Toddler Health: New guidelines stress activity, sleep over screen time

Melissa Erickson

If they are to grow up healthy, children under 5 should spend less time sitting watching screens or restrained in seats, get better-quality sleep and have more time for active play, according to new guidelines from the World Health Organization.

“As we think of ways to prevent obesity we are learning that the earlier we introduce healthy habits, the better,” said Dr. Dominique Williams of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, Columbus, Ohio, and assistant professor of pediatrics at Ohio State University College of Medicine. “The guidelines provide parents and families with evidence-based recommendations to improve the health of their child. They also emphasize the importance of free play and adequate rest — concepts that are evolving as our world changes and technology becomes more commonplace.”

A panel of experts compiled the new guidelines, which are based on scientific evidence from published studies regarding benefits of increased physical activity and the effects of inadequate sleep and time spent sitting watching screens or restrained in chairs and strollers.

One standout is that the new guidelines recommend zero screen time for children under 2.

“Parents will likely need help from the entire family to make no screen time a reality, but every little bit counts, even when the days get busy,” Williams said. “It may be helpful to engage older siblings, extended family and friends by having them sing along to music or talk to the baby; older siblings can practice their reading skills; everyone can take turns talking to the baby, telling stories or playing.”

Recommendations for children under 1 include:

- Zero screen time.

- Being physically active several times a day in a variety of ways, especially floor-based play plus at least 30 minutes of tummy time.

- Not being restrained for more than 1 hour at a time. When babies are sedentary, reading and storytelling with a caregiver is encouraged.

- Good-quality sleep including naps: 14 to 17 hours for the first three months and 12 to 16 hours for infants 4 to 11 months.

Ages 1-2 should:

- Be physically active for at least 180 minutes a day.

- Not be restrained for more than 1 hour at a time or sit for extended periods of time.

- Have 11 to 14 hours of good-quality sleep, including naps, with regular sleep and wake-up times.

- Screen time is not recommended for 1 year olds. At 2, screen time should be less than 1 hour a day, and less is better.

Children 3-4 should:

- Spend at least 180 minutes a day being physically active.

- Not be restrained for more than 1 hour.

- Limit screen time to no more than 1 hour.

- Get 10 to 13 hours of good-quality sleep, which may include a nap, with regular sleep and wake-up times.

While these new guidelines reflect a better understanding of the most current available data, pediatricians do not expect parents, caregivers and families to perfectly adhere to all of these recommendations.

“Instead, start with the ones that are most realistic for your family,” Williams said. “Go slow. Be patient. Follow up with your pediatrician if you have any concerns about behavior, sleep or your child’s ability to be active.”