Get Your Baby Moving and Sleeping (Not Sitting and Screening)

Unless you’ve been on a desert island (and if you’re like me, you might have spent more time by a dessert island), you’ve heard the news. Kids are becoming more obese. Not only are they more overweight; they’re suffering complications, such as type 2 diabetes, that had, for the most part, previously affected older adults.

Because of this, public health agencies have taken a hard look at what our kids are doing and not doing; what we, as parents, pediatricians, and other responsible adults who provide child services are doing and what we all might do to turn this around. One of the agencies that’s been on board is the World Health Organization (WHO). The WHO oversees a variety of international health issues—yes, many things we talk about in the U.S. are world problems—and has long cited the lack of physical activity in adults, adolescents and school-age children. In an effort to change this sedentary state, which is responsible for 5 million deaths worldwide each year, the organization came up with activity recommendations for these populations.

What we didn’t have is any recommendation on how infants and young children (under 5 years) should spend their day. The WHO recently took steps to fill that gap. The group came up with recommendations for physical activity from infancy to preschool age. They also recognized the importance of looking at what our youngest citizens are doing when they’re not active.

We may have to resort to “because I said so” occasionally when we talk with children, but public health officials tend to do things a little differently. In order to come up with recommendations, the group reviewed large amounts of studies. They examined how much physical activity little ones got. They also looked at screen time, sleep time, and sedentary time (basically, time sitting around). They looked for effects of these behaviors on a variety of outcomes later on—everything from obesity and heart health to growth and development of thinking and learning processes.

Let’s look at some of the WHO’s recommendations. While we’re at it, we’ll discuss a couple of things to think about in achieving them.

More Moving, Less Sitting

Among the WHO’s recommendations are the following:

  • Infants should be physically active several times a day. Babies who are not yet mobile should be given “tummy time” by placing them (awake) on their stomach for at least 30 minutes a day.
  • Toddlers and preschoolers should be active for at least 3 hours a day. In preschoolers, at least one hour of this should be “moderate-to-vigorous physical activity.”
  • Infants and young children should not be in a restrictive space (like a stroller) for more than one hour at a time. Time sitting should be at a minimum and involve interaction with a parent.

How to get there? The WHO doesn’t give instructions, but most kids are naturally programmed to move around if we let them! Mobile infants and younger toddlers sometimes respond to their own exploring space, such as a cupboard with rags or light pots and pans, or a discarded box. While not every child in these age groups will be involved in, say, an organized physical activity, there are lots of low-tech, low-cost (or even free) games that will keep kids active. And since most will involve a parent, there’s great parent-kid time to be had.

One caveat here: safety first! Young kids need to be supervised in their movement games. A baby walker (that thing with the wheels that goes everywhere) might seem like a great solution, but it hasn’t been found to be beneficial in motor (movement) development, and the risk of injury is just too great to recommend it. And remember that when you give awake “tummy time” to a young infant, he needs to be returned to “tummy up” for sleep time.

Decrease That Screen Time!

In recent years, child health agencies have spent quite a bit of effort examining the effect of screen time in children, and the news has not been good regarding its effect on obesity, fitness or even development. Thus, the WHO’s recommendations:

  • No screen time under the age of 2 years.
  • No more than one hour per day of screen time for children 2 years of age and above.

How to get there? We now have evidence that early screen time harms rather than helps development. The lure of phones, tablets and the ever-popular television can be tough to beat, but it’s not nearly as tough if it’s not turned on from the start. During times of inactivity, read to your child! It’s more time together, it will help with language development, and it will increase the chances of acquiring an enduring reading habit. Also remember that children model what they see, so it wouldn’t hurt to monitor your own screen habits.

Sleepy Time

The WHO has echoed the stance of the American Academy of Pediatrics on the amount of sleep young children should get. Their recommendations for daily amount:

  • Young infants (less than 3 months) should have 14-17 hours of sleep.
  • Older infants (4-11 months) should have 12-16 hours of sleep.
  • Toddlers (1-2 years) should have 11-14 hours of sleep.
  • Preschoolers (3-4 years) should have 10-13 hours of sleep.

While this amount does include naps, the authorities emphasized regular (i.e., same time each day) sleep times.

How to get there? Entire books continue to be written on this subject, and addressing every potential sleep situation is certainly beyond the scope of this blog. But it’s worth saying two words about establishing a good sleep routine: start early! While most young infants will establish a good sleep pattern after a few weeks, older infants and toddlers will sometimes deviate from the plan. You can lessen the chances of that by having that set bedtime; having a quiet, dark environment; and avoiding a lot of contact (except to see that she’s OK) should she wake. If she didn’t need a middle-of-the-night feed at age 4 months, she shouldn’t need one at age 8 months!

Recommendations are all very well and good, and hopefully some of the hints above in achieving them will be helpful. Certainly, schedules and living situations can interfere, and getting the good stuff in and the not-so-good stuff, well, not so much is easier in some households than others. That’s when involving your provider, other caregiver, and even a child development specialist is helpful. Your “kid support team” can help you take small steps toward achieving these goals for your little ones—and that just may lead to giant leaps in their health status later on in life.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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