When it comes to our children, we stress about everything. Is our child getting enough or too much of one thing or another? Are they playing enough? Getting enough good nutrition? Sleeping too little? Is screen time really as bad as everyone says? How much is too much? The questions and worries are endless, as are the answers. The problem, however, is that the advice you find on all fronts is often vague or conflicting.
Now, for the first time, the World Health Organization (WHO) is stepping in to give parents some factual guidelines on sedentary behaviour, physical activity and sleep requirements for children under the age of five1.
In the past, the organisation has been focussed on providing guidelines for groups older than five years of age. The necessity for the newly released guidelines was, however, recognised after a systematic review of scientific evidence in published studies on screen time, sleep (and more specifically the effects of inadequate sleep), time spent sedentary and restrained in prams and/or chairs as well as the benefits of physical activity in younger age groups.
Based on this information, a panel of WHO experts formulated the new guidelines, categorising them according to age group as follows:
- Infants younger than 1 year of age
- Children aged between 1 to 2 years
- Children 3 to 4 years of age.
The benefits of sitting less and playing more
The general consensus for all age groups is that they should spend less time sitting and/or watching screens, play more and get better quality sleep in order to enjoy optimum health.
According to WHO Director-General, Dr Tedros Adhanom Ghebreyesus, achieving health means doing what’s best for health right from the start of life. He adds that early childhood is a time of rapid development and when family and lifestyle patterns can be adapted to optimise the potential health gains.
The WHO’s Programme manager for surveillance and population-based prevention of noncommunicable diseases, Dr Fiona Bull echoes this sentiment. She explains that reducing the amount of time spent sitting, increasing physical activity and ensuring that children get quality sleep has both physical and mental health benefits. In addition, it also helps to prevent childhood obesity and the diseases associated with obesity later in life.
How sitting is actually killing us
Failure to meet the current guidelines for physical activity is responsible for more than 5 million deaths annually across the globe in all age groups. This is because habitual sitting and sedentary behaviour increases the risk of becoming obese and/or developing health conditions such as diabetes, cardiovascular disease, metabolic syndrome and deep-vein thrombosis2,3.
According to the WHO's statistics, over 23% of adults and 80% of adolescents are not physically active enough to remain healthy. A recent long-term US study shows that increased sedentary behaviours among all age groups in recent years is largely attributed to increased computer usage during leisure time across all age groups4.
Experts believe that if healthy amounts of sedentary behaviour, physical activity and sleep are established early in life, these habits will be continued throughout adolescence and adulthood.
What can parents and caregivers do?
According to the WHO’s Dr Juana Willumsen, it is important to ensure that children shift from sedentary time to play time without disrupting quality sleep. It is therefore advisable to establish solid 24-hour patterns wherein extended periods of restrained sitting and/or sedentary screen time are replaced with play activities, while ensuring that young children also get sufficient, good-quality sleep in-between.
Sedentary time should also be of a higher quality than just sitting doing nothing and involve non-screen-based activities. These can include things like interactive games, puzzles, singing, story telling and reading, all of which are vital in childhood development.
For more specific guidelines, the WHO recommends the following for each age category under 5:
Infants (babies younger than 1 year)
- Physical activity: Physical activity should be incorporated between naps several times a day. This may include up to 30 minutes of tummy time in very young infants, spread throughout the day during waking hours. In older infants, interactive floor-based play should be encouraged – the more time spent on these types of activities, the better!
- Sitting / Sedentary behaviour: Time spent sitting and restrained (i.e. in prams/strollers, high chairs or strapped to a mother or caregiver’s back) should be limited to no more than 1 hour. Engaging in interactive activities such as storytelling, singing or reading is preferable during sedentary periods.
- Sleep: Good quality sleep which includes naps should take place as follows for each age group:
- 0-3 months: 14 to 17 hours sleep
- 4 – 11 months: 12 – 16 hours of sleep
Children (1 – 2 years of age)
- Physical activity: At least 3 hours of various types of physical activity of any intensity should be enjoyed throughout the day. Once again, the more the better.
- Sitting / Sedentary behaviour: Children should not be restrained or sit for more than 1 hour at a time.
- Screen time: Screen time including TV, videos, tablets and/or playing video games is not recommended for 1 year olds. Children aged 2 may engage in these activities for up to an hour, but the less, the better and human-to-human development activities such as reading, storytelling etc. are preferable.
- Sleep: Children in this age group should get 11 to 14 hours solid sleep (including naps) with routine sleep and wake-up schedules.
Children (3 – 4 years of age)
- Physical activity: At least 3 hours of various types of physical activity throughout the day, one of which should be moderate to vigorous in nature. The more activity, the better.
- Sitting / Sedentary behaviour: Children of these ages should not be subject to restrained sitting or inactivity for more than 1 hour at a time.
- Screen time: Sedentary screen time should be restricted to an hour or less, again interpersonal games and interactions are preferable.
- Sleep: Children in this age group should get 10 to 13 hours of good quality sleep (including naps) with routine sleep and wake-up schedules.
While ensuring that a child gets this amount of activity, quality stimulation and sleep, especially if you’re a working parent, can be challenging. It is therefore extremely important to ensure that all parties involved in caregiving are aware of the requirements and work together to achieve them. Doing so can go a long way to ensuring the formation of positive habits and even lifelong health.
1. To grow up healthy, children need to sit less and play more. Who.int. https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more. Published 2019. Accessed April 26, 2019.
2. Wilmot E, Edwardson C, Achana F et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895-2905. doi:10.1007/s00125-012-2677-z
3. Owen N, Sparling P, Healy G, Dunstan D, Matthews C. Sedentary Behavior: Emerging Evidence for a New Health Risk. Mayo Clin Proc. 2010;85(12):1138-1141. doi:10.4065/mcp.2010.0444
4. Yang L, Cao C, Kantor E et al. Trends in Sedentary Behavior Among the US Population, 2001-2016. JAMA. 2019;321(16):1587. doi:10.1001/jama.2019.3636