"GET-UP" study rationale and protocol: a cluster randomised controlled trial to evaluate the effects of reduced sitting on toddlers' cognitive development

The sleep and activity database for the early years (SADEY) study: design and methods

BACKGROUND

Canada, Australia, the World Health Organization and other countries have released 24-hour movement guidelines for the early years which integrate physical activity, sedentary behaviour, and sleep, focusing on supporting children to achieve a healthy 24-hour day. The guideline evidence synthesis, however, highlighted the dearth of high-quality evidence, particularly from large-scale studies. The Sleep and Activity Database for the Early Years (SADEY) project aims to assemble a large, pooled database of 24-hour movement behaviours and health indicators in young children (birth to 5.99 years), to advance knowledge in these areas. This paper describes the SADEY design and methods.

METHODS

Data sets were identified with > 100 children and device-measured (hip-worn ActiGraph accelerometers) physical activity and sedentary behaviour, parent-reported or device-measured sleep, and at least one health outcome: physical (BMI, waist circumference, blood pressure), social-emotional (Strength and Difficulties Questionnaire), cognitive (Early Years Toolbox), or motor development (Test of Gross Motor Development 2). Led by the University of Wollongong co-ordinating centre, the SADEY project collates the datasets to create a pooled database.

FINDINGS

To date, 13 studies from 7 countries have been included in the database. Ethics clearance and data sharing agreements have been secured for all studies and the SADEY 1.0 database is being assembled including ~ 8,000 participants.

DISCUSSION

SADEY will be used to address questions of global importance to public health policy and practice, for example - Is the mix of movement behaviours across the 24-hour day associated with healthy development?, What is the optimal mix of these behaviours?, and; What factors can be targeted to support young children in achieving the optimal mix of 24-hour movement behaviours? Additionally, SADEY seeks to develop and disseminate protocols, develop capacity on the device-based measurement of movement behaviours, and seeks partnerships with stakeholders that promote knowledge translation on movement behaviours to support healthy development among young children.

Associations of sleep characteristics with cognitive and gross motor development in toddlers

OBJECTIVE

To examine cross-sectional associations of sleep characteristics (duration, consolidation, timing, variability) with cognitive and gross motor development in toddlers.

METHODS

Participants were 205 toddlers (19.6 ± 4.3 months) from the GET-UP!

STUDY

Nap/nighttime sleep onset and offset were measured using an accelerometer and used to calculate nap/nighttime sleep duration. Total sleep duration was calculated and classified as meeting or not meeting the sleep recommendation of the Australian 24-Hour Movement Guidelines (11-14 h/d). Nighttime sleep ratio (ie, nighttime sleep duration: total sleep duration), indicative of consolidation, was expressed as a percent value. Nighttime sleep midpoint (ie, the midpoint between nighttime sleep onset and offset), indicating the lateness of sleep schedules, was converted to a decimal hour. For sleep variability, the intraindividual standard deviation of nighttime sleep duration and nighttime sleep midpoint was calculated, respectively. Cognitive development (Bayley Scales of Infant and Toddler Development-III) and specific domains of gross motor development (Peabody Developmental Motor Scales, 2nd edition) were measured.

RESULTS

Shorter nap duration (B = -0.87, 95%CI: -1.71, -0.02) and higher nighttime sleep ratio (B = 0.13, 95% CI: 0.02, 0.24) were associated with better cognitive development. Regarding gross motor development, positive associations were found for nighttime sleep duration (object manipulation: B = 0.26, 95% CI: 0.01, 0.51; gross motor quotient: B = 1.21, 95% CI: 0.04, 2.38) and total sleep duration (object manipulation: B = 0.28, 95% CI: 0.03, 0.52); negative associations were found for nighttime sleep midpoint (stationary: B = -0.31; 95% CI: -0.58, -0.06) and nighttime sleep duration variability (stationary: B = -0.32, 95% CI: -0.64, -0.004).

CONCLUSIONS

In toddlers, more consolidated sleep may be an indicator of better cognitive development. Promoting longer and more consistent nighttime sleep duration, as well as an earlier nighttime sleep schedule, may facilitate gross motor development. However, our findings for the associations of sleep characteristics with cognitive and gross motor development need to be confirmed in prospective studies.

Longitudinal differences in levels and bouts of sedentary time by different day types among Australian toddlers and pre-schoolers

The aim of the present study was to characterize sedentary time (ST) and sedentary bouts among young children, across a typical week and by day type (childcare days, non-childcare days and weekends), over a 12-month period.ST % (ST/accelerometer wear time*100) and number of sedentary bouts/hours were assessed using accelerometers at two time-points 12-months apart in 153 toddlers and 74 pre-schoolers. Differences between baseline and follow-up according to the whole week and the different day types were calculated using linear mixed models with adjustment for age, sex, socio-economic status and zBMI.During the weekend, toddlers had more 20-30 min/h sedentary bouts at follow-up than at baseline (MD: 0.03). In pre-schoolers, ST % (MD:-8.4), the number of 1-4 min/h (MD:-1.45), 5-9 min/h (MD: -0.46) and 10-19 min/h sedentary bouts (MD:-0.11) were lower at baseline, compared to follow-up, on non-childcare days; as were the number of 5-9 min/h sedentary bouts on weekends (MD:0.40). P < 0.05 for all.This study found that longer sedentary bouts (20-30 min/h) tended to decrease among toddlers and pre-schoolers, whereas ST and shorter sedentary bouts increased over 12-months, particularly among pre-schoolers on non-childcare weekdays. Non-childcare days, and home environment may be targeted for intervention to reduce ST and sedentary bouts among pre-schoolers.

Objectively Measured Sedentary Levels and Bouts by Day Type in Australian Young Children

BACKGROUND

This study aimed to understand whether a higher number of sedentary bouts (SED bouts) and higher levels of sedentary time (SED time) occur according to different day types (childcare days, nonchildcare weekdays, and weekends) in Australian toddlers (1-2.99 y) and preschoolers (3-5.99 y).

METHODS

The SED time and bouts were assessed using ActiGraph GT3X+ accelerometers. The sample was composed of 264 toddlers and 343 preschoolers. The SED bouts and time differences were calculated using linear mixed models.

RESULTS

The toddlers' percentage of SED time was higher on nonchildcare days compared with childcare days (mean difference [MD] = 2.3; 95% confidence interval, 0.7 to 3.9). The toddlers had a higher number of 1- to 4-minute SED bouts on nonchildcare days compared with childcare days. The preschoolers presented higher percentages of SED time during nonchildcare days (MD = 3.1; 95% confidence interval, 1.6 to 4.5) and weekends (MD = 1.9; 95% confidence interval, 0.4 to 3.4) compared with childcare days. The preschoolers presented a higher number of SED bouts (1-4, 5-9, 10-19, and 20-30 min) during nonchildcare days and weekends compared with childcare days. No SED times or bout differences were found between nonchildcare days and weekends, neither SED bouts >30 minutes on toddlers nor on preschoolers.

CONCLUSION

The SED time and bouts seem to be lower during childcare periods, which means that interventions to reduce sedentary time should consider targeting nonchildcare days and weekends.

Sedentary time and blood pressure in Australian toddlers: The get-up study longitudinal results

Epidemiological data suggests that the genesis of cardiovascular disease occurs during childhood. Sedentary time (ST) is a main driver of high blood pressure (BP) in adolescents and adults. However, associations between ST and cardiovascular health in young children are uncertain. Prospective associations between ST and BP were assessed among 172 toddlers (88 boys), aged 19.5 ± 3.9 months at baseline, recruited from the GET-UP! Study, Australia and followed over a 12-month period. BP was measured with a digital monitor and z-scores were computed by age and sex for systolic and diastolic BP. Total ST was measured over 7 days using Actigraph accelerometers and expressed over a 24-h period. Multilevel linear regression models were used to assess regression coefficients and standard errors, predicting BP at follow-up from ST at baseline. Analyses controlled for socio-economic status, height, age, gender, group (intervention or control) and zWC at baseline. Adjusted analyses showed that total ST did not predict systolic or diastolic BP (β = 0.0009, p = 0.368 and β = 0.002, p = 0.05, respectively). Most likely, longer follow-up periods might be needed to confirm or rule out our results, as the effects of cumulative ST over time on BP values are prone to manifest later in life and track into adolescence and adulthood.

The Get-Up! study: adiposity and blood pressure in Australian toddlers

BACKGROUND

Because the elevated blood pressure (BP) in childhood is strongly associated with overweight and is a risk factor for later cardiovascular disease, a need to comprehend the early development of BP and its association with overweight is needed. We assessed differences of BP by weight status in Australian toddlers.

METHODS

From the Get-Up! Study in Australia, this sample included 265 toddlers (136 boys), aged 19.6 ± 4.2 months. BP was measured with a digital vital signs monitor. Participants were categorized as nonoverweight and overweight according to the World Health Organization definition for body mass index (BMI). Physical activity was captured with activPAL accelerometers, during childcare hours. To test differences in BP between nonoverweight and overweight children, we performed an analysis of covariance adjusting for sex, age, physical activity, and socioeconomic status.

RESULTS

Children with overweight showed higher z systolic BP values (P = .042 for BMI and P = .023 for waist circumference) when compared to nonoverweight children. However, no differences were found for z diastolic BP levels, between overweight and nonoverweight children. After adjustments for potential confounders (socioeconomic status, physical activity, sex, and age), there were no significant differences in BP variables between BMI and waist circumference groups.

CONCLUSIONS

No associations between adiposity and BP levels were found in this sample. The unadjusted results, however, showed that children with higher levels of adiposity (BMI and waist circumference) exhibited higher levels of BP. Additional research is needed to determine which environmental and genetic factors might contribute to pediatric hypertension, particularly among toddlers.

The Associations Between Environmental Characteristics of Early Childhood Education and Care Centers and 1-Year Change in Toddlers' Physical Activity and Sedentary Behavior

BACKGROUND

This study examined the associations between environmental characteristics of early childhood education and care (ECEC) centers and 1-year change in toddlers' physical activity and sedentary behavior while at the centers.

METHODS

Data from 292 toddlers from the GET-UP! study were analyzed. Environmental characteristics of ECEC centers were rated using the Infant/Toddler Environment Rating Scale-revised edition at baseline. Children's physical activity and sedentary behavior in the centers were assessed using activPAL devices, at baseline and at 1-year follow-up. Linear mixed models were performed to examine the associations between the environmental characteristics and change in the proportion of time spent in physical activity and sedentary behavior.

RESULTS

Compared with baseline, children spent a higher proportion of time in sedentary behavior (sitting) but a lower proportion of time in standing and physical activity (stepping) while at ECEC centers, at 1-year follow-up. The environmental characteristics "interaction" (B = -1.39; P = .01) and "program structure" (B = -1.15; P = .04) were negatively associated with change in the proportion of time spent in physical activity.

CONCLUSION

Better "interaction" and "program structure" may preclude children's physical activity from declining over time and may be considered important features to target in future interventions in ECEC centers aiming at promoting active lifestyles.

The cross-sectional and prospective associations between sleep characteristics and adiposity in toddlers: Results from the GET UP! Study

BACKGROUND

The associations between sleep characteristics and adiposity in children under three years are not fully understood yet.

OBJECTIVE

The objective of the study is to examine the cross-sectional and prospective associations between sleep characteristics and adiposity in toddlers over a 12-month period.

METHODS

Participants were 202 toddlers from the GET-UP!

STUDY

Sleep duration, sleep timing, and sleep variability were assessed using 24-hour accelerometry for seven consecutive days. Height and weight were measured, and BMI z scores were calculated. Linear mixed models were performed to examine the cross-sectional and prospective associations between sleep characteristics and adiposity, with adjustments for clustering effects and demographic factors.

RESULTS

Total sleep duration was negatively associated with higher adiposity cross-sectionally (B = -0.12; 95% CI: -0.23, -0.01; .033) but not prospectively (B = 0.01; 95% CI: -0.13, 0.10; .843). Nap duration was prospectively associated with higher levels of adiposity (B = 0.41; 95% CI: 0.14, 0.68; .003). Sleep variability and sleep timing were not associated with concurrent or subsequent adiposity.

CONCLUSION

Although sleep duration is an important factor associated with obesity in toddlerhood, the potential effects of different types of sleep duration may vary. While longer total sleep duration may protect children from increasing adiposity, longer nap duration seems to be risk factor. As evidence in this age group is scarce, more research is needed to confirm this finding.

Concurrent validity of the ActiGraph GT3X+ and activPAL for assessing sedentary behaviour in 2-3-year-old children under free-living conditions

OBJECTIVES

ActiGraph accelerometer cut-points are commonly used to classify sedentary behaviour (SB) in young children. However, they vary from 5counts/5s to 301counts/15s, resulting in different estimates and inconsistent findings. The aim was to examine the concurrent validity of ActiGraph GT3X+cut-points against the activPAL for measuring SB in 2-3-year-olds during free-living conditions.

DESIGN

Observational validation-study.

METHODS

Sixty children were fitted with the activPAL and ActiGraph simultaneously for at least 2h. Nine ActiGraph cut-points ranging from 60 to 1488 counts per minute were used to derive SB. Bland & Altman plots and equivalent tests were performed to assess agreement between methods.

RESULTS

Estimates of SB according to the different ActiGraph cut-points were not within the activPAL ±10% equivalent interval (-4.05; 4.05%). The ActiGraph cut-points that showed the lower bias were 48counts/15s (equivalence lower limit: p= 0.597; equivalence upper limit: p<0.001; bias: -4.46%; limits of agreement [LoA]: -21.07 to 30.00%) and 5counts/5s (equivalence lower limit: p<0.001; equivalence upper limit: p= 0.737; bias: -5.11%; LoA: 30.43 to 20.20%). For the 25counts/15s, 37counts/15s and 48counts/15s ActiGraph cut-points, the upper limits were within the equivalent interval (p<0.001) but not the lower limits (p>0.05). When using the 5counts/5s and 181counts/15s ActiGraph cut-points, lower limits were within the equivalent interval (p<0.001) but not the upper limits (p>0.05). Confidence intervals of the remaining ActiGraph cut-points lie outside the equivalent interval.

CONCLUSIONS

Although none of the ActiGraph cut-points provided estimates of SB that were equivalent to activPAL; estimates from 48counts/15s and 5counts/5s displayed the smallest mean bias (˜5%).

Associations between gross motor skills and cognitive development in toddlers

BACKGROUND

The early years of life are critical for motor and cognitive development. A better understanding is needed on the associations between the control and development of motor and cognitive tasks.

AIM

This study aimed to examine the association between gross motor skills and cognitive development in toddlers.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

This study included 335 toddlers (aged 19.80 ± 4.08 months, 53.7% boys) from 30 childcare services in Australia.

OUTCOME MEASURES

Children were assessed on gross motor skills (Peabody Developmental Motor Scales 2nd Edition; PDMS-2) and cognitive development (Bayley Scales of Infant and Toddler development 3rd edition; Bayley-III).

DATA ANALYSIS

A one-way ANCOVA was conducted to assess associations between gross motor skills and cognitive development controlling for childcare center, sex, age, body mass index and socioeconomic status.

RESULTS

The average scores were 96.41 ± 9.84 for gross motor skills (range gross motor quotient 35-165) and 11.45 ± 3.03 for cognitive development (range standard score 1-19). There was a significant positive association between gross motor skills and cognition, F_(2,260) = 12.245, p < 0.001. Both locomotion and object manipulation were significantly positively associated with cognition, F_(2,266) = 14.607, p < 0.001 and F_(2,265) = 9.039, p < 0.001 respectively.

CONCLUSIONS

Levels of gross motor skills are positively associated with cognitive development in this sample of Australian toddlers. Results reinforce the need for early commencement of gross motor skill promotion as this might be important for cognitive development in the early years.

Environmental characteristics of early childhood education and care, daily movement behaviours and adiposity in toddlers: A multilevel mediation analysis from the GET UP! Study

STUDY OBJECTIVE

This study aimed to examine the direct effects of environmental characteristics of early childhood education and care (ECEC) centres on adiposity, and the indirect effects through daily movement behaviours (physical activity, sedentary time and naps).

METHODS

274 children (average age 19.73 ± 4.15 months) from 27 ECEC centres participated in this study. Environmental characteristics of ECEC centres were rated using the Infant/Toddler Environment Rating Scale-revised edition (ITERS-R). Daily movement behaviours were assessed using 24-h accelerometry. Body mass index z-scores were used to indicate adiposity.

RESULTS

There were no significant direct effects or indirect effects of environmental characteristics on toddlers' adiposity through daily movement behaviours. However, the environmental characteristics of "personal care routine" (B=0.72, p = 0.041) and "activity" (B = 0.87, p < 0.050) were positively associated with the percentage of time these toddlers spent in moderate-to-vigorous physical activity (MVPA). "Listening and talking" was also positively associated withnap(s) durations (B = 4.08 p = 0.001).

CONCLUSION

The relationships between environmental characteristics of ECEC centres and adiposity in toddlers, as well as, the mediating roles of daily movement behaviours still need confirmation by future longitudinal and experimental studies with long follow-up periods. At the same time, a broader spectrum of environmental characteristics of these settings needs to be examined with toddlers' adiposity in future studies; other potential mediators may also need to be taken into considerations.

Association between breaks in sitting time and adiposity in Australian toddlers: Results from the GET-UP! study

BACKGROUND

In youth, research on the health benefits of breaking up sitting time is inconsistent. Our aim was to explore the association between the number of breaks in sitting time and adiposity in Australian toddlers.

METHODS

This study comprised 266 toddlers (52% boys), aged 19.6 ± 4.2 months from the GET-UP! Study, Australia. Body mass index (BMI) was calculated and z-scores by age and sex were computed for waist circumference (WC). Participants were classified as overweight according to the WHO criteria for BMI. For WC, participants with a z-score≥1SD were considered overweight. Sitting time was assessed with activPALs during childcare hours and participants were classified by tertiles of the number of breaks/h in sitting time: <26 breaks/h; 26-39 breaks/h, and >39 breaks/h. Logistic regression assessed odds ratios for non-overweight (BMI or waist circumference categories) by number of breaks in sitting time/h, controlling for age, sex, and socioeconomic status.

RESULTS

The number of breaks in sitting time significantly predicted a lower weight status (non-overweight) according to WC values (P for trend = 0.032) after adjustments.

CONCLUSIONS

Breaking up sitting time was positively associated with toddlers' waist circumference. Future studies are needed to determine whether breaking up sitting time is a protective for cardiometabolic health in toddlers.

Correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in toddlers: results from the GET UP! Study

OBJECTIVE

To explore the correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in a sample of Australian toddlers.

METHODS

Participants were 173 toddlers (average age 19.7 ± 4.1 months) from the GET UP!

STUDY

Nocturnal sleep duration, nocturnal sleep variability, nap(s) and physical activity were measured using 24-h accelerometry (Actigraph GT3X+) over seven consecutive days. Nocturnal sleep problems were assessed using the Tayside Children's Sleep Questionnaire. Screen time was reported by the parents. Logistic regression models were used to examine the associations between potential correlates (ie, age, sex, socio-economic status, weight status, physical activity, screen time, nap(s), bedtimes, and wake-up times) and nocturnal sleep characteristics.

RESULTS

Older children were more likely to have greater sleep variability (OR: 1.97; 95% CI: 1.08-3.61). Less physical activity (OR: 2.38; 95% CI: 1.27-4.45), shorter nap(s) (OR: 2.42, 95% CI: 1.29-4.55), and later wake-up times (OR: 4.42; 95% CI: 2.32-8.42) were associated with higher odds of having longer nocturnal sleep duration. Late bedtimes were associated with shorter nocturnal sleep duration (OR: 0.09; 95% CI: 0.04-0.18) and with greater nocturnal sleep variability (OR: 1.97; 95% CI: 1.06-3.68). None of the potential correlates were associated with nocturnal sleep problems.

CONCLUSION

The present study identifies several correlates of nocturnal sleep duration (total physical activity, nap(s), bedtime, and wake-up time) and nocturnal sleep variability (age and bedtime), whereas no correlates were identified for nocturnal sleep problems. The association between late bedtimes and shorter nocturnal sleep duration and greater nocturnal variability suggests that these may be modifiable targets for future sleep interventions in early childhood.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616000471482, 11/04/2016, retrospectively registered.

Gross motor skills in toddlers: Prevalence and socio-demographic differences

OBJECTIVES

Gross motor skills (GMS) are a vital component of a child's development. Monitoring levels and correlates of GMS is important to ensure appropriate strategies are put in place to promote these skills in young children. The aim of this study was to describe the current level of GMS development of children aged 11-29months and how these levels differ by age, sex, BMI and socio-economic status.

DESIGN

Cross-sectional study.

METHODS

This study involved children from 30 childcare services in NSW, Australia. GMS were assessed using the Peabody Developmental Motor Scales Second Edition. Prevalence was reported using the gross motor quotient and both raw and standard scores for locomotor, object manipulation and stationary subtests. Socio-demographics were collected via parent questionnaires. Analyses included t-tests, chi-square tests, one-way ANOVA and linear regression models.

RESULTS

This study included 335 children (mean age=19.80±4.08months, 53.9% boys). For the gross motor quotient, 23.3% of the children scored below average. For the GMS subtests, 34.3% of children scored below average for locomotion, 10.1% for object manipulation and 0.3% for stationary. Boys were more proficient in object manipulation than girls (p=0.001). GMS were negatively associated with age and a higher socio-economic status (all p<0.05). There were no associations for BMI.

CONCLUSIONS

This is the first descriptive study to show the prevalence of below average at locomotor skills in toddlers is higher than reported in normative samples. Early commencement of GMS promotion is recommended with a focus on locomotor skills and girls' object manipulation skills.

Associations between gross motor skills and physical activity in Australian toddlers

OBJECTIVES

Physical activity can be promoted by high levels of gross motor skills. A systematic review found a positive relationship in children (3-18 years) but only few studies examined this in younger children. The aim of this study was to examine the association between gross motor skills and physical activity in children aged 11-29 months.

DESIGN

Cross-sectional study.

METHODS

This study involved 284 children from 30 childcare services in NSW, Australia (Mean age=19.77±4.18months, 53.2% boys). Physical activity was measured using accelerometers (Actigraph GT3X+). Gross motor skills were assessed using the Peabody Developmental Motor Scales Second Edition (PDMS-2). Multilevel linear regression analyses were computed to assess associations between gross motor skills and physical activity, adjusting for sex, age and BMI.

RESULTS

Children spent 53.08% of their time in physical activity and 10.39% in moderate to vigorous physical activity (MVPA). Boys had higher total physical activity (p<0.01) and MVPA (p<0.01) than girls. The average gross motor skills score was 96.16. Boys scored higher than girls in object manipulation (p<0.001). There was no association between gross motor skills and total physical activity or MVPA.

CONCLUSIONS

Although gross motor skills were not associated with physical activity in this sample, stronger associations are apparent in older children. This study therefore highlights a potential important age to promote gross motor skills.

Compliance with the Australian 24-hour movement guidelines for the early years: associations with weight status

BACKGROUND

For effective public health and surveillance it is important to document the proportion of young children who meet the new Australian Integrated 24 h Movement Guidelines for the Early Years and how these associate with health outcomes. We aimed to (i) assess compliance with the new Integrated 24 h Movement Guidelines for the Early Years in a sample of Australian toddlers; and (ii) ascertain whether compliance with the guidelines associates with weight status.

METHODS

The sample comprised 202 toddlers (104 girls) aged 19.74 ± 4.07 months from the GET UP!

STUDY

Participants wore accelerometers (Actigraph GT3X+) for 24 h over 7 consecutive days to assess physical activity, sedentary time and sleep. Parents reported participants' screen time. Weight and height were measured and body mass index (BMI) z-scores by age and sex were calculated. Analysis of Covariance (ANCOVA) was performed to test differences in BMI z-scores between participants complying with (i) none or any individual guideline, (ii) any combination of meeting two guidelines, and (iii) those who met all three guidelines, adjusting for child age, gender and socioeconomic status.

RESULTS

Only 8.9% of the sample met the overall 24 h movement guidelines. Most of the sample met the physical activity (96.5%) and sleep (79.7%) guidelines but only 11.4% met the sedentary behavior guideline. Average BMI Z-scores did not significantly differ between children who complied with none or any individual guideline, any combination of meeting two guidelines, and those who met all three guidelines (p > 0.05). Although the lack of significant differences, participants who accomplished any combination of two guidelines or all three guidelines appear to have had a lower BMI Z-score than those complying with one of the guidelines or none.

CONCLUSIONS

Just under 9% of our sample met the overall Australian 24 h Movement Guidelines for the Early Years. BMI was not associated with the accomplishment of any of the 24-h Movement Guidelines. Strategies to promote adherence to the 24-h movement guidelines in toddlers, particularly for screen time, are necessary, as promoting health-related behaviors in early childhood has the potential to provide children a strong foundation for lifelong physical and mental health.