Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years)

It is Feasible for 3 to 5-Year-Old Children to Use Smartwatch Activity Trackers: A Systematic Review

AIM

This review aimed to summarise the evidence related to the feasibility, efficacy for increasing physical activity, and implications of smartwatch activity tracker use in preschool-aged children.

METHODS

In November 2023, we searched Medline, PsycINFO, CINAHL, Web of Science, ProQuest Central and SPORTDiscus. From an initial 7449 studies, we included 15 studies that explored the use of smartwatch activity trackers in preschool children aged three to 5 years. Data were extracted on feasibility, efficacy, and reported advantages and disadvantages of use. We used the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Studies that reported adherence to wear indicate good feasibility. No studies evaluated the efficacy of activity trackers for influencing physical activity and sedentary behaviours. Potential limitations of activity tracker use by preschool children include discomfort and a loss of interest.

CONCLUSION

Smartwatch activity trackers may be feasible for use by preschool children, but no studies have explored whether these devices can increase physical activity in this age group. Short-term use of these devices may encourage physical activity by promoting family discussions and increasing awareness of physical activity, but discomfort and a loss of interest over time may be barriers to long-term use by young children.

Reallocating 24-hour movement behaviors and its impact on mental health in preschool children: a compositional data and dose-response analysis

BACKGROUND

Mental health issues in preschool children are a significant public health concern with long-term developmental implications. Understanding how reallocations of time among different 24-hour movement behaviors-moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior (SED), and sleep (SLP)-affect various dimensions of mental health is essential for designing effective interventions.

METHODS

In this cross-sectional study, 828 Chinese preschool children aged 3 to 6 years were assessed. Physical activity and sleep were objectively measured using accelerometers to capture MVPA, LPA, SED, and SLP. Mental health was evaluated using the Strengths and Difficulties Questionnaire (SDQ), assessing Total Difficulties, Internalizing Problems, Externalizing Problems, and Prosocial Behavior. Compositional data analysis was conducted using isometric log-ratio (ilr) transformation, followed by multivariate linear regression to assess associations. Additionally, isotemporal substitution modeling and dose-response analysis were applied to examine the effects of reallocating time between behaviors on mental health outcomes, adjusting for age, gender, BMI, parental education, and parental attitudes toward physical activity.

RESULTS

Increased MVPA was significantly associated with lower Total Difficulties (ßMVPA= - 1.587; P < 0.001) and Internalizing Problems (ßMVPA= - 0.663; P = 0.017). Increased SED was associated with higher Total Difficulties (ßSED= 1.512; P < 0.05), while increased SLP was linked to improved Externalizing Problems (ßLPA= - 1.792; P = 0.008). Reallocating as little as 1 min from LPA or SED to MVPA or SLP significantly reduced Total Difficulties and Internalizing Problems (P < 0.05). Conversely, replacing SED or SLP with LPA increased Externalizing Problems, particularly Conduct Problems and Hyperactivity/Inattention (P < 0.05). A critical threshold at 30 min was identified, beyond which the effects on mental health outcomes became more pronounced.

CONCLUSIONS

Reallocating time from LPA or SED to MVPA or SLP significantly improves Total Difficulties and Internalizing Problems in preschool children, even with brief substitutions. However, increasing LPA at the expense of SED or SLP exacerbates Externalizing Problems, especially Conduct Problems and Hyperactivity/Inattention. Interventions should promote MVPA and adequate sleep while considering the critical 30-minute threshold where effects become more pronounced to enhance emotional and behavioral well-being.

Accelerometer Monitoring Duration for Reliable Estimates of Physical Activity, Sedentary Behavior, and Step Counts in Preschoolers

PURPOSE

This study aims to establish the reliability of accelerometer-based measurements for physical activity, sedentary behavior, and step counts in preschoolers and determine the optimal monitoring duration necessary for reliable data.

METHODS

The study analyzed data from 434 preschoolers (ages 3-5) who wore waist-worn ActiGraph wGT3X-BT accelerometers for 7 days as part of the Sunrise Study in Spain. Two-way mixed effects intraclass correlation coefficients were calculated for various combinations of daily wear time and number of valid days to assess reliability. The Spearman-Brown prophecy formula was applied to determine the required days to achieve reliability scores of 0.7, 0.8, and 0.9.

RESULTS

The findings showed that reliability improved with increased wear time, although intraclass correlation coefficients values were weaker around 7 to 9 hours per day. To achieve a reliability score of 0.7, moderate to vigorous physical activity required 3 to 4 days, light physical activity required 4 to 7 days, and sedentary behavior required 8 to 13 days. Steps per day required 7 to 9 days for a reliability score of 0.7, while other step outcomes needed 10 to 13 days.

CONCLUSION

The study provides evidence-based recommendations on the monitoring duration required for reliable estimates of physical activity, sedentary behavior, step counts, and sleep duration in preschoolers using accelerometers. These findings are crucial for researchers and practitioners aiming to accurately assess and promote physical activity in early childhood.

The LEG program promotes the development of physical activity and fundamental movement skills in preschool children aged 3-6 years: a Delphi study

Background

Effectively addressing physical inactivity and the delayed development of fundamental movement skills in preschool children aged 3-6 years.

Methods

We assembled an interdisciplinary team of experts to systematically validate the LEG program indicators using the Delphi method. This Delphi study thoroughly and meticulously explored the insights of experts in the field to identify the necessary indicators of the LEG program's role in promoting the sustainable development of physical activity and fundamental movement skills in preschoolers aged 3-6. Using a 5-point Likert scale and Wilcoxon statistical techniques, this study examines the dynamic consensus among experts and elucidates potential differences in their views.

Results

After three rounds of Delphi surveys, O1, O2, and O3 reached consensus in all three rounds. T5, I5, I14, C11, and C12 disagreed due to disciplinary differences, while C18 and C22 disagreed due to cultural differences. Finally, the LEG program indicators achieved consensus on three objectives, seven tasks, 17 indicators, and 25 content areas. The results of this study strongly convey the experts' positive perceptions of the LEG program indicators in promoting sustainable development of physical activity and fundamental movement skills in preschoolers aged 3-6 years.

Conclusion

This indicates that the LEG-structured curriculum indicators we developed are scientific and reliable, aligning with the physical and mental development of preschoolers aged 3-6 years. This understanding fosters the in-depth integration of early childhood physical education and preschool education, providing a foundation for enhancing the sustainable development of physical activity and fundamental movement skills among preschoolers aged 3-6 years.

Sedentary behavior and sleep for children and adolescents with obesity: A systematic review

Sedentary behavior and inadequate sleep are well-known lifestyle determinants of obesity that are linked to poor health outcomes, including into adulthood. This systematic review aims to synthesize evidence on how sedentary behavior (different durations, frequencies, patterns, or types) and improved sleep and/or sleep hygiene are related to improved health and functioning and reduced obesity-associated disability for the integrated management of obesity. We systematically searched electronic databases and trial registries for randomized trials and prospective cohort studies published between 2012 and 2023. The searches yielded 8990 records, 95 of which were read in full text by independent reviewers. No completed studies met the selection criteria. Only one ongoing study will likely meet the review's selection criteria, but data collection has not yet been completed. The lack of participants with obesity at baseline was the most common exclusion reason (51 studies, 53%), followed by ineligible exposures (12 studies, 12%) like dietary counseling or parenting interventions. As randomized trials and prospective cohort studies concerning sedentary behavior or sleep in children and adolescents have traditionally focused on the primary prevention of obesity, future research should include children and adolescents with obesity and present subgroup analyses for different degrees of obesity and comorbidities.

Associations Between Movement Behaviors, Cognition, and Academic Achievement in Children and Adolescents: A Systematic Review

OBJECTIVE

This systematic review summarizes the literature on the associations between movement behaviors (eg, sleep, sedentary behavior, and physical activity [PA]) and cognition, and academic achievement (AA) in children and adolescents.

METHODS

Four electronic databases (PubMed, Embase, PsycINFO, and SPORTDiscus) were searched from inception until October 2023.

RESULTS

This systematic review included 24 reports, representing 48,558 youth aged 6-17.9 years. Ten reports (46%) showed a high risk of bias, and overall quality of evidence ranged from very low to moderate. No reports assessed the associations between sleep and cognition; 1 cross-sectional report showed beneficial associations between sleep and AA. Sedentary behaviors showed null associations with AA in 43% of the reports; however, screen time was detrimentally associated with AA in all reports. Overall, 57% of the reports looking at the associations between PA and cognition showed beneficial associations; 53% showed beneficial associations between PA and AA; 56% of the randomized controlled trials showed beneficial impacts on cognition (3 out of 5) or on AA (2 out of 4).

CONCLUSIONS

Overall, this systematic review showed evidence of beneficial associations between PA and cognition and AA, as well as detrimental effects of screen time. Due to the many inconsistent results found for sedentary behavior, together with scarce data on associations between sleep duration and cognition, and AA in children and adolescents, more research is needed so researchers can draw strong and evidence-based conclusions.

Prospective relationship between family screen time rules, obesogenic behaviours, and childhood obesity

Family screen use rules (FSRs) could plausibly protect against the development of childhood obesity, although the mechanisms underlying these protective effects remain largely unexplored. This research aimed to investigate prospectively the associations between exposure to FSRs at age 24 months, obesogenic behaviours (excessive screen time and short sleep duration) at age 45 months, and obesity at age 54 months. Additionally, a model proposing the mediating role of obesogenic behaviours in the association between FSRs and childhood obesity was tested. Data were obtained from 5733 children and their mothers participating in the 'Growing Up in New Zealand' study. Logistic regressions examined the association between three FSRs (rules on quality, quantity and timing of screen time, and different numbers of FSRs), obesogenic behaviours, and childhood obesity. Structural equation modelling (SEM) was applied to assess the potential mediating roles of obesogenic behaviours in the association between FSRs and zBMI. Neither exposure to individual nor all three FSRs was significantly associated with lower odds of obesity. However, protective effects of FSRs were observed concerning obesogenic behaviours. Exposure to individual or all three FSRs correlated with reduced odds of not meeting screen time and sleep duration recommendations. SEM analysis indicated no direct association between FSRs and zBMI; nevertheless, a significant indirect association was identified through the mediation of obesogenic behaviours. These findings suggest the potential benefits of promoting the adoption of FSRs as a promising population-based strategy to enhance child health behaviours and mitigate the risk of childhood obesity.

Effects of movement behaviors on preschoolers' cognition: a systematic review of randomized controlled trials

BACKGROUND

Movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep, are fundamental to early childhood development. These behaviors interact dynamically within a 24-hour period, creating a complex balance that influences not only physical health but also cognitive and emotional well-being in young children. While the physical health benefits of movement behaviors are well-documented, systematic evaluations of how interventions targeting these behaviors affect cognitive development in preschool-aged children remain limited.

METHODS

This review was guided through PRISMA 2020 guidelines. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the impact of interventions targeting PA, SB, and sleep on cognitive outcomes in preschool-aged children. A comprehensive search was performed across five databases: PubMed, PsycInfo, Web of Science, Embase, and CINAHL, covering studies published between January 2000 and December 2023. Eligible studies were those that focused on at least one movement behavior, had a minimum intervention duration of four weeks, and assessed cognitive development as a primary outcome. The cognitive outcomes evaluated included executive function, attention, memory, and other key domains critical to early childhood development, such as language, processing speed, and social cognition.

RESULTS

Twenty-two RCTs (14 individual, 8 cluster) met the inclusion criteria. Of these, 21 studies focused on PA, while only one targeted SB, and none specifically addressed sleep or combined movement behaviors. PA interventions, particularly those involving cognitively engaging activities, significantly improved cognitive domains such as executive function, inhibition, and attention, with effect sizes ranging from moderate to large (Cohen's d > 0.5). The SB-focused study did not report significant cognitive improvements. A clear gap exists in understanding the effects of sleep and multi-behavior interventions on cognitive outcomes.

CONCLUSIONS

Cognitively engaging PA interventions demonstrated the largest effects, while motor skill-focused and general PA programs produced moderate to smaller gains. Evidence on SB and sleep interventions remains limited, with no studies exploring the combined effects of these three movement behaviors. Future research should focus on integrated interventions that address PA, SB, and sleep to achieve a more comprehensive understanding of their collective impact on cognitive development in early childhood.

TRIAL REGISTRATION

This study was registered with PROSPERO under the registration number CRD42023479156.

Extending Our Understanding of the Social Determinants of Physical Activity and Sedentary Behaviors in Families: A Systems Mapping Approach

BACKGROUND

The social environment is important to consider for effective promotion of movement behaviors like increased physical activity (PA) and reduced sedentary behavior (SB); yet, it is less often considered than individual and built environments. One way to advance social environment research is to develop system maps, an innovative, participatory, action-oriented research process that actively engages stakeholders to visualize system structures and explore how systems "work." The purpose of this research was to develop PA and SB system maps of the social environment embedded within the core/nuclear family system.

METHODS

The development process began with a 2-day multicountry, 16-researcher, in-person participatory workshop in August 2023, followed by multiple online follow-up consultations. Attendees contributed to the creation of the maps through shared development of critical determinants and their causal pathways. The structure of the final maps was analyzed using network analysis methods to identify indicators of centrality, and key feedback loops and areas for potential intervention were explored.

RESULTS

Key central determinants that were likely critical targets for systems intervention to produce changes in PA and SB and featured prominently in most of the reinforcing and balancing feedback loops included shared family interests, values and priorities, family logistical support, family cohesion/organization, and shared experiences. The maps also highlighted key determinants of the broader social environment external to the family.

CONCLUSIONS

These system maps support current evidence on movement behaviors in family systems and socioecological theories and have the utility to galvanize future research and policy to promote PA and reduce SB.

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Early life, environmental, and demographic factors associated with change in toddlers' objectively measured sedentary behaviour between 18 and 36 months of age

This study examined individual variation in change over time in sedentary behaviour and factors associated with higher or lower sedentary behaviour and change in sedentary behaviour in 110 toddlers from 18 to 36 months of age. Mother/child dyads were recruited into the study when children were 6 months of age. Mothers completed surveys, and children were measured at 6-month intervals to 36 months. Children wore accelerometers for one week at each time point, and height and weight were measured. Growth curve modelling examined relationships between demographic, early life, and environmental factors and sedentary behaviour from 18 to 36 months. Fifty-one percent of the children were boys. The trajectory of sedentary behaviour increased from 18 to 24 months then declined. Children with higher sedentary behaviour were less likely to be enrolled in daycare (p < 0.05), and they engaged in higher TV/electronic media use (p < 0.05). Children with lower sedentary behaviour were more likely to have been breastfed (p < 0.05). Children with higher locomotion scores at 6 months were less sedentary at 18 months (p < 0.05), but this difference diminished over time. Mothers should be encouraged to breastfeed, limit their child's TV/electronic media use, and provide opportunities for their young children to be physically active.

How strong is the evidence supporting the WHO guidelines on physical activity, sedentary behaviour and sleep in early childhood?

BACKGROUND

The WHO issued recommendations about the ideal amount of physical activity, sedentary behaviour and sleep in infants, toddlers and preschool children. To facilitate their interpretation and translation into public health policies, we analysed the quantity and quality of the evidence that supported the development of each WHO recommendation.

METHODS

All data for each exposure-outcome pair analysed in the studies informing WHO guidelines were extracted, and predefined criteria, based upon GRADE methodology, were used to classify each outcome and study result.

RESULTS

Among the 237 studies that could be included, 37 were experimental and 200 were observational, yielding 920 analyses of exposure-outcome associations. Sixty-two analyses used a relevant outcome, with or without significant results. Five of the 10 WHO recommendations were based upon zero analyses with significant results on relevant health outcomes. The remaining recommendations were mostly based upon analyses evaluating obesity-related outcomes. Eight of the 10 GLs thresholds were not supported by any significant analysis on clinically relevant outcomes.

CONCLUSION

While these findings should not be interpreted as an attempt to disprove the benefits of healthy lifestyle habits in early childhood, neither to minimize the work of the experts in this complex research field, very limited evidence currently supports the adoption of recommended thresholds as behavioural surveillance and public health interventions targets. Therefore, until further data are available, public health interventions should be developed balancing whether to focus on the achievement of specific targets that are still not supported by high-quality evidence or on the general promotion of healthy behaviours.

Associations between sedentary types, sedentary patterns and cognitive ability in preschool children

The preschool years are a critical period for developing cognitive abilities such as reasoning, memorization, comprehension, quick thinking, and problem-solving. Sedentary behavior (SB) is known to be associated with cognitive development in preschool children. However, limited research has focused on how different types of SB (active, passive) and sedentary patterns (bouts, breaks) affect preschool children's cognitive abilities. This cross-sectional study aimed to investigate: (1) the relationship between sedentary types and preschoolers' cognitive abilities; and (2) the relationship between sedentary patterns and preschoolers' cognitive abilities. Preschoolers aged 3 to 6 years (n = 353) were recruited from 5 kindergartens in Changsha, Hunan, China. Sedentary types were reported by parents, sedentary patterns were measured by preschoolers wearing an ActiGraph wGT3X-BT for seven consecutive days, and cognitive abilities were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV). The relationships between variables were analyzed using multiple linear regression models. Non-screen-based active SB was associated with higher full-scale IQ and fluid reasoning index in boys and higher visual spatial index in girls. Screen-based active SB was negatively associated with overall cognitive ability. Passive SB potentially had a negative effect on overall cognitive ability, but screen-based passive SB was positively associated with higher fluid reasoning indices in girls. Preschoolers' cognitive ability was positively associated with sedentary breaks, but not with sedentary bouts.

CONCLUSIONS

Not all types of SB are equal when examining optimal cognitive development in preschoolers. Frequent breaks from sedentary time were associated with better cognitive development. Encouraging more frequent breaks to interrupt prolonged SB may be a viable strategy for reducing sedentary time to promote optimal cognitive development. These findings should be further validated in larger prospective studies.

WHAT IS KNOWN

• Sedentary behavior is not advantageous for cognitive development.

WHAT IS NEW

• Not all types of sedentary behavior are harmful. • Active sedentary behaviors are beneficial to overall cognitive development, but screen-based active sedentary behaviors may negatively impact some areas of cognitive performance. • Cognitive abilities in preschoolers are associated with sedentary breaks, but not with sedentary bouts.

Optimal levels of sleep, sedentary behaviour, and physical activity needed to support cognitive function in children of the early years

BACKGROUND

Sleep, sedentary behaviour, physical activity, and the composition of these movement behaviours across the 24-h day are associated with cognitive function in early years children. This study used a Goldilocks day compositional data analysis approach to identify the optimal duration of sleep, sedentary behaviour, light physical activity, and moderate-to-vigorous physical activity associated with desired cognitive function outcomes in early years children.

METHODS

This cross-sectional study included 858 children aged 2.8-5.5 years from the Sleep and Activity Database for the Early Years. 24-h movement behaviours (sleep, sedentary behaviour, light physical activity, moderate-to-vigorous physical activity) were measured using ActiGraph accelerometers. Cognitive function was measured using three tasks from the Early Years Toolbox: visual-spatial working memory, response inhibition, and expressive vocabulary. A Goldilocks day compositional data analysis approach was used in R software to identify the optimal time-use compositions associated with the best 10% of the cognitive function scores.

RESULTS

The movement behaviour composition and the relative time spent in sleep and sedentary behaviour but not different intensities of physical activity were significantly associated with working memory (P ≤ 0.01). The movement behaviour composition and relative time spent in sleep, sedentary behaviour, and different intensities of physical activity were not significantly associated with response inhibition or expressive vocabulary (P > 0.2). Therefore, optimal time use was only determined for working memory. Optimal daily durations for working memory were observed with 11:00 (hr:min) of sleep, 5:42 of sedentary behaviour, 5:06 of light physical activity, and 2:12 of moderate-to-vigorous physical activity.

CONCLUSION

Working memory was the only cognitive function outcome related to the 24-h movement behaviour composition. Optimal sleep for working memory was consistent with current recommended durations, while optimal moderate-to-vigorous physical activity greatly exceeded minimal recommended levels. Optimal sedentary behaviour was longer and light physical activity was shorter than the sample average.

Screen Exposure in 4-Year-Old Children: Association with Development, Daily Habits, and Ultra-Processed Food Consumption

This study aimed to investigate the association between child development, daily habits, and ultra-processed food consumption with screen exposure in 4-year-old children. A cross-sectional study was conducted using a questionnaire that included sociodemographic data, the child's daily habits, and screenings for child development and eating habits. The daily screen exposure time (cell phone, computer, television, and/or tablet) was measured in minutes and classified as inadequate if >60 min. We conducted bivariate analyses and a generalized linear model. Overall, 362 caregivers-children pairs were investigated. The average screen time per child was 120 min (IQR: 120), and most of the children (71%) showed inadequate screen time for the age group. The longest screen time was associated with the lowest score in child development (β = -0.03; p = 0.01), an increased habit of eating in front of screens (β = 0.34; p < 0.001), and the highest score of ultra-processed foods (UPFs) (β = 0.05; p = 0.001). The sample showed a high prevalence of inadequate screen time, and this has been associated with the lowest score in child development, an increased habit of eating in front of screens, and the highest score of UPFs.

Physical Literacy and Physical Activity in Early Years Education: What's Known, What's Done, and What's Needed?

Background: Physical literacy (PL) is increasingly recognised as essential for fostering lifelong engagement in physical activity (PA), particularly when nurtured in early childhood. Yet there remains limited understanding of how stakeholders in early years (EY) education perceive, value, and implement a PL-informed approach. This study aims to explore knowledge and beliefs regarding PL and PA in relation to 3-5-year-olds, investigating key questions around perceived importance, current practices, and barriers to implementation. Methods: A concurrent mixed-methods approach was used, incorporating semi-structured expert interviews (n = 11), focus groups (n = 22), and a survey (n = 210). Thematic analysis was used to identify key themes from qualitative data, and survey data were analysed to complement and triangulate the qualitative findings. Results: The findings revealed variation in stakeholders' awareness of PA recommendations and confusion over terminology. Whilst stakeholders acknowledged the importance of PL, there remains uncertainty about the connection between theory and practical application. Identified barriers included resource limitations, conflicting priorities, and insufficient training and policy support. Feedback on an educational PL-EY model was generally positive, suggesting strong potential as a tool to support PL understanding and application in early childhood contexts. Conclusions: Given the pivotal role of EY education in shaping children's behaviours, health, and wellbeing, this study highlights the necessity of a holistic approach to interventions, strong stakeholder involvement, and evidence-based practices to foster PL in EY children. The PL-EY model presents a promising direction for future resources and education and raises critical questions about what effective interventions to develop PL in this age group should consider and look like.

Associations between adherence to 24-hour movement guidelines and socio-emotional competence among preschool children: A cross-sectional study

BACKGROUND

This study investigated the association between adherence to 24-h movement guidelines and socioemotional competence among Chinese preschool children.

METHODS

A total of 1288 parents of Chinese preschoolers (54.64 % boys, 45.36 % girls; Mage = 4.48, SD = 0.97) reported the time their children spent on physical activity (PA), screen time (ST), and sleep duration (SD), and completed questionnaires measuring socioemotional competence. Multiple logistic regression analyses were used to explore the associations between individual and combined measures of PA, ST, and SD, and the risk of low socioemotional competence.

RESULTS

The risk of low socioemotional competence was significantly lower for children aged 4 (odds ratio [OR] = 0.47, 95 % CI: 0.31-0.71), 5 (OR = 0.23, 95 % CI: 0.15-0.35), and 6 (OR = 0.16, 95 % CI: 0.10-0.25) compared to 3-year-olds. Children with a family income level higher than 20,000CNY had a significantly lower risk of low socioemotional competence than those with a family income level not higher than 3000CNY (OR = 0.21, 95 % CI: 0.08-0.59). Urban residency was associated with significantly lower odds of low socioemotional competence than rural residency (OR = 0.41, 95 % CI: 0.21-0.82). Adherence to the PA-only guidelines (OR = 0.45, 95 % CI: 0.22-0.94), SD-only guidelines (OR = 0.25, 95 % CI: 0.08-0.72), ST + SD guidelines (OR = 0.33, 95 % CI: 0.16-0.67), and PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.18-0.70) were associated with a lower risk of low socioemotional competence. In addition, among boys, only adherence to the PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.14-0.90) was associated with a lower risk of low socioemotional competence. Among girls, adherence to SD guidelines only (OR = 0.22, 95 % CI: 0.04-0.90), ST + SD guidelines (OR = 0.17, 95 % CI: 0.06-0.49), and PA + ST + SD guidelines (OR = 0.37, 95 % CI: 0.14-0.91) were all associated with a lower risk of low socioemotional competence.

CONCLUSIONS

Adhering to 24-h movement guidelines is crucial for enhancing socioemotional competence in preschool children, especially girls. Interventions should focus on promoting physical activity, reducing screen time, and ensuring adequate sleep.

Urban Versus Rural Differences in Meeting 24-h Movement Behaviour Guidelines Among 3-4-Year-Olds: An Analysis of SUNRISE Pilot Study Data From 10 Low- and Middle-Income Countries

BACKGROUND

Insufficient physical activity, excessive screen time and short sleep duration among young children are global public health concerns; however, data on prevalence of meeting World Health Organisation 24-h movement behaviour guidelines for 3-4-year-old children in low- and middle-income countries (LMICs) are limited, and it is unknown whether urbanisation is related to young children's movement behaviours. The present study examined differences in prevalence of meeting 24-h movement behaviour guidelines among 3-4-year-old children living in urban versus rural settings in LMICs.

METHODS

The SUNRISE Study recruited 429, 3-4-year-old child/parent dyads from 10 LMICs. Children wore activPAL accelerometers continuously for at least 48 h to assess their physical activity and sleep duration. Screen time and time spent restrained were assessed via parent questionnaire. Differences in prevalence of meeting guidelines between urban- and rural-dwelling children were examined using chi-square tests.

RESULTS

Physical activity guidelines were met by 17% of children (14% urban vs. 18% rural), sleep guidelines by 57% (61% urban vs. 54% rural), screen time guidelines by 50% (50% urban vs. 50% rural), restrained guidelines by 84% (81% urban vs. 86% rural) and all guidelines combined by 4% (4% urban vs.4% rural). We found no significant differences in meeting the guidelines between urban and rural areas.

CONCLUSIONS

Only a small proportion of children in both rural and urban settings met the WHO 24-h movement guidelines. Strategies to improve movement behaviours in LMICs should consider including both rural and urban settings.

"I Use Technologies Strategically With My Family Now": Practices That Parents Value to Promote Physical Activity in Young Children

BACKGROUND

Although widely accessible digital technology (DT) provided multiple opportunities for young children's play, learning, and development, it also raised parents and professionals' concerns regarding its impact on children's physical activity. This study aimed to identify practices involving DT that were valued by parents in helping their young child to be physically active.

METHODS

Participants were parents of ambulatory young children (less than 5 y of age) engaged with a playgroup. The study involved representatives from 3 service organizations, who compiled a list of digital resources related to using DT to promote children's physical activity that were suitable to be shared and trialed by parents and young children. During a pretrial workshop, researchers, participants, and organization representatives collaboratively developed the intervention, which involved the delivery of selected resources by weekly email, over a 12-week period. Participants provided weekly feedback about their experiences and participated in a postintervention semistructured qualitative interview.

RESULTS

Thirteen families, with children aged between 15 and 36 months, completed the trial. Participants reported several valued practices to promote their children's physical activity, including those where the child was active while engaging with DT, where child engagement with DT acted as a prompt for later physical activity, where DT assisted parents in planning physical activity, where DT assisted parents in integrating movement with learning and play, and where DT was used to reinforce the child's enthusiasm for physical activity.

CONCLUSIONS

Parents reported several valued practices where children were physically active, rather than sedentary, while using digital technology.

Associations Between Combinations of 24-Hour Movement Behaviors and Dietary Outcomes in Children and Adolescents: A Systematic Review

Background/Objectives: Twenty-four-hour movement behaviors, including physical activity, sedentary time, and sleep, are associated with a range of health outcomes. However, the relationship between the combinations of these behaviors and dietary outcomes in young populations remains unclear. We conducted a systematic review to explore how combined movement behaviors are linked to dietary outcomes in children and adolescents. Methods: We searched MEDLINE, Embase, and PsycINFO from January 2017 to July 2024, including studies that were (1) written in English, (2) published in peer-reviewed journals, (3) quantitatively analyzed two or three movement behaviors with dietary outcomes, and (4) focused on populations aged between 0 and 18 years. Results: Ten cross-sectional studies met these criteria. The majority of studies (6 out of 10) assessed all three movement behaviors, although sleep was less frequently examined, appearing in only 4 of the studies. Our findings indicated that adhering to all movement recommendations was consistently associated with healthier dietary patterns, including a higher consumption of fruits, vegetables, nuts, fish, and cereals, and a lower intake of sweets and pastries. Additionally, adhering to physical activity and sedentary time guidelines was linked to improved dietary habits in children, including more fruit and vegetable intake and less sugary drink and snack consumption. Conversely, higher sedentary time and inadequate sleep were linked to poorer dietary outcomes, particularly lower fruit intake and hydration. Conclusions: This review suggests that meeting movement behavior guidelines correlates with healthier dietary outcomes in children and adolescents. However, given the limited number of studies and their cross-sectional design, further high-quality research, including longitudinal and intervention studies, is needed to clarify causal relationships.

Reallocation of time to moderate-to-vigorous physical activity and estimated changes in physical fitness among preschoolers: a compositional data analysis

BACKGROUND

Previous research has examined the associations of preschoolers' 24-h movement behaviours, including light and moderate-to-vigorous physical activity (LPA and MVPA), sedentary behaviour (SB), sleep, with physical fitness in isolation, ignoring intrinsically compositional nature of movement data while increasing the risk of collinearity. Thus, this study investigated the associations of preschoolers' 24-h Movement behaviours composition with physical fitness, estimated changes in physical fitness when time was reallocated between movement behaviours composition, and determined whether associations differ between different genders, using compositional data analysis.

METHODS

In the cross-sectional study, a total of 275 preschoolers (3 ~ 6 y) from China were included. SB, LPA and MVPA times were objectively monitored with an ActiGraph GT9X accelerometer for 7 consecutive days. Sleep duration was obtained using parental reports. Physical fitness parameters, including upper and lower limb strength, static balance, speed-agility, and cardiorespiratory fitness (CRF), were determined with the PREFIT battery. The associations of 24-h movement behaviours composition with each physical fitness parameter were examined employing compositional multivariable linear regression models. The changes following time reallocation among behaviours were estimated employing compositional isotemporal substitution analyses.

RESULTS

Greater MVPA, but not LPA, was significantly related to better upper and lower limb strength, speed-agility, and CRF. Reallocating time from LPA or SB to MVPA was related to better physical fitness. The associations were non-symmetrical: the estimated detriments to physical fitness from replacing MVPA with LPA or SB were larger than the estimated benefits associated with adding MVPA of the same magnitude. The aforementioned associations with lower limb strength, CRF, and speed-agility were observed in boys, while associations with upper and lower limb strength were noted in girls.

CONCLUSION

Our findings reinforce the importance of physical activity (PA) intensity for the development of physical fitness in preschoolers. Replacing LPA or SB time with MVPA may be an appropriate strategy for enhancing preschoolers' physical fitness.

Association of screen exposure/sedentary behavior and precocious puberty/early puberty

Background

In recent years, with the development of society, children's daily exposure to screen time has gradually increased. Screen exposure and sedentary behavior have brought a host of harms to children's lives. The aim of this study was to explore the effects of screen exposure and sedentary behavior on precocious puberty and early development.

Methods

This is a cross-sectional study in the school-based population. A total of 3,560 children were recruited from Qufu City, Shandong province using multistage stratified cluster random sampling. All study subjects had a physical examination by professional pediatricians in October 2019, and were investigated with health questionnaires. Precocious puberty is defined as development of secondary sexual signs in boys before 9 years or in girls before 8 years. Screen time was calculated as the average of screen time on weekdays and weekend days, and sedentary time was calculated as the average of sedentary time on weekdays and weekend days. After adjusting for potential confounders, logistic regression was used to examine the association between screen exposure and sedentary behavior and early puberty and precocious puberty.

Results

Sedentary time was a risk factor for precocious puberty and early development (OR = 1.428, 95% CI = 1.087-1.876) in girls without adjustment. No significant association was found between screen exposure and early puberty and early development both in girls and boys.

Conclusions

Excessive sedentary behavior was associated with an increased risk of early puberty, especially in girls, while there was no significant association between screen exposure and early puberty and early development. In addition, further longitudinal investigations are needed to determine the causal relationship between screen exposure, sedentary behavior and precocious puberty.

Effectiveness of a parent-focused intervention targeting 24-hour movement behaviours in preschool-aged children: a randomised controlled trial

BACKGROUND

Interventions focusing on individual behaviours (physical activity, sedentary behaviour, sleep) of preschool-aged children have been widely studied. However, there is a lack of understanding about integrated interventions that target all three 24-hour movement behaviours. This is the first study to assess the effectiveness of an intervention aimed at improving all three 24-hour movement behaviours among preschoolers in Hong Kong.

METHODS

A 12-week randomised controlled trial with a 12-week follow-up was conducted. Parent-child pairs were randomised to integrated approach (targeting all three behaviours), dyadic approach (targeting physical activity and sedentary behaviour including screen time), or wait-list control group. Utilising the Internet-based delivery, this intervention consisted of education materials, workshops, and interactive questionnaires and reminders. Two intervention groups employed the same strategies, with the only difference being that the integrated approach targeted sleep in addition to physical activity and sedentary behaviour. The outcomes were preschoolers' overall 24-hour movement behaviours which were assessed by the Activity Sleep Index (ASI), movement behaviour composition, and absolute duration of movement behaviours. Generalised estimating equations were conducted to evaluate the intervention.

RESULTS

A total of 147 preschoolers (4.8 ± 0.9 years old, 56.5% boys) and their parents were included. Preschoolers in all groups had a lower ASI at follow-up compared with baseline. Preschoolers in the integrated approach had a smaller decline in ASI at follow-up, compared to that in the control group (3.41; 95% confidence interval [CI] = 0.07, 6.76). Preschoolers in both intervention groups had a smaller reduction of the composition of time spent in physical activity at follow-up, and a decreased screen time at postintervention and follow-up. No significant differences were found for the sleep subcomponent. Furthermore, preschoolers in the dyadic approach had a smaller increase in the sedentary behaviour subcomponent (vs.

CONTROL

- 0.21; 95% CI = - 0.37, - 0.05) at follow-up.

CONCLUSIONS

Both intervention groups showed a decrease in screen time at postintervention, but there were no significant changes in other behaviours. The favourable changes observed at follow-up demonstrated the effectiveness of both intervention approaches on alleviating the decline in the composition of time spent in physical activity and reducing screen time and revealed the possible effectiveness of the integrated approach in promoting overall movement behaviours among preschoolers.

TRIAL REGISTRATION

The study is prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2200055958).

Efficacy of a Physical Activity e-Learning Course Delivered to Early Childhood Educators on Preschoolers' Physical Activity and Sedentary Behaviors: A Cluster Randomized Controlled Trial

PURPOSE

This study examined the effectiveness of an early childhood educator (ECE)-focused physical activity e-Learning course on children's physical activity and sedentary time in childcare.

METHODS

A cluster randomized controlled trial was conducted in 12 childcare centers in London, Ontario, Canada. A total of 145 preschoolers and 42 ECEs participated in this study. ECEs in the intervention condition completed a 5-hour e-Learning course related to physical activity. Outcomes were preschoolers' minutes of moderate- to vigorous-intensity physical activity, light-intensity physical activity, and sedentary time assessed using accelerometers.

RESULTS

The intervention did not have a significant effect on moderate- to vigorous-intensity physical activity (d < 0.01, P = .984), light-intensity physical activity (d = -0.17, P = .386), or sedentary time (d = 0.07, P = .717) from baseline to postintervention. There was also no significant intervention effect on moderate- to vigorous-intensity physical activity (d = 0.27, P = .260), light-intensity physical activity (d = -0.08, P = .740), or sedentary time (d = -0.15, P = .520) from baseline to follow-up.

CONCLUSIONS

Providing ECEs with online training in physical activity through an e-Learning course may not be sufficient to increase physical activity levels among young children in their care. It may be essential to deliver multicomponent interventions to increase preschoolers' engagement in physical activity in childcare.

Balancing screen time: Insights and impact on preschool children

Over the past decade, the exposure of young children to screen devices at home and preschool has become increasingly common. Screen viewing time (SVT) has risen alongside the surge in ownership of screen devices such as television, smartphones, tablets and laptops worldwide.1 In many countries, screen time and digital technology is utilised as tools to support young children’s development of practical skills in creativity, problem-solving, curiosity, and expanding their knowledge to new topics, cultures and ideas. However, screen time can be a double-edged sword.2

Screen time and social-emotional skills in preschoolers with developmental, behavioural or emotional issues in Singapore

Introduction

This study aimed to determine patterns of screen viewing time (SVT) in preschool children with developmental, behavioural or emotional (DBE) issues, and to identify its relationship with social-emotional development.

Method

This cross-sectional study involved children aged 0-5 years who were referred to a developmental paediatric clinic for DBE issues. Parents completed a screen time questionnaire, and the Devereux Early Childhood Assessment-Clinical (DECA-C) question-naire which assessed the social-emotional competence of the children. Data were analysed using logistic regression, correlational analyses and tests of comparison.

Results

Among 225 children (mean age: 32.4 months), mean daily SVT was 138 minutes. More than half (51.1%) of the children had clinical features of language delay, while 26.6% had features suggestive of autism spectrum disorder. Screen time was first introduced at a mean age of 13.8 months, with 32.4% of children previously experiencing higher SVT. Compared to SVT introduction after 1 year of age, SVT in the first 12 months was primarily to facilitate feeding (P<0.05). Children with higher past SVT had poorer attention, more aggression, and increased behavioural concerns. Children with DBE issues have significantly more screen time than same-aged peers.

Conclusion

Children with DBE issues are exposed to SVT at a very young age and have significantly more screen time than their peers. It is crucial to guide parents to reduce SVT in early childhood, particularly around mealtimes.

The efficacy of the TEACH e-Learning course at improving early childhood educators' physical activity and sedentary behaviour self-efficacy, knowledge, intentions, and perceived behavioural control: a randomized controlled trial

BACKGROUND

Early childhood educators play a critical role in promoting physical activity and reducing sedentary time in childcare centres. However, early childhood educators receive limited specialised pre- and in-service learning opportunities relating to these behaviours and may lack the capacity to effectively engage children in healthy movement behaviours. This study aimed to examine the efficacy of an e-Learning course on increasing early childhood educators' physical activity and sedentary behaviour-related capacities.

METHODS

A two-group parallel randomized controlled trial was conducted with early childhood educators in Canada (Mage = 41.78, 97% female). Participants randomized to the intervention group were asked to complete a physical activity and sedentary behaviour e-Learning course within a 4-week period. Participants randomized to the waitlist control condition were assigned to a waitlist to receive the intervention after the testing period. Participants reported on their self-efficacy, knowledge, intentions, and perceived behavioural control relating to physical activity and sedentary behaviours at baseline, post-intervention, and 3 months follow-up. Linear mixed effects models were estimated to determine difference in changes in outcomes from baseline to post-intervention, and follow-up.

RESULTS

A total of 209 early childhood educators participated in the study (intervention n = 98; control n = 111). The TEACH e-Learning course was found to be efficacious at improving all of the examined outcomes, with standardized effect sizes ranging from d = 0.58 to d = 0.65 for self-efficacy outcomes, d = 0.66 to d = 1.20 for knowledge outcomes, d = 0.50 to d = 0.65 for intention outcomes, and d = 0.33 to d = 0.69 for perceived behavioural control outcomes post-intervention. The intervention effects were sustained at follow-up for all outcomes apart from perceived behavioural control to limit screen time. Additionally, the magnitude of the effect for knowledge outcomes decreased at follow-up, with standardized effect sizes ranging from d = 0.49 to d = 0.67.

CONCLUSIONS

The e-Learning course was highly successful at improving early childhood educators' capacity pertaining to physical activity and sedentary behaviours. Providing training content through e-Learning may be an efficacious approach to providing continual professional learning opportunities relating to physical activity and sedentary time to early childhood educators on a large scale.

Adherence of Brazilian Minors to the 24-Hour Movement Guidelines after In-Person School Return

The levels of adequacy of movement behaviors after returning to in-person school activities following the COVID-19 pandemic are not yet well understood. This study aimed to assess the adherence of Brazilian minors to the recommendations of the 24-Hour Movement Guidelines (moderate to vigorous physical activity, recreational screen time, and sleep duration), as well as overall adherence to these guidelines, after the relaxation of COVID-19 social isolation measures and the resumption of in-person schooling. A cross-sectional study was conducted with parents or guardians (39 ± 7.8) of minors aged up to 18 years of age (3.8 ± 2.5). A total of 172 individuals responded to the questionnaire. Data were compared with those obtained in the Survey of the Adequacy of Brazilian Children and Adolescents to the 24-Hour Movement Guidelines before and during the COVID-19 Pandemic. There was an 18.6 percentage decrease (p-value < 0.001) in overall adherence to the 24-Hour Movement Guidelines when comparing the periods before the COVID-19 pandemic (March 2020) and after the return to in-person schooling (March 2021). The largest percentage drop in adherence between these periods was observed for moderate to vigorous physical activity (27.4%; p-value < 0.001) and the lowest for sleep (10.5%; p-value < 0.001). Adherence to the 24-Hour Movement Guidelines did not return to pre-pandemic levels with the resumption of in-person school activities.

Study on the relationship and related factors between physical fitness and health behavior of preschool children in southwest China

OBJECTIVE

To investigate the physical fitness level and health behavior status of preschool children in China, explore the relationship between physical fitness and health behavior, and further reveal the main factors affecting health behavior, to provide a reference for improving the physical fitness level of preschool children and maintaining healthy behavior.

METHODS

A total of 755 preschool children (394 boys and 361 girls, aged 4.52 ± 1.11 years) were selected from Chongqing and Liupanshui in China by cluster random sampling method for questionnaire survey and physical monitoring, and SPSS21.0 software was used to process and analyze the data.

RESULTS

(1) Heart rate (p = 0.015), protein content (p < 0.001), and time spent on the balance beam (p < 0.001) were significantly lower in boys than in girls, while BMI (p = 0.012), muscle mass (p < 0.001), and distance of standing long jump (p < 0.001) were significantly higher in boys than in girls. Meanwhile, systolic blood pressure (p = 0.004) and diastolic blood pressure (p = 0.001) of rural children were significantly higher than those of urban children, while BMI (p < 0.001) and sitting forward flexion (p = 0.019) were significantly lower than those of urban children. (2) The light-intensity physical activity (LPA) and moderate to vigorous physical activity (MVPA) of boys were significantly higher than that of girls (p < 0.001), and the MVPA of urban children was significantly higher than that of rural children (p = 0.001), and the former participated in sports classes more frequently (p < 0.001). (3) There was a significant correlation between physical activity (PA) and physical fitness indicators of preschoolers. Participating in sports interest classes was only significantly correlated with systolic blood pressure (r = 0.08) and sitting forward flexion (r = 0.09). (4) The PA level of preschool children was related to gender, household registration, kindergarten nature, age, residence environment, parental support, and participation degree. Participation in sports interest classes was related to gender, the nature of the kindergarten, household registration, age, and parent participation. Daily screen time was related to household registration, the nature of the kindergarten, the environment of residence, and the value perception of parents.

CONCLUSIONS

There were different degrees of correlation between preschool children's physical fitness and health behaviors, and children's health behaviors were closely related to gender, environment, parents, and other factors. Therefore, how to increase the protective factors of children's health behaviors and controlling the risk factors may be crucial to promoting the development of good health behaviors and improving the physical fitness of preschool children.

Television Time, Especially During Meals, Is Associated With Less Healthy Dietary Practices in Toddlers

BACKGROUND

While several studies examine the relationship between screen time and dietary practices in children and teenagers, there is limited research in toddlers. This study evaluates the association between television (TV) exposure and dietary practices in 2-year-old children.

METHODS

We conducted a cross-sectional, secondary data analysis from the Greenlight Intervention Study. Toddlers' daily TV watching time, mealtime TV, and dietary practices were assessed by caregiver report at the 24-month well-child visit. Separate regression models were used and adjusted for sociodemographic/household characteristics and clinic site.

RESULTS

Five hundred and thirty-two toddlers were included (51% Latino; 30% non-Latino Black; 59% ≤$20,000 annual household income). Median daily TV watching time was 42 minutes (interquartile range: 25, 60); 25% reported the TV was "usually on" during mealtimes. After adjustment, toddlers who watched more TV daily had higher odds of consuming sugar-sweetened beverages, fast food, and more junk food; those watching less TV had higher odds of consuming more fruits/vegetables. Those with the TV "usually on" during mealtimes were more likely to consume sugar-sweetened beverages (aOR 3.72 [95% confidence interval {CI} 2.16-6.43]), fast food (aOR 2.83 [95%CI 1.54-5.20]), and more junk food (aOR 4.25 [95%CI 2.71-6.65]).

CONCLUSIONS

Among toddlers from primarily minoritized populations and of lower socioeconomic status, those who watched more TV daily and usually had the TV on during meals had significantly less healthy dietary practices, even after adjusting for known covariates. This study supports the current American Academy of Pediatrics screen time guidelines and underscores the importance of early counseling on general and mealtime TV.

A multivariate multilevel approach to unravel the associations between individual and school factors on children's motor performance in the REACT project

OBJECTIVE

The aim was to (1) estimate the relationship between physical fitness (PF) and object control fundamental movement skills (FMS), (2) identify child characteristics that relate with PF and FMS, and (3) examine associations between the school environment, PF, and FMS.

METHODS

The sample included 1014 Portuguese children aged 6-10 years from the REACT project. PF was assessed via running speed, shuttle run, standing long jump, handgrip, and the PACER test. Object control FMS were assessed with stationary dribble, kick, catch, overhand throw, and underhand roll. Test performances were transformed into z-scores, and their sum was expressed as overall PF and FMS. Child-level variables included body mass index (BMI) z-scores, accelerometer-measured sedentary time and moderate-to-vigorous physical activity, and socioeconomic status (SES). School size, physical education classes, practice areas, and equipment were also assessed.

RESULTS

Approximately, 90% of the variance in object control PF and FMS was at the child level, and 10% at the school level. The correlation between PF and object control FMS was .62, which declined to .43 with the inclusion of covariates. Older, more active, and higher SES children had higher object control PF and FMS, and boys outperformed girls. BMI was negatively associated with PF but not with object control FMS. Sedentary time and number of physical education classes were not significant predictors. Most school predictors did not jointly associate with PF and object control FMS.

CONCLUSION

PF and object control FMS z-scores were moderately related. Not all child characteristics were associated with both PF and object control FMS, and their effect sizes were different. School characteristics only explained 10% of the total variation in PF and object control FMS.

A lifestyle screening tool for young children in the community: needs and wishes of parents and youth healthcare professionals

BACKGROUND

Youth healthcare has an important role in promoting a healthy lifestyle in young children in order to prevent lifestyle-related health problems. To aid youth healthcare in this task, a new lifestyle screening tool will be developed. The aim of this study was to explore how youth healthcare professionals (YHCP) could best support parents in improving their children's lifestyle using a new lifestyle screening tool for young children.

METHODS

We conducted four and seven focus groups among parents (N = 25) and YHCP (N = 25), respectively. Two main topics were addressed: the experiences with current practice of youth healthcare regarding lifestyle in young children, and the requirements for the lifestyle screening tool to be developed. The focus groups were recorded, transcribed verbatim and analysed using an inductive approach.

RESULTS

Both parents and YHCP indicated that young children's lifestyles are often discussed during youth healthcare appointments. While parents felt that this discussion could be more in-depth, YHCP mainly needed clues to continue the discussion. According to parents and YHCP, a new lifestyle screening tool for young children should be easy to use, take little time and provide courses of action. Moreover, it should be attractive to complete and align with the family concerned.

CONCLUSIONS

According to parents and YHCP, a new lifestyle screening tool for young children could be useful to discuss specific lifestyle topics in more detail and to provide targeted advice.

Thai Preschoolers' movement behaviors outside kindergarten: prevalence of meeting individual and integrated movement guidelines

BACKGROUND

This study aimed to investigate movement behaviors of Thai preschoolers (aged 3-6 years) occurring outside kindergarten in urban areas across Thailand.

METHODS

Surveillance of digital Media in eArLy chiLdhood Questionnaire® was used to collect data from 1051 parents recruited from 12 schools. Descriptive statistics and logistic regressions were applied for data analysis.

RESULTS

Thai preschoolers engaged in physical activity (PA), sedentary screen time, and sleep on weekends significantly more than weekdays with no significant sex differences. Preschoolers met the sleep guidelines the most (62.3%), followed by PA guidelines (48.0%), and screen time (ST) guidelines the least (44.1%). Only 14.6% met the integrated movement guidelines, and 11% met none of the guidelines. Age was positively associated with meeting the PA guidelines, and negatively associated with meeting the sleep and integrated movement guidelines. The number of digital devices at home and geographical region influenced preschoolers in meeting the PA and ST guidelines.

CONCLUSIONS

Thai preschoolers' time spent on all forms of activities outside kindergarten was significantly more on weekends than weekdays with no sex disparity. The prevalence of meeting the integrated movement guidelines was low, and needs to be addressed through comprehensive programs including all forms of activities concurrently.

IMPACT

Thai preschoolers engaged in physical activity (PA), screen time (ST), and sleep on weekends significantly more than weekdays with no significant sex differences. Only 14.6% of preschoolers met the integrated movement guidelines. Age had a significant relationship with meeting the PA, sleep, and integrated movement guidelines. Meeting the PA and ST guidelines in preschoolers was positively associated with the number of digital devices at home. Despite some limitations, this study presented preschoolers' time engaged in the three movement behaviors concurrently, and provided important inputs for development of the national strategic plan to promote PA among Thai children and youth.

Examining the relationship between meeting 24-hour movement behaviour guidelines and mental health in Chinese preschool children

Background

Limited research has explored the relationship between adhering to 24-h Movement Behaviour guidelines and mental health in Chinese preschool children. The objectives of this study encompassed two primary goals: (1) to investigate the adherence of preschool children in China to the 24-h Movement Behaviour guidelines; and (2) to analyze the relationship between fulfilling various combinations of these guidelines and mental health, identifying the most advantageous combination.

Methods

Utilizing a convenience sampling approach, this study included 205 preschool children (117 boys and 88 girls, average age 4.8 ± 0.51 years) from five kindergartens in Hengyang, Hunan Province. The physical activity (PA) and sedentary behaviour of preschool children were objectively assessed using waist-worn accelerometers, while sleep duration and screen time were reported by the children's parents. To evaluate mental health, the parent version of the internationally validated Strength and Difficulties Questionnaire (SDQ) was employed, which measures externalizing problems, internalizing problems, and prosocial behaviour. Employing Mplus 8.0 for Structural Equation Modeling analysis, while controlling for demographic variables, the study explored the connection between preschool children's mental health and their adherence to the 24-h Movement Behaviour guidelines.

Results

Worryingly, merely 14.6% of preschoolers met the recommended guidelines for all three aspects (PA, sleep duration, and screen time). Positive correlations were identified between meeting PA guidelines and displaying prosocial behaviour (β = 0.184; p < 0.05), while screen time adherence exhibited a negative correlation with externalizing problems (β = -0.207; p < 0.05). Similarly, there was a negative association between sleep duration adherence and externalizing problems (β = -0.191; p < 0.05). Meeting all three recommended guidelines was notably linked to enhanced prosocial behaviour (β = 0.464; p < 0.05), while following the screen time and sleep duration guidelines was negatively associated with externalizing problems (β = -0.246; p < 0.05).

Conclusion

This study underscores the limited adherence of Chinese preschoolers to the comprehensive 24-h Movement Behaviour guidelines. Noteworthy findings include the positive influence of PA on prosocial behaviour, alongside the significant roles that sleep duration and screen time play in mitigating externalizing problems within this age group. Alignment with the 24-h Movement Behaviour guidelines is associated with more favorable mental health indicators in preschoolers.

Isotemporal substitution effect of 24-hour movement behavior on the mental health of Chinese preschool children

The 24-h movement behavior of preschoolers comprises a spectrum of activities, including moderate-to-vigorous intensity physical activity (MVPA), light-intensity physical activity (LPA), screen-based sedentary behavior (SCSB), non-screen-based sedentary behavior (NSCSB), and sleep. While previous research has shed light on the link between movement behaviors and children's mental health, the specific impacts on the unique demographic of Chinese preschoolers remain underexplored. This study significantly contributes to the literature by exploring how 24-h movement behavior affects the mental health of preschoolers in a Chinese context. The study involved205 Chinese preschool children (117 boys and 88 girls) between the ages of 3 and 6 years wore accelerometers to measure their LPA, MVPA, and sedentary behavior (SB), while their parents reported the time spent on sleep and SCSB. The parents also completed the Strength and Difficulties Questionnaire to assess their children's mental health. The study used compositional regression and isotemporal substitution models to examine the relationship between the various components of 24-h movement behavior and mental health. The results showed that greater NCSSB compared to MVPA, LPA, sleep, and SCSB was associated with good prosocial behavior and lower scores on externalizing problems. This highlights the potential of NSCSB as a beneficial component in the daily routine of preschoolers for fostering mental well-being. Replacing 15 min of sleep and SCSB with 15 min of NSCSB was associated with a decrease of 0.24 and 0.15 units, respectively, in externalizing problems. Reallocating 15 min of sleep to NSCSB was linked to an increase of 0.11 units in prosocial behavior. There were no significant substitution effects between LPA and MVPA time with any other movement behavior on prosocial behavior and externalizing problems. Given the positive associations observed, further longitudinal studies are necessary to explore the link between 24-h movement behavior and mental health in preschool children.

Developmental associations of fundamental motor skills and executive functions in preschoolers - The role of the physical activity and the effects on early numeracy

BACKGROUND

Physical activity, fundamental motor skills, executive functions and early numeracy have shown to be related, but very little is known about the developmental relations of these factors.

PROCEDURE

We followed 317 children (3-6 years) over two years. Fundamental motor skills and executive functions (inhibition+switching, updating) were measured at all time points (T1, T2, T3) and physical activity at T1 and early numeracy at T3.

MAIN FINDINGS

Children with better fundamental motor skills at T1 developed slower in inhibition and switching. Fundamental motor skills developed faster in children who had better initial inhibition and switching ability. Vigorous physical activity at T1 was associated with a weaker initial inhibition and switching. The initial level and the developmental rate of updating were related to better early numeracy skills.

CONCLUSIONS

Findings indicate that fundamental motor skills and executive functions are developmentally related, and updating is an important predictor for early numeracy in preschoolers.

Parental use of routines, setting limits, and child screen use during COVID-19: findings from a large Canadian cohort study

Background

An increase in child screen time has been observed throughout the COVID-19 pandemic. Home environment and parenting practices have been associated with child screen time. The purpose of this study was to examine associations between parental use of routines, limit setting, and child screen time during the (COVID-19) pandemic to inform harm-reducing strategies to limit the potential harms ensued by excessive screen use.

Methods

A cohort study was conducted in 700 healthy children (3,628 observations) aged 0-11 years though the TARGet Kids! COVID-19 Study of Children and Families in Toronto, Canada from May 2020-May 2021. The independent variables assessed were parent-reported use of routines and setting limits. Outcomes were parent-reported child daily screen time in minutes and whether the Canadian 24-Hour screen time guideline was met, defined as 0 for <1 years, 60 or less for 1-5 years, and 120 or less for >5 years. Linear and logistic mixed-effects models were fitted using repeated measures of independent variables and outcomes with a priori stratification by developmental stages (<3, 3-4.99, ≥5 years).

Results

A total of 700 children with 3,628 observations were included in this study [mean age = 5.5 (SD = 2.7, max = 11.9) years, female = 47.6%]. Mean change in child screen time before vs. during the pandemic was +51.1 min/day and level of parental use of routines and setting limits remained stable. Lower use of routines was associated with higher child screen time (β = 4.0 min; 95% CI: 0.9, 7.1; p = 0.01) in ages ≥5 years and lower odds of meeting the screen time guideline in ages <3 years and ≥5 years (OR = 0.59; 95% CI: 0.38, 0.88; p = 0.01; OR = 0.76; 95% CI: 0.67, 0.87; p < 0.01). Lower use of limit setting was associated with higher child screen time and lower odds of meeting the screen time guideline in ages ≥5 years (β = 3.8 min; 95% CI: 0.69, 6.48; p < 0.01; OR = 0.86; 95% CI: 0.78, 0.94; p < 0.01).

Conclusions

Lower parental use of routines and limits during the COVID-19 pandemic were associated with higher screen time and lower odds of meeting the screen time guideline among school-age children. Results may help inform strategies to promote healthy screen use in this age group.

Adherence to the Singapore Integrated 24-Hour Activity Guidelines by Infants and Toddlers and Its Association With Well-Being

BACKGROUND

This study estimated the prevalence of Singapore infants and toddlers who met the new Singapore Integrated 24-Hour Activity Guidelines for Early Childhood and examined its association with well-being.

METHODS

A total of 267 parents of children aged between 0 and 2 years completed an online questionnaire that consists of the Singaporean Children Lifestyle Questionnaire and either the Pediatric Quality of Life (PedsQL) Inventory Infant Scale or the Strength and Difficulties Questionnaire. Well-being of infants was measured through parent responses to PedsQL and that of toddlers was measured through Strength and Difficulties Questionnaire. Data were benchmarked against age-specific guidelines for physical activity, screen time, and sleep in the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood.

RESULTS

A higher percentage of infants (37.3%) than toddlers (20.6%) had met 3 guidelines. In contrast, a lower percentage of infants than toddlers met at least one or did not meet any guidelines (3.8% and 0% for infants vs 22.4% and 1.8% for toddlers, respectively). Infants who met more guidelines had significantly higher parent-reported PedsQL total scale score than infants who met fewer guidelines (P < .05). However, the present study found that the number of guidelines met was not associated to infants' PedsQL scale score and toddlers' total difficulty score (P > .05).

CONCLUSION

Adherence to this set of local guidelines should be widely publicized, so parents will have greater awareness and knowledge on cultivating good physical activity, screen time, and sleep habits for their child from a young age.

The influence of screen time on behaviour and emotional problems among adolescents: A comparison study of the pre-, peak, and post-peak periods of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has brought drastic changes globally in the past three years, one of which is an increase in the use of digital media or electronic devices. Previous studies have shown that long screen time may stimulate the neurobiological system, resulting in various behavioural and emotional problems; however, there is insufficient population-based evidence. This study aimed to investigate the influence of screen time on behavioural and emotional problems in Indonesian adolescents at three time points: the pre-, peak, and post-peak periods of COVID-19. Data were collected using an online community mental health survey. This survey incorporated the Youth Screen Time Survey to gauge screen time and the adolescent version of the Strengths and Difficulties Questionnaire to assess emotional, conduct, and prosocial behaviour problems. The participants were adolescents in secondary and senior high schools, with 337, 423, and 1,096 participants from the pre-, peak-, and post-pandemic periods, respectively, included in the analysis. Daily average screen time was compared, followed by the calculation of odds ratios for screen time and mental health problems during the different periods. The results demonstrated significant differences in adolescents' total daily average screen time between the different pandemic periods. Decreased screen time was associated with reduced emotional, conduct, and prosocial behaviour problems, especially during the peak period. Thus, psychoeducation on screen time in adolescents should be considered as a point of interest for mental well-being interventions.

Sociodemographic factors, parental mental health and movement behaviours in the early years: the SUNRISE Finland study protocol

BACKGROUND

The World Health Organization (WHO) has identified the prevention of obesity in young children as one of its key priorities for the 21st century, and 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) play a key role in this priority. The SUNRISE Finland Study is part of the international SUNRISE Study, which examines the movement behaviours of young children in 64 low-, middle- and high-income countries. The SUNRISE Finland Study will investigate what proportion of 3- to 4-year-old children living in Finland meet the WHO global guidelines on 24-hour movement behaviours, and how that proportion and children's motor and cognitive skills compare with children from other countries involved in the SUNRISE Study. We also aim to identify potential correlates of children's movement behaviours, focusing on socioeconomic factors, residential environmental features, and parents' mental health. In addition, this study will examine the associations between children's movement behaviours, motor and cognitive skills, adiposity, and psychosocial wellbeing. Finally, we aim to establish a cohort of families who participate in the study and conduct follow-ups in the future.

METHODS

We will recruit 1,000 children aged 3.0 to 4.9 years and their caregivers through early childhood education and care centres in Finland (50% in urban and 50% in rural areas). We will assess children's 24-h movement behaviours using two accelerometers and a parental report. Children will perform validated tests to measure gross and fine motor skills and executive functions, and their height, weight and waist circumference will be measured. Caregivers will complete questionnaires regarding sociodemographic factors, nature visits, their own movement behaviours, symptoms of depression, anxiety, stress, insomnia, nomophobia, social media self-control failure, and happiness, and child's psychosocial wellbeing. Geographic Information System (GIS) will be used to examine residential environmental features.

DISCUSSION

In addition to facilitating international comparisons on movement behaviours and motor and cognitive skills, the SUNRISE Finland Study will provide novel evidence on factors associated with movement behaviours in young children. The results of this study will help in planning actions to promote healthy levels of movement behaviours at an early age and equal opportunities for healthy development.

CLINICAL TRIAL NUMBER

This is not a trial study.

Development and evaluation study of FLY-Kids: a new lifestyle screening tool for young children

Evaluating, discussing, and advising on young children's lifestyles may contribute to timely modification of unhealthy behaviour and prevention of adverse health consequences. We aimed to develop and evaluate a new lifestyle screening tool for children aged 1-3 years. The lifestyle screening tool "FLY-Kids" was developed using data from lifestyle behaviour patterns of Dutch toddlers, age-specific lifestyle recommendations, target group analyses, and a Delphi process. Through 10 items, FLY-Kids generates a dashboard with an overview of the child's lifestyle that can be used as conversation aid. FLY-Kids was completed by parents of children aged 1-3 years attending a regular youth healthcare appointment. Youth healthcare professionals (YHCP) then used the FLY-Kids dashboard to discuss lifestyle with the parents and provided tailored advice. Parents as well as YHCP evaluated the tool after use. Descriptive and correlation statistics were used to determine the usability, feasibility, and preliminary effect of FLY-Kids. Parents (N = 201) scored an average of 3.2 (out of 9, SD 1.6) unfavourable lifestyle behaviours in their children, while 3.0% complied with all recommendations. Most unfavourable behaviours were reported in unhealthy food intake and electronic screen time behaviour. Parents and YHCP regarded FLY-Kids as usable and feasible. The number of items identified by FLY-Kids as requiring attention was associated with the number of items discussed during the appointment (r = 0.47, p < 0.001).     Conclusion: FLY-Kids can be used to identify unhealthy lifestyle behaviour in young children and guide the conversation about lifestyle in preventive healthcare settings. End-users rated FLY-Kids as helpful and user-friendly. What is Known: • A healthy lifestyle is important for optimal growth, development and overall health of young children (1-3 years). • Evaluating, discussing and advising on young children's lifestyles may contribute to timely modification of unhealthy behaviour and prevention of adverse health consequences. What is New: • The new lifestyle screening tool FLY-Kids generates a dashboard with an overview of young children's lifestyle that can be used as conversation aid between parents and youth healthcare professionals. • As parents and youth healthcare professionals rated FLY-Kids as helpful and user-friendly, and the number of items identified by FLY-Kids as requiring attention was associated with the number of items discussed during the appointment, FLY-Kids can be considered guiding the lifestyle discussion in preventive healthcare settings.

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.

Effects of Excessive Screen Time on Child Development: An Updated Review and Strategies for Management

Children's heavy reliance on screen media has raised serious public health issues since it might harm their cognitive, linguistic, and social-emotional growth. This study examines the effects of screen time on many developmental domains and covers management and limitation techniques for kids' screen usage. Screen media has a wide range of cognitive consequences, with both beneficial and detrimental effects noted. Screens can improve education and learning; however, too much time spent in front of a screen and multitasking with other media has been related to worse executive functioning and academic performance. As screen time reduces the amount and quality of interactions between children and their caregivers, it can also have an impact on language development. Contextual elements like co-viewing and topic appropriateness are key in determining how language development is impacted. Additionally, excessive screen usage has detrimental effects on social and emotional growth, including a rise in the likelihood of obesity, sleep disorders, and mental health conditions including depression and anxiety. It can obstruct the ability to interpret emotions, fuel aggressive conduct, and harm one's psychological health in general. Setting boundaries, utilizing parental controls, and demonstrating good screen behavior are all techniques that parents may use to manage children's screen usage. We can reduce the possible negative impacts of excessive screen time and promote children's healthy development and well-being by increasing knowledge and encouraging alternative activities that stimulate development.

Correlates of screen time in the early years (0-5 years): A systematic review

The majority of young children engage in high levels of screen time. To inform future interventions, knowledge on correlates of screen time is important. This review expands on previous work by focusing on the entire early childhood range, and including a broad focus regarding types of correlates and screens. A literature search (PubMed, Embase, PsycINFO, SPORTDiscus) was performed from 2000 up to October 2021. Included studies (cross-sectional and prospective) examined associations between a potential correlate and screen time (duration or frequency) in typically developing, apparently healthy children aged 0-5 years. Methodological quality was assessed by two independent researchers. Fifty-two of 6,614 studies were included. Two studies had high methodological quality. We found moderate evidence for a positive association between an electronic device in the bedroom, parental screen time, having a TV on at home, descriptive norms and screen time, and a negative association between sleep duration, household features, high value on physical activity, monitoring screen time, being in childcare, parental self-efficacy and screen time. We found no evidence for an association for child sex, body mass index, physical activity, temperament, number of siblings, being a first-born, neighborhood-related factors, socio-economic indicators, and parental marital status, physical activity, weight status, depression, wellbeing, sex, age and positive outcome expectations. The evidence for other investigated correlates was inconsistent or insufficient. Despite the evidence for moderate associations, we were unable to draw strong conclusions. More high-quality research is needed to identify correlates of screen time in early childhood.

Survey of the Adequacy of Brazilian Children and Adolescents to the 24-Hour Movement Guidelines before and during the COVID-19 Pandemic

The 24-Hour Movement Guidelines provide specific recommendations on movement behaviors for children and adolescents. The objective of this study was to verify the adequacy of children and adolescents to the guidelines for moderate to vigorous physical activity, recreational screen time, and sleep duration, and the overall adequacy to the guidelines, before and during the COVID-19 pandemic. A cross-sectional study was conducted with parents or guardians of children or adolescents from different regions of Brazil using a digital interview form including sociodemographic characteristics of families, moderate to vigorous physical activity, recreational screen time, and sleep duration before and during the pandemic. Statistically significant variation was observed in both groups in relation to moderate to vigorous physical activity and recreational screen time between the two periods evaluated. Overall adequacy to the guidelines before the pandemic was 19.28% for children from Group 1 (0-5 years old) and 39.50% for those from Group 2 (6 to 17 years old). During the pandemic, it corresponded to 3.58% in Group 1 and 4.94% in Group 2 (p-value between periods ≤0.001). This study showed the significant impact of pandemic restrictions on reducing overall compliance and physical activity, and increasing screen time among Brazilian children and adolescents.

The Relative Contributions of Center Demographic, Director, Parental, Social, Environmental, and Policy Factors to Changes in Outdoor Play in Childcare Centers During the COVID-19 Pandemic

BACKGROUND

The primary objective of this study was to investigate the relative contributions of factors from multiple social-ecological levels in explaining outdoor play changes in childcare centers during the COVID-19 pandemic.

METHODS

In Alberta, Canada, licensed childcare center directors (n = 160) completed an online questionnaire. For outcomes, changes in the frequency and duration of outdoor play in childcare centers during COVID-19 compared to before COVID-19 were measured. For exposures, center demographic, director, parental, social, environmental, and policy-level factors were measured. Hierarchical regression analyses were conducted separately for winter (December-March) and nonwinter months (April-November).

RESULTS

In most instances, factors at each social-ecological level explained a statistically significant amount of unique variance in changes in outdoor play in childcare centers during COVID-19. Full models accounted for more than 26% of the variance in the outcomes. Changes in parental interest in outdoor play was the most consistent correlate of changes in the frequency and duration of outdoor play in both winter and nonwinter months during COVID-19. In terms of changes in the duration of outdoor play, social support from the provincial government, health authority, and licensing, and changes in the number of play areas in licensed outdoor play spaces were also consistent correlates in both winter and nonwinter months during COVID-19.

CONCLUSIONS

Factors from multiple social-ecological levels uniquely contributed to changes in outdoor play in childcare centers during the COVID-19 pandemic. Findings can help inform interventions and public health initiatives related to outdoor play in childcare centers during and after the ongoing pandemic.

Associations of activity, sedentary, and sleep behaviors with cognitive and social-emotional health in early childhood

Background

Early childhood is important for cognitive and social-emotional development, and a time in which to promote healthy movement behaviors (sedentary behavior, physical activity, and sleep). Movement behaviors may have interactive influences on cognition and social-emotional factors in young children, but most previous research has explored them independently. The purpose of this study was to determine if movement behaviors are associated with measures of cognitive and social-emotional health in young children and if so, to describe optimal compositions of movement behaviors of a daily cycle for such outcomes.

Methods

Children (n = 388, 33 to 70 months, 44.6% female) from a clinical trial (ClinicalTrials.gov ID: NCT03285880, first posted September 18, 2017) wore accelerometers on their wrists for 24-h for 9.56 ± 3.3 days. Movement behavior compositions consisted of time spent in sedentary behaviors, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sleep. Outcomes were cognitive (receptive vocabulary, declarative and procedural memory, and executive attention) and social-emotional measures (temperament and behavioral problems). Compositional linear regression models with isometric log ratios were used to investigate the relations between the movement behavior composition and the cognitive and social-emotional health measures. If a significant association was found between the composition and an outcome, we further explored the "optimal" 24-h time-use for said outcome.

Results

Movement behavior compositions were associated with receptive vocabulary. The composition associated with the predicted top five percent of vocabulary scores consisted of 12.1 h of sleep, 4.7 h of sedentary time, 5.6 h of light physical activity, and 1.7 h of MVPA.

Conclusions

While behavior compositions are related to vocabulary ability in early childhood, our findings align with the inconclusiveness of the current evidence regarding other developmental outcomes. Future research exploring activities within these four movement behaviors, that are meaningful to cognitive and social-emotional development, may be warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-023-00016-6.