Adherence to SG’s healthy activity guidelines for early childhood decline with age

How children in Singapore meet sleep, screen time, and physical activity recommendations appears to slip as they transition from infants to screen-focused toddlers and preschoolers, according to a study.

“Two significant findings emerged from this study. First … was a decline in the percentage of children who met all three criteria for physical activity, screen viewing time, and sleep as they transitioned from infancy, toddlerhood to preschool age,” researchers said. “Second, while a larger proportion of infants and toddlers adhered to all three recommendations on weekdays, the opposite trend was observed among preschoolers.”

In 2022, Singapore launched the Integrated 24-Hour Activity Guidelines for Early Childhood to address the importance of healthy habits for young children. These guidelines promote a “whole day matters” approach, emphasizing the interconnectedness of physical activity, sleep, and screen time throughout the day. [https://www.cfps.org.sg/assets/1-Circular-for-GPs/7-CPCHS-Singapore-Integrated-24-Hr-Activity-Guidelines-for-Early-Childhood-2021-Main.pdf; https://www.who.int/publications/i/item/9789241550536]

The guidelines state that infants (0 to <12 months) have at least 30 minutes of tummy time or floor-based play, no screen viewing time, and total sleep of 14–17 hours at age 0–3 months or 12–16 hours at age 4–11 months. Toddlers (1 to <3 years), on the other hand, are advised to have at least 180 minutes of total physical activity, a total sleep of 11–14 hours per day, and zero screen viewing time at age 1 to <2 years or less than an hour at age 2 to <3.

For preschoolers (3 to <7 years), at least 180 minutes of total physical activity per day, less than an hour of screen time, and total sleep of 10–13 hours at age 3–5 years or 10–11 hours at age 6.

The researchers examined adherence levels to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood among 219 infants, 379 toddlers, and 303 preschoolers. Their caregivers completed questionnaires that evaluated the children’s physical activity, screen viewing time, and sleep durations on both weekdays and weekends. 

Analysis of data showed that compared with weekdays, weekends saw a higher proportion of toddlers and preschoolers meeting the recommended amount of physical activity (68.9 percent vs 50.1 percent and 78.9 percent vs 55.4 percent, respectively; p<0.05), as well as a lower proportion of toddlers meeting the recommended screen viewing time (38.8 percent vs 21.8 percent; p=0.001). [PLoS One 2024;19:e0298968]

Adherence to all three activity guidelines declined as age groups progressed from infants (44.7 percent) to toddlers (15.8 percent) and then to preschoolers (9.4 percent). There was a concurrent deterioration in meeting screen viewing time recommendations across the age groups, with adherence rates being highest among infants (83.1 percent), followed by toddlers (15.8 percent) and then preschoolers (9.4 percent).

“Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to screen viewing time guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating screen viewing time among infants and young children,” the researchers said.