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GLASGOW, Scotland – Children under 5 must be physically active and sleep well, spend as little time as possible in a pram or a bench and sit in front of a screen to grow up healthy, for example. guidelines from the World Health Organization (WHO).
The new guidelines, published on April 24, will also be presented this weekend at the European Conference on Obesity (ECO) 2019. The opinion has however been criticized by experts who question the quality of evidence used for recommendations, as well as the feasibility and benefits of limiting projection time.
The WHO convened a group of experts to review available literature on the consequences of insufficient sleep, screen time and sedentary behaviors on children, as well as the benefits of Increased activity.
They then developed a series of separate recommendations for infants, children aged 1 to 2 years, and children aged 3 to 4 years, who focus on physical activity and good quality sleep. .
In addition, they emphasize that it is important that children do not spend more than one hour per day in a pram or stroller, and recommend that they spend as little time as possible in front of a screen.
The director general of the WHO, Tedros Adhanom Ghebreyesus, said in a press release that "to ensure health for all means to do what is best for health from the beginning of people's lives ".
Fiona Bull, PhD, responsible for the program for surveillance and prevention of noncommunicable diseases among the population at WHO, added that the intensification of activities, the reduction of sedentary periods and the guarantee of Good quality sleep would improve physical and mental health as well as well-being.
In addition, these changes "will help prevent childhood obesity and related diseases later in life".
Bring back the recreation … even if it is not always practical
And for Juana Willumsen, PhD, Department of Noncommunicable Disease Prevention, WHO, Geneva, Switzerland, the guidelines highlight the need to "bring back play for children".
"It's about going from sedentary to recess while protecting sleep," she urged.
Talk to Medscape Medical NewsSimon Williams, PhD, president of the Association for the Study of Obesity, said that although the evidence for some of the recommendations is weak or non-existent, "I applaud [WHO] to make an effort to use the evidence, we need to make these recommendations. "
He added that the recommendations can be used as objective objectives to evaluate interventions for parents and their children.
Williams added, "One of the benefits of these recommendations is the way they clearly linked physical activity, sedentary screen time, and sleep so that we focus on each of these three behaviors over a period of time. 24 hours and think about how they can integrate with each other ".
He added, "I guess for some parents it may be more effective to focus on reducing sedentary time than asking them to increase physical activity, and I guess we'll see well. that if children reduce their sedentary time, especially the sedentary screen, then it could well be replaced by physical activity ".
However, Max Davie, MD, head of health improvement at the Royal College of Pediatrics and Child Health of the United Kingdom, warned in a statement that even though he welcomed the guidelines these could have "unintended consequences".
"If it is important for children to be as active as possible, the barriers are more often related to housing, work habits, family stress and lack of access to play spaces than to children." the active choice of being sedentary, "he said.
"Similarly, the limited screen time limitations suggested by the WHO do not seem proportionate to the potential damage."
Davie said: "Our research has shown that there is currently no evidence strong enough to warrant setting time limits for the screen and that the use of the screen should be considered. alongside a range of activities to badess its impact. "
He also questions whether households with children of different ages can successfully protect a baby from exposure to screening, as recommended.
Latest proofs included: No time on screen for babies
The development of guidelines began in 2017, when technical experts and stakeholders from six regions of the WHO met to determine the critical issues and results to be evaluated.
Previous systematic literature reviews have been updated and the search criteria expanded to include data published in 2017-18, and the evidence was reviewed in April 2018.
In addition, the guideline development group considered the risks and benefits of implementing the recommendations, as well as their feasibility, acceptability and resource implications.
The guidelines state that infants under the age of 1 must be physically active several times a day in different ways, including for 30 minutes while lying on their stomachs or at all times on the stomach, throughout the day, when Child is awake.
Babies should not be strapped for more than one hour at a time in a pram, stroller or high chair. Projection time is not recommended in this age group.
Infants should also have 14 to 17 hours of good quality sleep per day, including naps at 0 to 3 months and 12 to 16 hours at 4 to 11 months.
Children 1 to 2 years old must be active for at least 180 minutes throughout the day, which includes moderate to vigorous physical activity.
Again, they should not be immobilized for more than an hour at a time or sit for long periods of time.
Children aged 1 to 2 should not spend more than one hour per day in front of a screen and would benefit from 11 to 14 hours of good quality sleep a day, including napping, as directed, with regular hours of sleep and waking.
Children aged 3 to 4 should do 180 minutes of physical activity daily, including at least 60 minutes of moderate to vigorous physical activity.
Again, they should not be held for more than an hour or sit for long periods of time, and they should not stay more than an hour in front of a screen.
The recommended sleep time for children aged 3 to 4 is 10 to 13 hours a day, possibly with a nap, with regular sleep and waking hours.
The authors emphasize that the recommendations apply to all healthy children under the age of five, regardless of gender, cultural background or socio-economic status of the family.
Sedentary activities nonscreen Important: read and make puzzles
The guidelines also emphasize that children must adhere to all recommendations for physical activity, sedentary behavior and sleep 24 hours a day.
In addition, the quality of sedentary living with a caregiver who participates in non-screen activities such as reading, narration, singing and puzzles is emphasized as being important for child development and recommended for all. ages.
Andrew Przybylski, PhD, badociate professor and director of research at the Oxford Internet Institute of the University of Oxford, UK, said in a press release that the recommendations contained in the guidelines "are based on very low quality correlational evidence".
He adds, "The authors are overly optimistic when they conclude that screen time and physical activity can be exchanged on an individual basis.
"This suggestion, as well as many others in the report, rely on extremely weak correlations and the lack of evidence from intervention studies."
For Przybylski, the recommendations put too much emphasis on the amount of screen time, which does not take into account "the content and the context of use" because "all the time". screen is not created equal ".
"Context is essential because the time spent in front of the screen can have positive effects on the family system as a whole, for example by freeing parents from necessary household chores and offering young people benefits such as relaxation, games and more. low energy or communication with family. "
In the same vein, Jenny Radesky, MD, badistant professor of pediatrics at the University of Michigan, Ann Arbor, was quoted in the Washington Post saying that screen time recommendations for kids can induce a "real conflict".
"The more we give directions, it seems that there will be more discordance between what the experts say … and what it feels like to be a parent in the real world every day. days, "she commented.
Jean M. Twenge, PhD, professor of psychology at the State University of San Diego, California, stressed that "the top priority for very young children must be face-to-face interaction , exercise and sleep.
"I think the temptation to give a phone or tablet to young children whenever they feel like it is misguided," said Twenge.
"Children need to learn to self-soothe and manage their emotions, and if they receive these devices frequently, they do not learn these things."
No funding or conflict of interest has been declared.
WHO guidelines.
ECO 2019. Presented 28 April 2019. Summary IS2.02.
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