WHO Recommends Young Children Play More, Watch Screens Less, Get Plenty Of Sleep

For children under five years, increasing active play and reducing sedentary screen-time, while getting sufficient sleep, is critical for healthy physical and cognitive development, which impacts life-long health, according to new World Health Organization guidelines.

WHO’s first-ever Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age, released today, assert that improving the physical activity, sedentary behaviour and sleep time of young children “will contribute to their physical health, reduce the risk of developing obesity in childhood and the associated NCDs [noncommunicable diseases] in later life and improve mental health and wellbeing.”

These guidelines fill a previous gap in such recommendations for this age group. They explain that similar recommendations had already been made for the age groups 5-17, 18-64 and over 65 years, “but up until this point did not include children under the age of 5 years.”

“Achieving health for all means doing what is best for health right from the beginning of people’s lives,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said in a press release on the guidelines. “Early childhood is a period of rapid development and a time when family lifestyle patterns can be adapted to boost health gains.”

“What we really need to do is bring back play for children,” Dr Juana Willumsen, WHO focal point for childhood obesity and physical activity, said in the release. “This is about making the shift from sedentary time to playtime, while protecting sleep.”

“Physical inactivity has been identified as a leading risk factor for global mortality and a contributor to the rise in overweight and obesity. Early childhood is a period of rapid physical and cognitive development and a time during which a child’s habits are formed and family lifestyle habits are open to changes and adaptations,” the guidelines state.

The recommendations in the guidelines are based on the amount of time in a 24-hour day that young children under five should be physically active, sedentary or sleeping, to support their health and well-being. According to the guidelines, the recommendations are “intended to assist officials as they develop national plans to increase physical activity, reduce sedentary time and improve time spent sleeping in young children.”

The guidelines note that while the recommendations may be applicable to some children with disabilities and disease, they do not specifically address the physical activity, sedentary and sleep needs of these children.

Summary of Recommendations

A summary of the recommendations on physical activity, sedentary behaviour and sleep from the guidelines is included below.

Infants (less than 1 year) should:

  • Be physically active several times a day in a variety of ways, particularly through interactive floor-based play; more is better. For those not yet mobile, this includes at least 30 minutes in prone position (tummy time) spread throughout the day while awake
  • Not be restrained for more than 1 hour at a time (e.g., prams/strollers, high chairs, or strapped on a caregiver’s back). Screen time is not recommended. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 14–17h (0–3 months of age) or 12–16h (4–11 months of age) of good quality sleep, including naps.

Children 1–2 years of age should:

  • Spend at least 180 minutes in a variety of types of physical activities at any intensity, including moderate- to vigorous-intensity physical activity, spread throughout the day; more is better.
  • Not be restrained for more than 1 hour at a time (e.g., prams/ strollers, high chairs, or strapped on a caregiver’s back) or sit for extended periods of time. For 1-year-olds, sedentary screen time (such as watching TV or videos, playing computer games) is not recommended. For those aged 2 years, sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 11–14h of good quality sleep, including naps, with regular sleep and wake-up times.

Children 3–4 years of age should:

  • Spend at least 180 minutes in a variety of types of physical activities at any intensity, of which at least 60 minutes is moderate- to vigorous- intensity physical activity, spread throughout the day; more is better.
  • Not be restrained for more than 1 hour at a time (e.g., prams/ strollers) or sit for extended periods of time. Sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 10–13h of good quality sleep, which may include a nap, with regular sleep and wake-up times.

Background on the Guidelines

In 2010, WHO published their Global recommendations on physical activity for health, detailing the importance of physical activity in the prevention of noncommunicable diseases (NCDs). In these recommendations, WHO noted that while it had physical activity data for adults and adolescents, it did not have any comparable data at the time for younger children.

The need for these clear guidelines on physical activity, sedentary behaviour and sleep in young children was later recognised and called for in 2016 by the Commission on Ending Childhood Obesity.

The guidelines were then developed by a WHO panel of experts that “assessed the effects on young children of inadequate sleep, and time spent sitting watching screens or restrained in chairs and prams. They also reviewed evidence around the benefits of increased activity levels,” the release says.

While the overall quality of the evidence was rated as “very low,” the recommendations are nonetheless “strong,” as “favourable outcomes outweigh possible harms of combinations of more physical activity, less sedentary screen time and longer sleep duration, and that the greatest benefits result from meeting all three behaviours,” the guidelines say.

The recommendations, the guidelines explain, “will be updated within ten years, unless further research in the area provides additional evidence to warrant an earlier update.”

Image Credits: WHO.

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