Editor’s Perspective

WHO Guidelines for Children Under Age 5

Jan. 2, 2020

By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor, Review of Myopia Management

Last year the World Health Organization issued “Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children Under 5 Years of Age.” You may have missed these new recommendations because they did not receive the widespread media attention they deserved.

Children under five must spend less time sitting watching screens, or restrained in strollers and seats, get better quality sleep, and have more time for active play if they are to grow up healthy, according to the WHO guidelines.1 Applying the recommendations in the WHO guidelines during the first five years of life will contribute to children’s motor and cognitive development, lifelong health, and may reduce the incidence of myopia in children.

WHO Recommendations at a Glance

Infants (less than 1 year) should:

  • Be physically active several times a day in a variety of ways, particularly through interactive floor-based play; more is better. For those not yet mobile, this includes at least 30 minutes in a prone position (tummy time) spread throughout the day while awake.
  • Not be restrained for more than 1 hour at a time (e.g., prams/strollers, highchairs, or strapped on a caregiver’s back). Screen time is not recommended. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 14–17h (0–3 months of age) or 12–16h (4–11 months of age) of good quality sleep, including naps.

Children 1-2 years of age should:

  • Spend at least 180 minutes in a variety of types of physical activities at any intensity, including moderate-to-vigorous-intensity physical activity, spread throughout the day; more is better.
  • Not be restrained for more than 1 hour at a time (e.g., prams/strollers, highchairs, or strapped on a caregiver’s back) or sit for extended periods. For 1-year-olds, sedentary screen time (such as watching TV or videos, playing computer games) is not recommended. For those aged 2 years, sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 11-14 hours of good quality sleep, including naps, with regular sleep and wake-up times.

Children 3-4 years of age should:

  • Spend at least 180 minutes in a variety of types of physical activities at any intensity, of which at least 60 minutes is moderate- to vigorous-intensity physical activity spread throughout the day; more is better.
  • Not be restrained for more than 1 hour at a time (e.g., prams/strollers) or sit for extended periods. Sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.
  • Have 10–13h of good quality sleep, which may include a nap, with regular sleep and wake-up times.

Eye care professionals should advise parents and caregivers of children to:

  • Apply the WHO guidelines for children under 5 years of age.
  • Ensure that children over the age of five spend more time outdoors and less time on digital devices. Recommend outdoor sport and play of at least 2 hours per day in total, spread between outdoor school activity and after school.
  • Take breaks every 20 minutes by looking across the room for 20 seconds when using a computer or reading (20-20-20 rule).
  • Children should not spend more than three hours a day – in addition to school time – on close work such as reading, homework, or screen-time.
  • Monitor eyesight and eye health in children with yearly complete eye exams.

I encourage you to refer all parents of children under five years of age to the WHO website to read these important guidelines.

Best professional regards,

Dwight H. Akerman, OD, MBA, FAAO
Chief Medical Editor
dwight.akerman@gmail.com

 

Reference

1World Health Organization. (2019). Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age.

ISBN 978-92-4-155053-6

 

 

 

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