Restricting the number of hours young children sit in front of screens may free up more time for physical activity, human interaction, and sleep — all critical for healthy development and preventing childhood obesity, according to the WHO. The new guidelines were developed in collaboration with the WHO’s Commission on Ending Childhood Obesity and will be part of WHO’s Global Action Plan on Physical Activity 2018–2030.
“What we really need to do is bring back play for children,” says Juana Willumsen, Ph.D., who focuses on childhood obesity and physical activity at WHO in Geneva and contributed to the new guidelines. “This is about making the shift from sedentary time to playtime while protecting sleep.”
Inactivity is a big part of the problem. More than 23 percent of adults and 81 percent of teens worldwide don’t get enough physical activity, according to a 2018 report from the WHO. And a 2018 report from the Centers for Disease Control and Prevention found that in the United States more than 3 out of every 4 adults are not meeting the national exercise guidelines. Habits set early in life — whether good or bad — tend to follow children through adolescence and adulthood, putting them on a path to obesity and a whole host of other chronic health problems when they’re too sedentary.
The new recommendations from WHO marks the first time the organization has set guidelines on physical activity, sedentary time, or sleep for children under 5, Dr. Willumsen says. The guidelines were based on a review of research on how child development and adult health may be impacted by behaviors learned early in life.
“The evidence we reviewed showed that increased screen time was associated with poorer motor and cognitive development and increased body weight,” Willumsen says.
The sedentary time that young humans spend interacting with a caregiver, however, was found to be good for cognitive development, Willumsen adds. “So storytelling, singing, and playing with a child is good, whereas children passively watching or playing on screens with no adult input or interaction is not.”
Here’s what WHO says kids under 5 need every day.
For infants (younger than 1 year):
- No screen time at all
- A variety of physical activities several times a day, as often as possible while interacting with a caregiver. Before babies can crawl or walk, they need “tummy time” prone on the floor.
- No more than 1 hour a day restrained in a high chair, stroller, or worn on a caregiver’s back
- Sleep including naps totaling 14 to 17 hours until 3 months old; 12 to 16 hours from 4 to 11 months old.
For toddlers (1 to 2 years old):
- No sedentary screen time for 1-year-olds, an hour or less of screen time for two-year-olds
- At least 180 minutes of various physical activities, spread throughout the day
- No more than 1 hour a day restrained in a high chair, stroller or baby carrier
- Sleep, including naps, totaling 11 to 14 hours, with regular bedtimes and wakeup times
For preschoolers (3 to 4 years old)
- An hour or less of sedentary screen time
- At least 180 minutes of various physical activities, spread throughout the day, with at least 60 minutes of moderate- to vigorous-intensity exercise
- No more than 1 hour a day restrained in a high chair, stroller or baby carrier
- Sleep including naps totaling 10 to 13 hours, with regular bedtimes and wakeup times
Babies and Toddlers Need Exercise, Too
Many families may mistakenly think babies are too young for physical activity, says Rachel Gross, MD, an assistant professor of pediatrics and population health at New York University School of Medicine in New York City.
“Most babies are ready for active play right from the beginning,” Gross says. Even before newborns can roll over or sit up, “tummy time” in a prone position helps them get active and develop strength and coordination.
Another misconception is that shows and apps billed as educational help toddlers with cognitive and other skills, Gross says. Current research suggests the opposite — that electronic learning tools may actually hinder young children’s ability to learn, according to a report published in January 2019 by the American Academy of Pediatrics (AAP) in the journal Pediatrics.
For many busy families, meeting all these guidelines will mean setting new boundaries around screen time for adults, too, not just kids, says Beth Natt, MD, MPH, the director of pediatric hospital medicine and regional programs for Connecticut Children’s and Western Connecticut Health Network in Danbury.
The simplest change parents can make to their daily routine to promote healthy habits for their kids is 100 percent free but can sometimes be the most difficult to do, which is setting aside time each day to put down their devices and engage with their children,” Dr. Natt says.
Imagine a child gazing at their parent staring at their phone. The child wants to play and engage naturally, but is learning that entertainment happens only on the screen, Natt explains. When the adult unplugs, even if just for a few minutes, she says: “It creates an opportunity for eye contact, active play, conversation, and movement — which are the foundations for a healthy lifestyle and good social skills.”
Kids who are more active and engaged throughout the day may also have an easier time falling and staying asleep, notes Jenny Radesky, MD, a developmental-behavioral pediatrician at the University of Michigan Medical School and C.S. Mott Children’s Hospital in Ann Arbor, who researches family digital media use and child development. (Research shows that getting adequate physical activity throughout the day is linked to falling asleep more quickly and being more likely to get sufficient sleep.)
n addition to staying active throughout the day, Dr. Radesky suggests parents help kids establish healthy sleep habits by working on a nighttime routine that calms the whole family down, Radesky advises. “Sleep helps build the neural connections that really help children develop optimally.” (And we all know sleep is good for adults’ health, too.)
Sleep routines help children learn how to regulate their body and calm down, and as a bonus, it can help parents de-stress, too, she says. “Read, snuggle, turn off the news, set your phones to ‘do not disturb,’ and tell stories or sing songs that your loved ones sang to you,” Radesky suggests.
Smartphones and tablets haven’t been around long enough yet for there to be good long-term studies showing how shifts in screen time use, activity levels, and sleep might directly affect long-term health outcomes. The WHO recommends more research to explore the impact of its new guidelines.
Parents Should Be Questioning How Much Time Their Kids Spend Looking at Screens
While guidelines for screen time, physical activity, and sleep are new for this age group for the WHO, other health and medical groups have issued similar guidelines for babies and adolescents in this age range.
The AAP recommends against any screen time for kids under 2 and no more than an hour a day for older children in the group’s aforementioned Pediatrics report from this year. The group also recommends: Toddlers 1 to 2 years old should get at least 30 minutes a day of structured physical activity and at least 60 minutes a day of active, unstructured play. Starting at age 3, kids should play outside as much as possible because this results in more physical activity than playing indoors.
Finally, the AAP also recommends 12 to 16 hours of sleep a day for infants 4 to 12 months old; 11 to 14 hours of daily sleep for kids 1 to 2 years old; and 10 to 13 hours of daily sleep for children 3 to 5 years old.
The new WHO guidelines (as well as these existing ones from the AAP) are a reminder that parents should be questioning the role screens should play in their children’s lives, says Dimitri Christakis, MD, MPH, the director of the Center for Child Health, Behavior, and Development at Seattle Children’s Research Institute.
While it may seem a stretch to some parents and caregivers to think of infants as too sedentary, the realities of modern technology have indeed made even babies less active than they should be, Dr. Christakis says.
“The changes to our lifestyles that technology has made possible are both amazing and empowering, but we must be mindful of the potential downsides in terms of their impact on our health,” Christakis says. “We have come to learn that for all of us — but most especially young children — sleep, exercise, and screen time have profound effects on children’s cognitive, social, and emotional development.”