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Under-fives must play more and spend less time sitting with screens

WHO guidelines call for young children to be more active and get good sleep to be healthy

Louise Prime

Thursday, 25 April 2019

Preschool-aged children should be playing and sleeping more and spending less time sitting and using screens for them to grow up healthy, according to new World Health Organisation (WHO) guidelines. UK experts have welcomed WHO’s focus on child health and activity levels, but added that not only do blanket recommendations risk alienating rather than motivating families, its suggested screen time restrictions “do not seem proportionate to the potential harm”.

WHO said its new guidelines on physical activity, sedentary behaviour and sleep for children under five years of age were developed by its panel of experts who 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. As a result, they concluded that the pattern of overall 24-hour activity is key: replacing prolonged restrained or sedentary screen time with more active play, while ensuring that young children get enough good-quality sleep. But they added that “quality sedentary time” spent in interactive non-screen-based activities with a caregiver, such as reading, storytelling, singing and puzzles, is also very important for child development. The recommendations are that:


Infants (less than one 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 one 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 aged 1-2 years 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 one 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 one-year-olds, sedentary screen time (such as watching TV or videos, playing computer games) is not recommended. For those aged two years, sedentary screen time should be no more than one hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • have 11-14 hours of good quality sleep, including naps, with regular sleep and wake-up times.

And children 3-4 years old 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 one hour at a time (e.g., prams/strollers) or sit for extended periods of time. Sedentary screen time should be no more than one 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.

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

WHO argued that if healthy physical activity, sedentary behaviour and sleep habits are established early in life, this helps shape habits through childhood, adolescence and into adulthood.

The Royal College of Paediatrics and Child Health welcomed WHO’s focus on “important health issues” and said it hoped the result would be more research and interventions to help children and families lead healthy lives. However, it warned that “without the right support in place, striving for the perfect could become the enemy of the good”.

The College’s officer for health improvement Dr Max Davie said: “Recommendations alone can have a number of unintended consequences, and simply proposing standards without providing the right support could discourage families rather than motivate.

“While it is important for children to be as active as possible, the barriers are more frequently to do with housing, work patterns, family stress, and lack of access to play spaces rather than actively choosing to be sedentary.”

He went on: “The restricted screen time limits suggested by the WHO do not seem proportionate to the potential harm. Our research has shown that currently there is not strong enough evidence to support the setting of screen time limits, and that screen use should be considered alongside a range of activities to assess its impact. Also, it is difficult to see how a household with mixed-age children can shield a baby from any screen exposure at all, as is recommended.”

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