WHO guidelines on health for children under 5 yrs.

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2-Apr-2019: Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age

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 WHO Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age provide recommendations on the amount of time in a 24-hour day that young children, under 5 years of age, should spend being physically active or sleeping for their health and wellbeing, and the maximum recommended time these children should spend on screen-based sedentary activities or time restrained. They were developed using the best available evidence, expert consensus and consideration of values and preferences, acceptability, feasibility, equity and resource implications.

To meet daily physical activity time recommendations, particularly in children, the pattern of overall activity across a 24-hour period needs to be considered, since every day is made up of sleep time, sedentary time and light-, moderate- or vigorous-intensity physical activity.

Young children should have opportunities to participate in a range of developmentally-appropriate, safe, enjoyable play-based physical activities.  The quality of sedentary time matters and interactive non-screen based activities, such as reading, storytelling, singing and puzzles are important for social and cognitive development as well as recreation and relaxation. Regular sleep and wake-up times can help to ensure adequate, good quality sleep.

RECOMMENDATIONS FOR 24-HOUR PHYSICAL ACTIVITY, SEDENTARY BEHAVIOUR AND SLEEP FOR CHILDREN UNDER 5 YEARS OF AGE

These guidelines are for all healthy children under 5 years of age, irrespective of gender, cultural background or socio-economic status of families and are relevant for children of all abilities; caregivers of children with a disability or those with a medical condition, however, may seek additional guidance from a health professional.

For the greatest health benefits, infants, and young children should meet all the recommendations for physical activity, sedentary behaviour and sleep in a 24-hour period. Replacing restrained or sedentary screen time with more moderate- to vigorous-intensity physical activity, while preserving sufficient sleep, can provide additional health benefits.

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 14–17 hours  (0–3 months of age)  or 12–16 hours (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 11–14 hours 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 10–13 hours of good quality sleep, which may include a nap, with regular sleep and wake-up times.

Following the recommendations in these guidelines during the first 5 years of life is associated with better motor and cognitive development, psychosocial (emotional regulation) and cardiometabolic health, bone and skeletal health and reduced risk of injuries. Time spent restrained should be limited. Over the course of a day, a combination of more physical activity, less  sedentary  screen time and longer sleep duration results in the greatest benefits.

These guidelines are intended to assist all countries in the development of national plans and programmes aimed at increasing levels of physical activity, reducing sedentary time and improving time spent sleeping in young children.

The development of these new WHO guidelines was a recommendation of both the Commission on Ending Childhood Obesity and the Global Action Plan on Physical Activity 2018–2030.