This is the first study to report on the prevalence, and parental perceptions, of movement behaviours in a sample of UK infants and toddlers (0–18 months). With relatively little known about these behaviours worldwide, we note that screen time and high levels of restraint already appear to be prevalent in very young children. This suggests UK children would benefit from efforts to promote positive movement behaviours, ensuring optimal habits are formed and remain into the later preschool period.
As noted above, the number of UK infants and toddlers in this sample meeting the screen time guidelines is low, with less than half of children meeting screen, and combined sedentary behaviour, guidelines. Aligned with this, parents appeared not to be concerned about their child’s screen time, suggesting it was not a priority to limit this behaviour. The results reported in this study are slightly lower compared to those of a recent study conducted in Canada. Carson et al. reported screen time ranged from 18 min/day in those 2 months of age up to 35 min/day in those aged 6 months . Previous review evidence also suggests that adherence to the screen time guideline in those under 24 months ranges from 2.3 to 83.0% [10, 16]. However, it is worth noting that the majority of the studies included in these reviews reported adherence to the screen time guidelines to be between 10 and 30%, with only 2 studies reporting adherence greater than 50%. It could be that parents use screen time as a parenting strategy, allowing them to manage their time whilst keeping children occupied. They may therefore not perceive screens to be harmful, seeing it only as a beneficial way to keep their child (ren) occupied while they complete other jobs or have necessary downtime (particularly during the pandemic). It is also possible that, given the data collection period, screens were used as a means to remain connected to family and friends during ‘lockdowns’. The nuanced reasons as to why parents allow screen time in very young children needs to be understood before interventions can be put in place.
Conversely, parents reported that a large proportion of their children were meeting sleep guidelines, which was also one of parents’ key priorities. Levels reported here were comparable to those in a Canadian cohort , but higher than those in Australian children . It is perhaps unsurprising that parents prioritise this behaviour, given sleep (or lack thereof) often has wide-ranging influences on physical and mental health of young families, particularly during the first years of life . Parents also felt that sufficient physical activity was important, but interestingly, for children in the relevant age groups few met tummy time guidelines. In line with development, tummy time increased here up to the age of 7.9 months, then declined. However, only 31% of children under 12 months meet the recommendation of 30 minutes per day in this study (0–3.9 months: 22.2%; 4–7.9 months: 33.3%; 8–11.9: 35.5%). The results of our study contradict previous studies showing higher tummy time adherence at 4 month olds. A recent Canadian study showed children aged 2 and 6 months engaged in approximately 48 and 116 min/day of tummy time respectively, substantially more than the 31 min/day reported in this study .
These are large differences, and may relate to differences in parental knowledge and the promotion of specific behaviours in relevant countries. For example, in Canada the guidelines for the early years were released in collaboration with ParticipACTION. ParticipACTION is a social marketing and communications organization focussed on promoting physical activity in Canada and especially successful in reaching parents . It may therefore be that Canadian parents may be much more aware of the 24-hour movement behaviour guidelines compared to parents in the UK, where guideline release was not accompanied by a big marketing campaign. Whilst the inclusion of tummy time recommendations in the UK activity guidelines is a step forward, parents may not yet be aware of this and how to best go about providing tummy time safely.
Strengths and limitations
This study was conducted in children of a range of ages, across devolved nations in the UK (i.e. England, Scotland, Wales). Using published questionnaires, previously employed in infant and toddler studies [13,14,15, 19], it builds on the limited evidence base for children under 2, offering important insight into movement behaviours in UK infants and toddlers. It also provides novel information about parental priorities during the early years of life, which appears to mirror how these behaviours manifest in their children. Whilst there is some evidence that tummy time is beneficial to children’s gross motor and total development, and ability to move in the first year of life, more evidence is required to show longer-term benefits of this behaviour relating to social and cognitive development . It should also be born in mind that data collection for this study occurred during the COVID19 pandemic. It is possible that levels of screen time were therefore higher than they might have been normal, as digital technology was often the only means of seeing family members during this period, particularly in those over 12 months of age (those with children under 12 months old were partially exempt from social distancing restrictions). The use of non-validated questionnaires to measure sedentary behaviour and physical activity here, as none currently exist to measure these behaviours in this age group, is a limitation. However, as shown previously in older age groups, proxy-report measures can be of use to capture the proportion of children meeting movement guidelines, particularly for large-scale national surveillance, where device-based measures may be less practical. Though proxy-report measures can afford vital contextual information about movement behaviours in small children, they may be subject to recall or social-desirability biases. In contrast, device-based measures are beneficial to capture intensity and duration information about children’s behaviours, but given the challenges of assessing movement behaviours in young children, more work is needed to validate objective measures in this age group. Collaborative efforts should be encouraged to ensure consensus around these methods to prevent divergence of methods in elements such as cut points that has occurred in the older preschool measurement field.