapted to new scientific advances in health and well-being.

Author Contributions

Conceptualization, A.R.-P.; methodology, L.F.C.; software, A.R.-P. and L.F.C.; validation, A.R.-P. and L.F.C.; formal analysis, A.R.-P. and L.F.C.; investigation, A.R.-P. and L.F.C.; data curation, A.R.-P. and L.F.C.; writing—original draft preparation, A.R.-P. and L.F.C.; writing—review and editing, A.R.-P. and L.F.C. visualization, A.R.-P. and L.F.C.; supervision, A.R.-P.; project administration, A.R.-P. and L.F.C.; funding acquisition, A.R.-P. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Chair of Development of Healthy Organizations and Territories of the University of Lleida (2024DOTSS001: Analysis of Health Education in Teacher Education).

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflicts of Interest

The authors declare no conflicts of interest.

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Societies 15 00106 g001
Figure 1. PRISMA flowchart on the scientific literature on HE in Early Childhood Education.
Figure 1. PRISMA flowchart on the scientific literature on HE in Early Childhood Education.
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Figure 2. Number of publications per year.
Figure 2. Number of publications per year.
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Figure 3. Studies from their perspective to justify the relevance of EPS in Early Childhood Education.
Figure 3. Studies from their perspective to justify the relevance of EPS in Early Childhood Education.
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Table 1. Summary of the analysis of HE studies in the field of education (2014–2024).
Table 1. Summary of the analysis of HE studies in the field of education (2014–2024).
SubcategoryN. of StudiesMain ApproachesReferences
Teacher training5Inclusion of HE in the curricula, student perception and motivation, and impact of the pandemic on training.[37,38,39,44,45]
Pedagogic strategies3Interdisciplinary methods, kindergarten education and accident prevention in the school environment.[34,40,41]
Promotion of healthy habits2Personal hygiene and physical activity education for health literacy.[29,30]
Sociocultural factors2Influence of external aspects (cultural and community) on the transmission of health knowledge.[32,46]
Note: created by the authors.
Table 2. Summary of the areas and themes of the studies on HE in Early Childhood Education.
Table 2. Summary of the areas and themes of the studies on HE in Early Childhood Education.
Main AreaN. of StudiesKey Topic AddressedReferences
Area of Education12Teacher training, healthy habits, and sociocultural factors[29,30,32,34,37,38,39,40,41,44,45,46]
Medicine and Nursing4Disease prevention, gamification in health, digital literacy in health.[31,33,42,43]
Public Health and Nutrition4Nutrition education, prevention of childhood obesity, evaluation of comprehensive programs.[35,36,47,49]
Psychology1Emotional well-being and its relationship with the promotion of children’s health.[48]
Note: created by the authors.
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Ramos-Pla, A.; Fornons Casol, L. Health Education in Early Childhood Education: A Systematic Review of the Literature. Societies 2025, 15, 106. https://doi.org/10.3390/soc15040106

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Ramos-Pla A, Fornons Casol L. Health Education in Early Childhood Education: A Systematic Review of the Literature. Societies. 2025; 15(4):106. https://doi.org/10.3390/soc15040106

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Ramos-Pla, Anabel, and Laura Fornons Casol. 2025. "Health Education in Early Childhood Education: A Systematic Review of the Literature" Societies 15, no. 4: 106. https://doi.org/10.3390/soc15040106

APA Style

Ramos-Pla, A., & Fornons Casol, L. (2025). Health Education in Early Childhood Education: A Systematic Review of the Literature. Societies, 15(4), 106. https://doi.org/10.3390/soc15040106

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