Physical activity and sedentary behavior across three time-points and associations with social skills in early childhood

Clustering Patterns of 24-Hour Physical Activity in Children 6-36 Months Old

PURPOSE

To determine 24-hour physical activity (PA) clusters in children 6-36 months of age, factors associated with the clusters, and their agreement across time.

METHOD

A longitudinal study followed 150 infants from South Carolina up to 36 months of age. Measures included 24-hour PA and demographic data. Functional clustering was used to obtain the clusters. The association between cluster membership and infant/parent characteristics was examined by Kruskal-Wallis and chi-squared tests. Concordance was measured with the kappa coefficient and percent agreement.

RESULTS

At each follow-up, 3 clusters were optimal, identified as late activity (cluster 1), high activity (cluster 2), and medium activity (cluster 3). The defining feature of the late activity cluster was that their physical activity (PA) activity was shifted to later in the day versus children in clusters 2 and 3. At 6 months, the clusters were associated with race (<0.001), crawling (0.043), other children in the household (0.043), and mother's education (0.004); at 12 months with race (0.029), childcare (<0.001), and education (<0.001); and at 36 months with other children in the household (0.019). Clusters showed moderate agreement (kappa = .41 [.25 to .57], agreement = 61% [49% to 72%]) between 6 and 12 months and, at 36 months, showed no agreement with either 6 or 12 months.

CONCLUSION

Twenty-four-hour PA can be clustered into medium, high, and late PA. Further research is needed into the consequences of late sleeping in children at this age. Clusters are associated with household and childcare factors, and cluster membership is dynamic across time.

Parental role-modeling on 24-hour movement behaviors among preschoolers during the COVID-19 pandemic

INTRODUCTION

Little is known about the association between parents' and children's 24-h movement behaviors during the pandemic. This cross-sectional study examined the association between the 24-h movement behaviors of parents and their preschoolers and investigated sex differences in this association.

METHODS

A total of 1740 preschoolers (4.5 ± 0.8 years old, 50.3% boys) and their parents (35.4 ± 4.9 years old, 24.3% males) in China participated in this study and provided valid and complete data. Parents completed an online survey or a written questionnaire in the period between October and December 2020. Preschoolers' and parents' movement behaviors (physical activity [PA], sedentary behavior [SB], screen time, and sleep) and demographic information were reported by the parents. Generalized linear models and logistic regression models were performed.

RESULTS

Positive associations were found between parents' and preschoolers' moderate-to-vigorous intensity PA (β = 0.28; 95% confidence interval [CI]: 0.20, 0.36), total PA (β = 0.21; 95% CI: 0.17, 0.24), and sleep (β = 0.05; 95% CI: 0.03, 0.06) with no apparent sex difference. No significant association was found between parents' and preschoolers' SB or screen time. Girls were more likely to meet all three 24-h movement guidelines when their parents met them (odds ratio = 2.38; 95% CI: 1.42, 4.01), but the relationship was not significant for boys.

CONCLUSIONS

Parental role-modeling was positively associated with children's PA and sleep. This finding suggests that supporting parents' movement behaviors has the potential to promote a healthy lifestyle among preschoolers.

Exploring the Nexus between Moderate-to-Vigorous Physical Activity, Self-Disclosure, Social Anxiety, and Adolescent Social Avoidance: Insights from a Cross-Sectional Study in Central China

Objectives: Psychological issues among adolescents represent a prevalent challenge in today's society. The purpose of this study is to explore the associations among moderate-to-vigorous physical activity, self-disclosure, social anxiety, and social avoidance in adolescents. Methods: This study collected cross-sectional data from 427 students in eight provincial key junior and senior high schools in the central China region of three provinces using snowball sampling and convenience sampling from July to August 2023. A structural equation model was employed to investigate the relationship between moderate-to-vigorous physical activity and social avoidance among adolescents. Results: The findings indicate that moderate-to-vigorous physical activity is negatively correlated with social anxiety (standardized coefficient = -0.219, p < 0.001) and positively correlated with self-disclosure (standardized coefficient = 0.454, p < 0.001). Social anxiety is negatively correlated with self-disclosure (standardized coefficient = -0.220, p < 0.001). Social avoidance is positively correlated with social anxiety (standardized coefficient = 0.461, p < 0.001) and negatively correlated with self-disclosure (standardized coefficient = -0.331, p < 0.001). Conclusions: The chain-mediated dual-path model between moderate-to-vigorous physical activity and social avoidance is facilitated by social anxiety and self-disclosure. In other words, adolescents who engage in more moderate to high-intensity physical activities exhibit lower levels of social anxiety, and those who have a stronger inclination for self-disclosure tend to demonstrate lower levels of social avoidance. In light of these findings, it is recommended that the government, society, schools, and families collaborate synergistically to promote the holistic well-being of adolescents and advance the development of a healthier China.

Association of screen time and physical activity with health-related quality of life in college students

OBJECTIVE

To determine the association between screen time and physical activity with quality of life among Chilean university students.

METHODS

Cross-sectional and analytical study conducted on 726 first-year university students who replied three questionnaires: Youth Risk Behavior Survey, WHO Quality of Life-BREF scale, and the International Physical Activity Questionnaire.

RESULTS

There were differences in overall quality of life (p < .001) and level of satisfaction in health (p < .01) according to screen exposure time. These results follow a linear trend for all the quality of life domains (p < .01), and they indicate that there is an inverse association between screen time and quality of life.

CONCLUSION

There is an inverse association between screen time and quality of life in university students. Students with a longer screen exposure time showed a lower quality of life, specifically in the domains of social relationships and psychological health, regardless of sex, physical activity, or socioeconomic level.

Consensus statement on Singapore integrated 24-hour activity guide for early childhood

Introduction

Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health.

Method

The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases.

Results

Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results.

Conclusion

This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.

Screen time and preschool children: Promoting health and development in a digital world

COVID-19 transformed the family media environment and spurred research on the effects of screen media exposure and use on young children. This update of a 2017 CPS statement re-examines the potential benefits and risks of screen media in children younger than 5 years, with focus on developmental, psychosocial, and physical health. Four evidence-based principles-minimizing, mitigating, mindfully using, and modelling healthy use of screens-continue to guide children's early experience with a rapidly changing media landscape. Knowing how young children learn and develop informs best practice for health care providers and early years professionals (e.g., early childhood educators, child care providers). Anticipatory guidance should now include child and family screen use in (and beyond) pandemic conditions.

Adherence to the World Health Organization's physical activity recommendation in preschool-aged children: a systematic review and meta-analysis of accelerometer studies

BACKGROUND

The World Health Organization (WHO) recommend that preschool-aged children should engage in 180 min of total physical activity (TPA) including 60 min of moderate-to-vigorous physical activity (MVPA) each day. No systematic reviews or meta-analyses have pooled adherence to the recommendation across multiple studies. This study aimed to estimate the prevalence of preschool-aged children achieving the WHO's physical activity recommendation for young children, and determine if the prevalence differed between boys and girls.

METHODS

Primary literature searches were conducted on six online databases and a machine learning assisted systematic review was used to identify relevant studies. Studies written in English reporting on the prevalence of children aged 3-5 years achieving overall WHO physical activity recommendation or the individual TPA or MVPA aspects of the recommendation measured using accelerometers were eligible for inclusion. Random effects meta-analysis was used to determine the prevalence of preschools achieving the overall WHO recommendation and the individual TPA and MVPA aspect of the recommendation, and to determine difference in prevalence between boys and girls.

RESULTS

Forty-eight studies reporting on 20,078 preschool-aged children met the inclusion criteria. Based on the most commonly employed accelerometer cut-points across all aspects of the recommendation, 60% (95% Confidence Interval [CI] = 37%, 79%) of preschool-aged children adhered to the overall physical activity recommendation, 78% (95% CI = 38%, 95%) adhered to the TPA aspect of the recommendation, and 90% (95% CI = 81%, 95%) adhered to the MVPA aspect of the recommendation. There was substantial variability is prevalence estimates between different accelerometer cut-points. Girls were significantly less likely to achieve the overall recommendation and the MVPA aspect of the recommendation than boys were.

CONCLUSIONS

Although there was substantial variability in estimated prevalence of preschool-aged children adhering the WHO physical activity recommendation between various accelerometer cut-points, the weight of available evidence suggests that the majority of young children are adhering to the overall recommendation and the individual TPA and MVPA aspects of the recommendation. Large-scale, intercontinental surveillance studies are needed to further strengthen the evidence regarding the prevalence of preschool-aged children achieving physical activity recommendation globally.

Risk factors for developmental quotients in ASD children: A cross-sectional study

Objective

To analyze the risk factors for developmental quotients (DQs) of children with autism spectrum disorder (ASD) and to better understand the effects of screen time on neurodevelopment in children with ASD.

Methods

We retrospectively analyzed the data of 382 children with ASD, including demographic profiles; socioeconomic status; score on the Chinese parent–child interaction scale (CPCIS); screen time questionnaire; ASD symptom rating scales, including the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Autism Diagnostic Observation Schedule Second Edition (ADOS-2); and DQs using Griffiths Development Scales–Chinese Edition. Univariate analysis was carried out to analyze the factors related to the DQs of children with ASD, and then the linear regression model was used to identify the independent influencing factors of the DQs of children with ASD.

Results

Vitamin D (β = 0.180, p = 0.002), age (β = −0.283, p = 0.000) and CARS score (β = −0.347, p = 0.000) are risk factors related to DQ of locomotor in children with ASD. Vitamin D (β = 0.108, p = 0.034), CARS score (β =  −0.503, p = 0.000), ADOS-2 severity score (β =  −0.109, p = 0.045) and CPCIS score (β = 0.198, p = 0.000) are risk factors related to DQ of personal social skill in children with ASD. Vitamin D (β = 0.130, p = 0.018), CARS score (β =  −0.469, p = 0.000), and CPCIS score (β = 0.133, p = 0.022) are risk factors related to DQ of hearing-speech in children with ASD. Vitamin D (β = 0.163, p = 0.003) and CARS score (β =  −0.471, p = 0.000) are risk factors related to DQ of eye-hand coordination in children with ASD. Age (β =  −0.140, p = 0.020), CARS score (β =  −0.342, p = 0.000), ADOS-2 severity score (β = −0.133, p = 0.034) and CPCIS score (β = 0.193, p = 0.002) are risk factors related to DQ of performance in children with ASD. Vitamin D (β = 0.801, p = 0.000) and CPCIS score (β = 0.394, p = 0.019) are risk factors related to DQ of practical reasoning in children with ASD.

Conclusion

Vitamin D status, the severity of autistic symptoms and parent-child interaction are risk factors for developmental quotients in children with ASD. Screen exposure time is negatively associated with DQs in children with ASD but is not an independent risk factor for DQs.

Primary Care Counseling of Parents Regarding Childhood Screen Media Use

Parental beliefs and motivation are instrumental in improving childhood digital media use (DMU). Parents (n = 611) completed questionnaires about childhood DMU assessing knowledge, interest in counseling, motivation to change, self-efficacy, and beliefs. Less than a third correctly recognized screen time limits. Twenty-seven percent received childhood DMU information from a doctor, while 46% stated they would like such information. Only 2% had a doctor-recommended DMU plan. Interest in DMU topics, motivation to improve, and management self-efficacy were moderate. Top negative beliefs were addiction to DMU (52%), sleep problems (39%), obesity (33%), social skills (33%), and inappropriate content (32%). Differences between age categories existed for social (48%, P = .01) and language (14%, P = .01) concerns (highest for toddlers), attention concerns (27%, P = .02; highest in preschoolers), and depression (13%, P < .001) and low self-esteem (8%, P = .04; highest in teens). Findings support further development of approaches to address DMU, tailored by age-specific common parental views.

Adherence to Canadian 24-Hour Movement Guidelines among infants and associations with development: a longitudinal study

BACKGROUND

To examine: 1) longitudinal adherence to the Canadian 24-Hour Movement Guidelines in a sample of infants and 2) associations between adherence to the guidelines over time and development.

METHODS

Participants were 250 parent-infant dyads from the Early Movers project in Edmonton, Alberta. At 2, 4, and 6 months of age, physical activity, sedentary behaviour, sleep, and development were measured with a parental questionnaire that included items from the Ages & Stages Questionnaire (ASQ-3). Parents also reported the dates six major gross motor milestones were acquired during the first 18 months of life according to World Health Organization criteria. In a sub-sample (n = 93), movement behaviours were also measured with a time-use diary at 2, 4, and 6 months and gross motor development was measured by a physiotherapist using the Alberta Infant Motor Scale (AIMS) at 6 months. Guideline adherence was defined as: 1) ≥ 30 min/day of tummy time, 2) no screen time, some reading time, no restrained bouts > 1 h (time-use diary only), and 3) 14-17 h (2 months) or 12-16 h (4 and 6 months) of sleep per 24-h period. Generalized estimating equations were conducted as well as linear mixed models and linear regression models that adjusted for demographic characteristics.

RESULTS

Few infants met the guidelines at all time-points (questionnaire: 2%; time-use diary: 0%). Infants that met a recommendation at 2 months, compared to those that did not, were 1.8-8.2 times more likely to meet that recommendation at subsequent time-points. Meeting more recommendations across time-points, according to both measures, was associated with a higher mean ASQ-3 gross motor score. Each additional time-point of tummy time recommendation adherence (questionnaire-measured) was associated with a 5-11-day earlier acquisition of independent sitting, crawling, and independent standing milestones. In the sub-sample, each additional time-point of guideline adherence was associated with a 16% higher AIMS score at 6 months.

CONCLUSIONS

Guideline adherence was low across the first 6 months of infancy. Overall, meeting more recommendations over this period appeared important for gross motor development. Parents and caregivers should be targeted as early as possible with guideline dissemination and activation strategies to promote healthy infant development.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Are There Bidirectional Influences Between Screen Time Exposure and Social Behavioral Traits in Young Children?

OBJECTIVE

Screen time in early childhood has been associated with children's prosocial and behavioral skills; however, the directionality of this relationship is unclear. We aimed to determine the direction of the relationship between screen time, social skills, and nonsocial behavioral traits in young children.

METHODS

This was a population-based, prospective cohort study with data across 5 time points. We examined the reciprocal relationships between caregiver-reported children's screen time at 12, 18, 24, 36, and 54 months and social behaviors collected using the Infant-Toddler Social-Emotional Assessment at 12 months; the Quantitative Checklist for Autism at 18, 24, and 36 months; and the Social Responsiveness Scale at 54 months. Cross-lagged path models were used for analysis.

RESULTS

A multiple imputation data set and complete data from 229 participants were included in the analyses. Screen time at 12, 18, and 36 months predicted nonsocial behavioral traits at 54 months. Cross-lagged path models showed a clear direction from increased screen time at earlier time points to both poorer social skills and atypical behaviors at later time points (Akaike information criterion 18936.55, Bayesian information criterion 19210.73, root mean square error of approximation 0.037, and comparative fit index 0.943). Social skills or behavioral traits at a younger age did not predict later screen time at any of the time points.

CONCLUSION

Screen time in early childhood has lagged influences on social skills and nonsocial behaviors; the reverse relationship is not found. Close monitoring of social behaviors may be warranted in the setting of excessive screen time during early childhood.

Risky Play and Social Behaviors among Japanese Preschoolers: Direct Observation Method

While limited evidence is available, preliminary studies highlight the potential health benefits of risky play. However, most of the studies have used subjective methods (i.e., questionnaires) to evaluate children’s risky play, which limits their validity and reliability. The purpose of the present study was to examine the relationship between the frequency of risky play and social behavior among Japanese preschoolers by using a valid and reliable method such as direct observation. A total of 32 Japanese preschoolers (71.4 ± 3.5 months old) participated in the study, and their social behaviors were measured by the Strength and Difficulties Questionnaire (SDQ). Data regarding the frequency of risky play was collected through direct observation. Results stated that, in a non-adjusted model, there was no significant association between children’s risky play and prosocial behavior. However, the association became significant after adjusting for covariates such as gender, parental employment status, and physical activity. In contrast, there was no significant association between children’s risky play and problem behavior (hyperactivity and aggression) after adjusting for covariates. In conclusion, covariates such as parental employment should be considered when examining the benefits of risky play.

Associations between the neighbourhood social environment and preschool children’s physical activity and screen time

Background

The neighbourhood social environment (NSE) has been associated with physical activity and screen time behaviours in adults and youth however less is known about this relationship in preschool-aged children (2–5 years). This study seeks to explore associations between the NSE and the physical activity and screen time behaviours of preschool-aged children.

Method

Cross-sectional data was collected in 2019. Parents (n = 214) of preschool-aged children (m = 3.8 ± 0.8 years), from 187 different Australian postcodes representing all states and territories were invited to complete an online survey where they answered questions about their NSE (perceived social cohesion, social interaction, sense of community, social norms and neighbourhood crime) and proxy-reported their child’s usual physical activity and screen time (minutes/day). Two hierarchical linear regressions were run separately to assess relationships between NSE predictor variables and physical activity and screen time. Three logistic regressions were run to determine associations between NSE constructs and the likelihood of meeting: 1) physical activity (≥ 180 min/day including ≥ 60 min of moderate-to-vigorous-intensity), 2) screen time (≤ 60 min/day) and 3) both physical activity and screen time guidelines. Child age, gender, childcare attendance, and neighbourhood level socioeconomic status (SES) were controlled for in all analyses.

Results

Social interaction was associated with increased daily physical activity (b = 17.76, 95%CI = 0.81, 34.71), decreased daily screen time (b = -12.77, 95%CI = -23.23, -2.23) and improved the likelihood of meeting physical activity (OR = 1.81, 95%CI = 1.20, 2.75) and combined physical activity and screen time guidelines (OR = 1.51, 95%CI = 1.03, 2.21). Higher neighbourhood crime was associated with a lower likelihood of meeting screen time guidelines (OR = 0.47, 95%CI = 0.47, 0.99). Social cohesion, sense of community and social norms were not statistically significant predictors of daily physical activity, screen time or meeting guidelines.

Conclusion

Social interaction showed the most consistent associations with physical activity and screen time. Future research should consider potential mediators of this relationship, including parental facilitation of children’s outdoor time. Improving understanding of the relationship between the NSE and physical activity and screen time in young children can help to guide community-based initiatives striving to optimise behavioural, health and social outcomes.

Move more - be happier? physical activity and health-related quality of life in children with congenital heart disease

OBJECTIVE

This cross-sectional study aimed to determine whether there is an association between objectively assessed physical activity (PA) and health-related quality of life (HRQoL) in children with CHD.

PATIENTS AND METHODS

From September 2017 to January 2021, 343 children with CHD (12.1 ± 3.3 years, 135 girls) provided valid PA data after a 7-day objective PA assessment. PA was evaluated as average daily steps and moderate-to-vigorous physical activity (MVPA) minutes assessed via wearable bracelet Garmin vivofit Jr. These children also completed the KINDL - a 24 Likert-scaled item questionnaires assessing HRQoL in the six dimensions physical well-being, emotional well-being, self-esteem, family, friends and everyday functioning.

RESULTS

Daily Steps (r = 0.166, P = .003) and daily MVPA minutes (r = 0.134, P = .017,) were both correlated to total KINDL score. Furthermore, both steps and MVPA were associated with the subscales physical well-being (steps: r = 0.165 p=.003; MVPA: r = 0.129, P = .022), friends (steps: r = 0.210, P < .001, MVPA: r = 0.179, P = .001), steps, and to everyday functioning (r = 0.142, P = .012). Logistic regression showed each MVPA minute increase conferred to a 1% increase in reporting better HRQoL (OR: 1.009 [95% CI: 1.002 - 1.017], P = .019).

CONCLUSIONS

PA was positively associated with HRQoL in children with CHD. Patients who move more are more likely to report better HRQoL. While the magnitude of this association needs to be further understood, continuous encouragement towards more PA seems to be crucial in a holistic approach to medical aftercare in children with CHD.

[Level of physical activity, sedentary behavior, and sleep in the early childhood population]

INTRODUCTION

the daily general activity pattern of preschool aged children is composed of sleep time, sedentary time, and physical activity of mild, moderate, or vigorous intensity.

OBJECTIVE

to determine the compliance with the recommendations for physical activity, sedentary behavior, and sleep according to the days of the week, sex, and age in children aged from 2 to 5 years.

METHODS

a cross-sectional study in 361 preschool aged boys and girls. The Questionnaire for the Measurement of Physical Activity and Sedentary Behavior in Children from Preschool to 4th grade (C-MAFYCS) was used, which inquires about three behaviors (physical activity, sedentary behavior, and sleep). The statistical analysis was carried out using the SPSS, version 24 program (Simón Bolívar University license).

RESULTS

on average, children perform 132.4  95.2 minutes of physical activity and spend 70.4  63.4 minutes per day in sedentary behaviors. The time dedicated to active play and organized sport is greater on Saturdays and Sundays (175.1  140 minutes) (p = 0.0001). The time spent watching television was greater during the weekend (70.7  69.4 minutes). On average, preschoolers sleep 10.2  0.9 hours per day, less during the week (9.3  0.7 minutes).

CONCLUSIONS

balance between these behaviors is essential for the health of children in this first stage of life. It is essential that parents, caregivers, and the community in general attend to the healthy lifestyles of this population since these are patterns that are learned and acquired to remain in the following stages of the life cycle.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Sociodemographic Correlates of Parental Co-Participation in Digital Media Use and Physical Play of Preschool-Age Children

Young children’s digital media use and physical activity have gained attention in recent research. Parental co-participation has a major impact on children’s health consequences. This study addressed a gap in the research by investigating daily parental co-participation in children’s digital media use and physical play, using the family ecological model theoretical framework. The participants in this nationally representative cross-sectional study were 2512 Finnish parents with two- to six-year-old children. Parents completed a questionnaire. Sociodemographic correlates of co-participation and of the awareness of guidelines regarding co-participation and correlation between co-participation in digital media use and physical play were analysed. Parental co-participation in physical play and digital media use correlated positively. Lower parental age, male parental gender, Finnish and Swedish languages, a fewer number of children, and a male child gender were associated with more co-participation in one or both activities, and parental female gender and low family income were associated with more awareness. The awareness of guidelines was not associated with co-participation in digital media use. There were sociodemographic differences in parental co-participation. From a health counselling perspective, parents may benefit from national recommendations on digital media use and physical activity, but adherence to guidelines depends on the family context.

Does the Spatial Layout of a Playground Affect the Play Activities in Young Children? A Pilot Study

Background

The objective of this study was to describe, through measurement of physical activity and observation of free outdoor play, the relation between children's free play and the spatial layout of the playground. To accomplish this, we altered the spatial layout of the same playground to see how the layout affects the play activity and the physical activity levels in the same children.

Methods

Participants were six young children (four girls and two boys; mean age = 5 years and 1 month, SD = 2.59 months). Participants' physical activity level and the duration of different types of action that occurred in each area and their transitions were compared before and after the alteration of the play-equipment layout using the data from accelerometers and video recordings.

Results

A significant increase in physical activity occurred after the spatial layout alteration, which was related to action differences. Before the alteration, children tended to play in a similar manner for a given play area; however, after the alteration, pronounced interindividual variation in play activity across children was observed.

Conclusion

The present pilot study found that in free play situations in the outdoor playground, the spatial layout of playground affects the pattern of play activity and the physical activity levels of young children.

The Association Between Preschooler Physical Activity Duration and Intensity and Social Emotional Development: Findings From the PLAYCE Study

BACKGROUND

Social emotional development is imperative to young children's long-term psychological and physical health. Physical activity (PA) may be important for young children's social emotional development. The association between preschooler PA duration and intensity and social emotional development was investigated.

METHODS

Data from six hundred and fifty-one 2- to 4-year-olds in the Play Spaces and Environments for Children's Physical Activity (PLAYCE) study were analyzed. PA was measured using ActiGraph-GT3X accelerometers worn over 7 days. Social emotional development was measured using the parent-completed Strengths and Difficulties Questionnaire. Multilevel linear regression models examined the association between PA duration and intensity and Strengths and Difficulties Questionnaire subscales.

RESULTS

Preschoolers did 158.2 (SD = 40.2) minutes per day of PA with 27% meeting the Australian Physical Activity Guidelines for the Early Years. There was a 1.74 point decrease in the total Strengths and Difficulties Questionnaire score for each additional hour of moderate-intensity PA per day (P < .05). Similar significant associations were found across all domains of social emotional development except hyperactivity, and were consistent across different intensities of light, moderate, and vigorous PA.

CONCLUSIONS

These findings highlight the potential importance of PA, especially moderate-intensity play-based PA, for different aspects of preschool children's social emotional development. Longitudinal and intervention research is required to confirm whether promoting PA in the early years provides developmental benefit.

The impact of the coronavirus disease 2019 pandemic on physical activity in U.S. children

BACKGROUND

Daily moderate-to-vigorous physical activity (MVPA) is vital to the physical, mental, and social well-being of children. Early restrictions during the coronavirus disease 2019 (COVID-19) pandemic included the closure of schools and physical activity (PA) amenities across the US. This study aimed to examine the impact of the pandemic on the PA and play behavior of U.S. children and to provide evidence-based recommendations to improve their PA.

METHODS

A cross-sectional, online, parent-reported survey was conducted of children aged 3-18 years between April and June 2020 to assess light PA and MVPA using a modified Godin Leisure-Time Exercise Questionnaire. Additional items included family/child socioeconomic demographics, child adaptability to the pandemic, and community access. The survey was shared through social media and snowball sampling distribution.

RESULTS

Analysis of 1310 surveys indicated child PA scores declined significantly during the pandemic (from 56.6 to 44.6, max 119, p < 0.001). Specifically, MVPA score decreased (from 46.7 to 34.7, max 98, p < 0.001) while light PA remained the same. Age-based changes were seen in the quantity, variety, and intensity of PA, with the lowest pandemic-related impact seen in preschoolers and the highest in high schoolers (-4.7 vs. -17.2, p < 0.001). Community-based peer PA decreased across all age groups.

CONCLUSION

This study shows decreased PA levels in U.S. children, according to parent reporting, during the COVID-19 pandemic. Recommendations for community leaders, educators, and parents to improve PA in children are provided. With continued spread of COVID-19, these results and recommendations may be imperative to the physical well-being of U.S. children.

Levels and correlates of physical activity and screen time among early years children (2-5 years): Cross-cultural comparisons between Canadian and South Korean data

BACKGROUND

Cross-cultural research can provide insight into whether levels and correlates of movement behaviours among early years children vary across different cultural contexts. This study (1) compared children's physical activity (PA) and screen time (ST) and parental and environmental correlates of PA and ST between samples of Canadian and South Korean (Korean thereafter) early years children (2-5 years) and (2) investigated parental and environmental correlates of PA and ST and whether country moderates the relationships.

METHODS

Cross-sectional data from 121 Canadian children (3.4 years; 49.6% girls) and 101 Korean children (3.4 years; 54.9% girls) who participated in the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) study were used. Demographic information, children's PA, ST, PA- or ST-specific parental cognitions and behaviours, and home and neighbourhood environments were measured using a proxy-reported questionnaire. Two-tailed independent samples T test or Mann Whitney U test, chi-square tests, linear regression and moderation analyses were performed.

RESULTS

Canadian children spent more time in non-organized PA compared to Korean children (111 vs. 63 min/day), whereas time spent in organized PA was higher in Korean children than Canadian children (25 vs. 9 min/day). Canadian children had more ST than Korean children (159 vs. 110 min/day). Similarly, Canadian parents reported higher screen (142 vs. 116 min/day) and sitting time (317 vs. 286 min/day) than Korean parents. Though children's behaviours, as well as parental cognitions and behaviours, varied between the two samples, similar correlates of children's PA and ST were observed. The relationship between presence of electronics in children's bedrooms and children's ST was moderated by country, with Canadian children showing a stronger relationship than Korean children.

CONCLUSIONS

Supporting parents to adopt cognitions and behaviours that are conducive to healthy PA and ST patterns of their own and their early years children may be important for both Canada and Korea.

Volume and accumulation patterns of physical activity and sedentary time: longitudinal changes and tracking from early to late childhood

BACKGROUND

Physical activity (PA) decreases and sedentary time (SED) increases across childhood, with both behaviours tracking. However, no studies have examined how accumulation patterns of PA and SED (i.e., prolonged bouts, frequency of breaks in sedentary time) change and track over time. The aim of this study was to investigate longitudinal changes in and tracking of total volume and accumulation patterns of SED, light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) among boys and girls.

METHODS

In 2008/09 (T1), children in HAPPY (3-5y; n = 758) in Melbourne, Australia wore ActiGraph GT1M accelerometers to objectively assess SED, LPA, MPA and VPA. This was repeated at age 6-8y (T2; n = 473) and 9-11y (T3; n = 478). Ten pattern variables were computed: bouts of ≥ 5-, ≥ 10-, ≥ 15- and ≥ 20-min for SED, ≥ 1- and ≥ 5-min for LPA, ≥ 1-min for MPA, ≥ 1- and ≥ 5-min for VPA, and breaks in SED (interruptions of > 25 counts 15 s^- 1). Longitudinal mixed models examined changes from T1-3, controlling for T1 age. Generalized estimating equations assessed tracking over the three time points, controlling for T1 age and time between measurements. Analyses were stratified by sex.

RESULTS

Total volume and bouts of SED and SED breaks increased, while total volume and bouts of LPA decreased for both sexes. There was a small decrease in total volume of MPA for girls, but time spent in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys only. All volume and pattern variables tracked moderately for boys, except for all SED bouts ≥ 15-min, LPA bouts ≥ 5-min and MPA bouts ≥ 1-min (which tracked weakly). For girls, total SED and SED bouts ≥ 1-min tracked strongly, total volume of LPA, MPA and VPA, ≥ 5- and ≥ 10-min SED bouts, and ≥ 1-min LPA and MPA bouts tracked moderately, and SED breaks, all SED bouts ≥ 15 min, LPA bouts ≥ 5 min and all VPA bouts tracked weakly.

CONCLUSIONS

Patterns of SED and PA change from early to late childhood; with the exception of SED breaks and VPA, changes were detrimental. Total volumes and short bouts tended to track more strongly than longer bouts. Interventions to prevent declines in PA and increases in SED are important from early in life.

Correlation Between Screen Time and Autistic Symptoms as Well as Development Quotients in Children With Autism Spectrum Disorder

Background: Electronic screen media play an increasingly vital role in children's entertainment; however, excessive screen time may negatively influence child development. The purpose of this study was to investigate the relationship between the screen time of children with autism spectrum disorder (ASD) and their autistic symptoms and development quotients (DQs). Methods: We compared the screen time of 101 children with ASD and 57 typically developing (TD) children. Then, we performed a correlation analysis to determine the correlations between the screen time and the ASD-related scale scores and developmental quotients of the Gesell Developmental Schedules (GDS) of ASD children. We further divided the ASD group into subgroups according to the screen time and age and then separately conducted the above correlation analyses by subgroup. Result: The results showed that the screen time of the children with ASD was longer than that of the TD children (3.34 ± 2.64 h vs. 0.91 ± 0.93 h). The screen time of the children with ASD was positively correlated with the Childhood Autism Rating Scale (CARS) score (r = 0.242, P = 0.021) and "taste, smell and touch" item of CARS(r = 0.304, P = 0.005), and negatively correlated with the language DQ of the GDS (r = -0.236, P = 0.047). The subgroup analysis showed that in the longer screen time subgroup of ASD children, the screen time was positively correlated with the CARS score (r = 0.355, P = 0.026) and negatively correlated with the DQs of all domains of the GDS (P < 0.05). In addition, in the younger age group of ASD children, the screen time was positively correlated with the CARS score (r = 0.314, P = 0.021) and negatively correlated with the DQs of all domains of the GDS, except for the personal-social behavior domain (P < 0.05). Conclusion: Compared with TD children, children with ASD have a longer screen time. The screen time is related to autism-like symptoms and the DQs of children with ASD. The longer the screen time, the more severe the symptoms of ASD (especially sensory symptoms), and the more obvious the developmental delay, especially in ASD children with a longer screen time and younger age, particularly in the language domain.

Maternal knowledge explains screen time differences 2 and 3.5 years post-intervention in INFANT

Very few early childhood interventions have observed sustained effects regarding television viewing and none have examined the mechanisms behind sustained intervention effects at long-term follow-ups. Thus, the aim of this study was to investigate potential mechanisms relating to the maintained intervention effect on television viewing at two long-term follow-ups in the Melbourne Infant Feeding Activity and Nutrition Trial (INFANT). INFANT was a cluster-randomised controlled trial. At the 2- and 3.5-year follow-ups, a total of 262 infant/mother pairs had complete information. Television viewing was assessed via a questionnaire at both follow-ups and six potential mediators were measured post-intervention (i.e. 15 months after baseline). Causal mediation analysis was conducted. At the 2- and 3.5-year follow-ups, the positive impacts of INFANT on maternal television viewing knowledge were maintained (B = 0.34 units; 95% confidence interval (CI₉₅): 0.21, 0.48). An indirect effect of the intervention on reducing children's television viewing time was observed at the 2- and 3.5-year follow-ups (B = -11.73 min/day; CI₉₅: -22.26, -3.28 and B = -4.78 min/day; CI₉₅: -9.48, -0.99, respectively) via improved maternal television viewing knowledge.Conclusion: The positive impacts of INFANT on maternal television viewing knowledge were maintained at both follow-ups, with better maternal knowledge associated with less television viewing time in their children. These results have implications for paediatricians and healthcare professionals as educating new parents early on regarding screen time may lead to the development of healthier screen time habits that are sustained through to the pre-school years. What is Known: • Lifestyle behaviours inclusive of screen time have been found to be established before the pre-school years and track. • Few trials have evaluated the long-term mechanisms related to maintained intervention effectiveness. What is New: • This study shows the positive impacts of a low-dose intervention on maternal television viewing knowledge at two long-term follow-ups. • Better maternal television viewing knowledge was associated with less television viewing time in their children.

Versão brasileira do Preschool-age Children’s Physical Activity Questionnaire (Pre-PAQ)

RESUMO Foi realizada a tradução e a adaptação transcultural do Preschool-age Children’s Physical Activity Questionnaire para a língua portuguesa do Brasil. O questionário foi traduzido em duas versões diferentes por dois profissionais proficientes na língua inglesa. Baseada nessas duas traduções independentes, foi criada a tradução única, então retrotraduzida para o inglês por outros dois tradutores. As retrotraduções passaram por novo processo de consenso, que gerou uma versão única, que foi comparada com o questionário em inglês original. A versão do questionário em português do Brasil, denominada Questionário de Atividade Física de Crianças em Idade Pré-Escolar (Pre-PAQ), foi revisada por uma comissão de especialistas para verificação do conteúdo e gerou a segunda versão de concordância. Em seguida, 28 profissionais da área avaliaram o questionário quanto à adequação para a língua portuguesa do Brasil e à adaptação cultural para crianças brasileiras de 3 a 5 anos de idade. Conclui-se que as etapas de tradução e adaptação cultural foram concluídas com sucesso, ainda que futuros estudos para testar a confiabilidade e validade do conteúdo da versão brasileira do Pre-PAQ sejam necessários para garantir a acurácia da aplicação na população-alvo.

Parents and children active together: a randomized trial protocol examining motivational, regulatory, and habitual intervention approaches

BACKGROUND

Regular physical activity (PA) is associated with many health benefits during childhood, and tracks into desirable PA patterns and health profiles in adulthood. Interventions designed to support these behaviours among young children are critical. Family-based interventions focusing on parent-child activities together (i.e., co-activity) among preschool-aged children are warranted. Targeting parental support practices can increase the frequency of co-activity, however interventions must move beyond merely building intention and planning skills for successful maintenance. Interventions designed to increase co-activity habit strength may facilitate the sustainability and thus impact child PA. The purpose of this study is to compare the effects of three intervention conditions designed to increase child PA through co-activity: a standard education condition (information about benefits), a planning (action planning, coping planning) + education condition and a habit (context-dependent repetition from prompts and cues) + planning +education condition.

METHODS/DESIGN

A longitudinal three-arm parallel design randomized trial will compare three conditions over six months. Families are eligible if they have at least one child between 3y and 5y that is not meeting 60mins/day of moderate to vigorous physical activity (MVPA). The primary outcome (child MVPA) is assessed via accelerometry at baseline, six weeks, three months and six months (primary endpoint). Intervention materials targeting co-activity are delivered post baseline assessment, with booster sessions at six weeks and three months. Parental co-activity habit, parent-child co-activity and other behavioural constructs are also assessed via questionnaire at all measurement occasions. As tertiary outcomes, parental PA is measured via accelerometry and co-activity is measured via a Bluetooth-enabled proximity feature. A total of 106 families have been recruited thus far from the Greater Victoria region. The study is ongoing with a minimum target of 150 families and an anticipated recruitment completion date of August 2022.

DISCUSSION

This protocol describes the implementation of a randomized trial evaluating the effectiveness of a habit formation group compared with a planning group and an education only group to increase child PA through targeting parent-child co-activity. This information could prove useful in informing public health initiatives to promote PA among families with preschool-aged children.

TRIAL REGISTRATION

This trial was prospectively registered on clinicaltrials.gov in February 2016, identifier NCT03055871 .

Effects of the Preschool-Based Family-Involving DAGIS Intervention Program on Children's Energy Balance-Related Behaviors and Self-Regulation Skills: A Clustered Randomized Controlled Trial

The study examines the effects of a preschool-based family-involving multicomponent intervention on children’s energy balance-related behaviors (EBRBs) such as food consumption, screen time and physical activity (PA), and self-regulation (SR) skills, and whether the intervention effects differed among children with low or high parental educational level (PEL) backgrounds. The Increased Health and Wellbeing in Preschools (DAGIS) intervention was conducted as a clustered randomized controlled trial, clustered at preschool level, over five months in 2017–2018. Altogether, 802 children aged 3–6 years in age participated. Parents reported children’s consumption of sugary everyday foods and beverages, sugary treats, fruits, and vegetables by a food frequency questionnaire, and screen time by a 7-day diary. Physical activity was assessed by a hip-worn accelerometer. Cognitive and emotional SR was reported in a questionnaire by parents. General linear mixed models with and without repeated measures were used as statistical methods. At follow-up, no differences were detected in EBRBs or SR skills between the intervention and control group, nor did differences emerge in children’s EBRBs between the intervention and the control groups when stratified by PEL. The improvement in cognitive SR skills among low PEL intervention children differed from low PEL control children, the significance being borderline. The DAGIS multicomponent intervention did not significantly affect children’s EBRBs or SR. Further sub-analyses and a comprehensive process evaluation may shed light on the non-significant findings.

Are primary care physicians ill equipped to evaluate and treat childhood physical inactivity?

Objective: To investigate primary care physician clinical practice patterns, barriers, and education surrounding pediatric physical activity (PA), and to compare practice patterns by discipline.Study design: Cross-sectional studyMethods: 4500 randomly selected pediatricians, family practice, and sports medicine physicians in the United States were surveyed (11% response rate). Main outcome measures were questionnaire answers on clinical effort, attitudes, and barriers surrounding PA, medical education in exercise science, and awareness of ICD-9 diagnostic codes pertaining to physical inactivity.Results: Approximately 15% of patient interaction time was spent on the evaluation and treatment of physical inactivity for a normal weight child. For an overweight or obese child, clinical time spent on PA almost doubles. Regardless of weight, sports medicine physicians spent significantly more time on the evaluation of physical activity compared to family/internal medicine physicians and pediatricians. Mean percentage of time family/internal medicine physicians spent on PA evaluation and treatment was consistently less than sports medicine physicians, and consistently more than pediatricians. Most physicians strongly agreed that PA assessment and treatment are important for disease prevention; only 28% had ever made the diagnosis of childhood physical inactivity. Limited clinical time was identified as a primary barrier to diagnosing childhood physical inactivity. Eighty-five percent of respondents were unaware of ICD-9 codes for reimbursement of PA evaluation. Eighty-one percent reported a paucity of exercise science education in medical school.Conclusion: While physicians report that PA evaluation is important in practice, behavior patterns surrounding time evaluating PA and treating childhood physical inactivity are discrepant. Pediatricians showed less favorable attitudes and effort surrounding PA compared to other primary care disciplines. The majority of physicians are unaware of physical inactivity diagnostic codes, have never made the diagnosis of childhood physical inactivity, and may not be receiving basic pediatric exercise science training required for evaluating and treating childhood physical inactivity.

Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018

Over the last decade, the lives of children in several countries, including Greece, have been affected by recession. The aim of the present study was (a) to examine time trends in physical activity (PA) and screen time (ST) of Greek preschool children, together with their family affluence (FA), from 2009 until 2018, and to explore the associations among them; and (b) to investigate the connections of parental educational level and children's BMIs to their achieving ST (<1h/day) and PA (11,500 steps/day) guidelines. A total of 652 children from four cross-sectional cohorts participated. PA was recorded with Omron HJ-720IT-E2 pedometers, whereas ST, family affluence (FA) and parental educational level were reported by participants' parents. The results of the one-way ANOVAs that were computed revealed statistically significant differences among cohorts, albeit of no practical importance, in PA, ST and FA. According to the regressions calculated, neither BMI nor the educational level was related to membership in ST and PA guidelines groups. ST was a significant predictor of children's PA in all week periods (school-time, leisure-time, weekend), whereas FA was not such a strong predictor. Multilevel interventions aiming at both ST and PA seem to be imperative for the benefit of young children's health.

Video Games, Obesity, and Children

PURPOSE OF REVIEW

To examine associations between video game play and obesity in children.

RECENT FINDINGS

Based on a scoping review of 26 studies (25 cross-sectional; 1 longitudinal) published in 2013-2018, 14 studies (53%) reported no association between video game play and obesity, and 12 studies reported positive associations. In a review of 8 systematic reviews, there was preliminary evidence on the effectiveness of exergame (physically active) play for weight reduction and to attenuate weight gain but little indication that interventions effectively reduced video game play or general screen time. This review found ambiguous evidence on the extent to which video game play is or is not significantly associated with obesity in children and preliminary evidence of exergame play as a tool for weight reduction and attenuation of weight gain. Several gaps existed in understanding the relationship between video game play and obesity, and prospective and interventional trials are needed.

Daily Physical Activity Among Toddlers: Hip and Wrist Accelerometer Assessments

Physical activity (PA) habits seem to track over time from as young as early childhood. For children under age 3 years, wearable sensor-measured PA levels have begun to be investigated. The aims of this study were to evaluate the feasibility of using hip- vs. wrist-worn accelerometers, and to report accelerometer-derived PA metrics among toddlers. A convenience sample of 22 toddlers aged 13 to 35 months and their mothers were recruited for this study. ActiGraph wGT3X-BT accelerometers were attached to wrist bands and waist belts. The mothers were asked to affix a wrist band and a waist belt to their participating children during waking hours for four days. They also completed an acceptability survey. Of the 22 toddlers, 19 (86%) had ≥ 3 valid days of hip data, while only 14 (64%) did so for wrist data (p = 0.16). In terms of acceptability, 18 mothers (82%) responded that the 4-day hip wear was easy, while only 13 (59%) responded that the 4-day wrist wear was easy (p = 0.19). Daily light-intensity PA (LPA) was on average 161 min, and daily moderate- and vigorous-intensity PA (MVPA) was on average 47 min, as determined using published hip accelerometer cut-points. There were no significant differences in LPA or MVPA by age or by sex. In conclusion, this study suggests that hip placement of an ActiGraph accelerometer is more feasible than wrist placement among toddlers.

Young Children's Screen Time and Physical Activity: Perspectives of Parents and Early Care and Education Center Providers

Early care and education (ECE) providers and parents can facilitate physical activity (PA) and reduce screen time in preschoolers. Input from caregivers on barriers and facilitators of PA and screen time is needed to comprehensively address these behaviors and promote children’s health. Four focus groups (3 parent and 1 ECE provider) were conducted. Thematic analysis was performed to identify themes and subthemes. Twenty-eight caregivers (21 parents and 7 ECE providers) participated. Caregivers reported responsibility for modeling and shaping children’s PA and screen time. Parents felt that a busy lifestyle was a PA barrier and encouraged screen time. ECE providers were concerned about certain environmental influences on PA. The groups differed in their view of screen time as either entertainment (parents) or educational (providers). Both types of caregivers were unaware of PA or screen time guidelines. Investigation into opportunities to utilize screen time to serve priorities of both caregivers and promote child PA are needed.