A majority of American children participate in non-parental child-care arrangements in child-care centers and homes. The child-care setting can play a major role in shaping children’s dietary intake, physical activity, and energy balance. In this article, the authors discuss trends in child-care use, child-care food and physical activity policies and environments, and obesity prevention interventions in preschool settings. The authors also discuss their original research which examined state child-care licensing regulations related to food, physical activity, and media use in home- and center-based child-care settings. Recommendations for strengthening regulations and strategies for achieving more healthful food and physical activity environments are also discussed.