New WHO guidelines on physical activity, sedentary behaviour and sleep for children under five seek to “bring back play.”

The World Health Organisation (WHO) has recommended that children under the age of five should not spend more than one hour a day watching television (or videos, playing games on a phone/tablet device etc) and screen time is not recommended at all for infants under the age of one.

The new WHO guidelines on physical activity, sedentary behaviour and sleep for children under five were developed by a WHO panel of experts. They 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.

Applying the recommendations in these guidelines during the first five years of life will contribute to children’s motor and cognitive development and lifelong health, the WHO stated.

This is the first time that the WHO has issued global recommendations in this area for children under five.

Overall the guidelines recommend that children under five must spend less time sitting watching screens, or restrained in prams and seats, get better quality sleep and have more time for active play if they are to grow up healthy.

“Improving physical activity, reducing sedentary time and ensuring quality sleep in young children will improve their physical, mental health and wellbeing, and help prevent childhood obesity and associated diseases later in life,” said Dr Fiona Bull, programme manager for surveillance and population-based prevention of noncommunicable diseases, at WHO.

The new guidelines recommend that infants under the age of one should be physically active several times a day in a variety of ways, particularly through interactive floor-based play. For those not yet mobile, this includes at least 30 minutes in prone position (tummy time) spread throughout the day while awake.

Children aged 1-4 years should spend at least 180 minutes in a variety of types of physical activities at any intensity and for 2-4-year olds, at least 60 minutes of this is recommended to be moderate to vigorous intensity.

According to the WHO, failure to meet current physical activity recommendations is responsible for more than 5 million deaths globally each year across all age groups. Currently, more than 23 per cent of adults and 80 per cent of adolescents are not sufficiently physically active. If healthy physical activity, sedentary behaviour and sleep habits are established early in life, this helps shape habits through childhood, adolescence and into adulthood.

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

The WHO advised that the pattern of overall 24-hour activity was key: replacing prolonged restrained or sedentary screen time with more active play, while making sure young children get enough good-quality sleep. Quality sedentary time spent in interactive non-screen-based activities with a caregiver, such as reading, storytelling, singing and puzzles, is very important for child development.

Welcoming the new guidelines Ms Laura Hickey, Children and Young People Programme Manager with the Irish Heart Foundation said, they “provide clear age-appropriate guidelines for physical activity, sedentary screen time and sleep. For children under 5 it is not just a critical time for growth and development but also a period where children begin to develop their healthy behaviours — developing healthy lifestyle habits in early life is crucial.”

“Today in Ireland just 19 per cent of primary school children are meeting the recommended guidelines for physical activity, most children are spending at least three hours on screen time per day. Collectively this is putting children at a higher risk for developing childhood obesity, as well as cardiovascular and other noncommunicable diseases,” she added.

The WHO Recommendations at a glance:

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 11-14 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 10–13h of good quality sleep, which may include a nap, with regular sleep and wake-up times.