Development of WHO Guidelines on Physical Activity, Sedentary Behavior, and Sleep for Children Less Than 5 Years of Age
Open accessAbstract
Background: Physical inactivity is a leading risk factor for global mortality and a contributor to the increase in overweight and obesity. The Commission on Ending Childhood Obesity identified the need for guidance on physical activity, particularly for early childhood (<5 y), a period of rapid physical and cognitive development. Methods: The World Health Organization (WHO) has developed the first global guidelines on physical activity, sedentary, and sleep behaviors, building upon high-quality systematic reviews. The WHO guideline process is a rigorous, systematic, and transparent method for the development of recommendations, using the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework. It takes into consideration the strength of the evidence as well as values and preferences, benefits and harms, equity and human rights. Results: The authors summarize the first global guidelines on time spent in physical activity, sedentary behavior (including screen time and time spent restrained), and sleep patterns in infants (birth to 1 y of age), toddlers (1–2.9 y of age), and preschoolers (3–4.9 y of age). Conclusions: WHO is actively disseminating and supporting implementation of these guidelines by national adoption and adaptation, through links with early childhood development and the Global Action Plan on Physical Activity 2018–2030.
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The WHO definition of sedentary screen time does not include active screen-based games like exergaming.
“The WHO, therefore, does not include screen activities like exergaming”
From The Conceptual and Methodological Mayhem of “Screen Time” (2020) · cites this paper as [14]
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“[1] These guidelines align with the World Health Organisation (WHO),[2] Canada, and Australia, who all have 24-hour integrated guidelines for young children; and they align with the United Kingdom guidelines on physical activity in the early years.”
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“Recognizing these interrelated and distinct properties, multi-behavior guidance for children’s physical activity, recreational (children and adolescents) or sedentary (young children) screen-time, and sleep, and subsequent guidelines were created from a Canadian group in 2016 [8–10].”
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“In recognition of the short- and long-term benefits of physical activity in young children, the World Health Organisation (WHO) has issued physical activity and movement guidelines for children from birth to 5 years [2].”
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“WHO recommendations before the COVID-19 pandemic have become a priority in educating the public about the health consequences of sedentary lifestyles [5,6].”
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“Moreover, getting young people physically active during their trip between home and school is currently one of the main priorities of global policies, such as the Global Action Plan on Physical Activity 2018–2030, promoted by the World Health Organization [12], and the 2030 Agenda for Sustainable Development, promoted…”
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“Recent studies have shown that a considerable number of preschoolers worldwide are not compliant with screen time [18], and are excessively exposed to screens since the first year of life [19–21].”
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“The WHO guidelines on sedentary behaviour for children less than 5 years of age [317] recommend limiting the amount of time spent restrained (such as in prams/strollers, high chairs, or strapped on a caregiver’s back) or sitting for extended periods.”
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“These movement behavior guidelines align with those released by the WHO [2], screen time”
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“Time spent watching screens (screen time or screen media use) (Bull et al., 2020), which typically falls under sedentary behaviour category, was also considered an outcome because of its stronger relationship with sleep compared with non-screen-based sedentary behaviour (Hale et al., 2018; Saunders…”
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“8% were at risk of delay [14], and young children are struggling to achieve the recommended level of daily physical activity (PA) [15].”
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“Their contents are consistent with those of other guidelines [1, 2, 9, 18].”
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“[1] The World Health Organization’s (WHO) Ending Childhood Obesity (ECHO) Report highlighted the need to address 24hour movement behaviours in early childhood for the prevention and management of obesity and noncommunicable diseases (NCDs).”
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“, no more than 60 min of screen time, not be restrained—such as sitting in a stroller or being held—more than 1 h at a time, and avoid sitting for extended periods), and obtain 10 to 13 h of sleep in a 24-h period [5].”
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“4% of the toddlers did not comply with the latest WHO guideline on screen time (3).”
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“The composite movement behavior score will comprise scores for the following six dimensions representing broad variables that have been examined in relation to the 24h movement guidelines (28, 29) and in previous studies on sleep among young children (30):”
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“7,12 The COVID-19 pandemic necessitated stringent measures, including person-to-person transmission mitigation, isolation protocols, and rigorous quarantine procedures, to effectively curb its spread.”
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“For example, the World Health Organization (WHO) has recently published guidelines with sleep, sedentary behavior, and physical activity recommendations for children under 5 years of age [6].”
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“4,10,20 These interventions aim to foster a conducive environment for reducing screen-time and promoting alternative, healthful activities among preschool-aged children.”
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“Several studies have shown that significant proportions of children do not meet the recommended PA levels of 180 min of light, moderate, and/or vigorous intensity PA (LMVPA) per day [13, 14].”
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“The guidelines were developed to respond to the childhood obesity epidemic and to initiate surveillance and monitoring of children’s movement behaviors over time (8).”
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“The World Health Organization (WHO) suggests that children under the age of two should not be exposed to screens in any capacity and that children aged two to four years should limit their sedentary screen time to less than one hour per day [12].”
BackgroundResultYao, D., Wang, S., Li, F., Gao, M.-J., & Shao, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.923757 · Cited by 10 · see citing works
“The guidelines issued by the WHO in 2019 define sleep duration <10 h a day is insufficient sleep duration for preschoolers (40).”
BackgroundDenche-Zamorano, Á. M., Franco-García, J. M., Pastor-Cisneros, R., Salas-Gómez, D., Collado‐Mateo, D., Olivares, P. R., & Adsuar, J. C. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12101591 · Cited by 10 · see citing works
“In addition, the way of quantifying the level of physical activity using indirect instruments could also be a limitation as several studies have reported that the IPAQ–SF overestimates PA level [41]; however, it has shown a good correlation with measurements in some populations [42].”
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“A physically active lifestyle should begin at an early age and continue throughout the life cycle [1,2], with a synergistic relationship between physical activity and motor competence [3].”
BackgroundPredictors for Screen Time Exposure among Children between 3 and 5 Years Old in Southern Brazil
Frata, B., de Souza, J. M., Montemezzo, D., Henning, E., Menegol, N. A., Okubo, R., Sonza, A., & Sanada, L. S. (2021) · Journal of Tropical Pediatrics · doi:10.1093/tropej/fmab092 · Cited by 8 · see citing works
Investigating young children’s physical activity through time and place
Remmers, T., Koolwijk, P., Fassaert, I., Nolles, J., de Groot, W., Vos, S. B., de Vries, S. I., Mombarg, R., & van Kann, D. (2024) · International Journal of Health Geographics · doi:10.1186/s12942-024-00373-8 · Cited by 8 · see citing works
“In 2020, the WHO formulated specific international guidelines for early childhood [18].”
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Draper, C. E., Silubonde, T. M., Mukoma, G., & van Sluijs, E. M. F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18063071 · Cited by 8 · see citing works
“This work can inform the dissemination of early years movement guidelines in other countries, including the WHO’s global guidelines [5].”
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“The importance of these early childhood lifestyle habits is highlighted by the World Health Organization’s guidelines for children’s health, which also discuss the importance of forming lifestyle habits in children before the age of 5 years [ 16].”
BackgroundAssociations between sedentary types, sedentary patterns and cognitive ability in preschool children
Li, D., Chia, M., Low, S. T., Chua, T. B. K., Ma, J., Kim, H., Zhang, L., Tian, L., & Li, X. (2024) · European Journal of Pediatrics · doi:10.1007/s00431-024-05813-y · Cited by 7 · see citing works
“Quantitative SB recommendations based on evidence are crucial [87, 88], and current guidelines focus on reducing prolonged SB with thresholds for different age groups and contexts [89–91].”
Carson, V., Predy, M., Hunter, S., Storey, K., Farmer, A. P., McIsaac, J. D., & Flynn, J. (2021) · Early Childhood Education Journal · doi:10.1007/s10643-021-01266-2 · Cited by 7 · see citing works
“…Study, Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada 5 APPLE Schools, Edmonton, AB, Canada 1 3 health behaviour guidelines, including the WHO Guidelines on Physical Activity, Sedentary Behavior, and Sleep for Children Less Than 5 Years of Age (Juana & Fiona, 2020).”
BackgroundDraper, C. E., Silubonde, T. M., Mukoma, G., & van Sluijs, E. M. F. (2021) · Journal of Physical Activity and Health · doi:10.1123/jpah.2021-0483 · Cited by 7 · see citing works
“12 The workshop discussion questions formed the basis of an initial thematic framework, and this was further developed to encompass the following main themes for the workshop discussions that are presented in this paper: (1) importance of the early years, (2) positive perceptions of the guidelines, and (3) importance…”
BackgroundPfledderer, C. D., Burkart, S. A., Dugger, R., Parker, H., von Klinggraeff, L., Okely, A. D., Weaver, R. G., & Beets, M. W. (2024) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-023-00041-5 · Cited by 6 · see citing works
von Ash, T., O’Hagan, B., Gupta, A., Deokule, N., Josephson, A., Chmielewski, S., & Chung, A. (2025) · Childhood Obesity · doi:10.1089/chi.2024.0384 · Cited by 5 · see citing works
COVID-19 and children’s screen time in Ceará, Brazil: a repeated cross-sectional survey
Rocha, H. A. L., Correia, L. L., Leite, Á. J. M., Machado, M. M. T., Lindsay, A. C., Rocha, S. G. M. O., Campos, J. S., Silva, A. C. E., & Sudfeld, C. R. (2022) · Journal of Children and Media · doi:10.1080/17482798.2021.2007967 · Cited by 5 · see citing works
“Based on AAP and WHO guidelines, an elevated level of screen exposure was defined as (Media Use in SchoolAged Children and Adolescents, 2016; Willumsen & Bull, 2020): Elevated levels are above one hour/day (for 3–4-year-olds) and above 2 hours (for 5–6-year-olds).”
BackgroundMethodAu, W. W., Leung, C. K., Lin, S. H., Yu, A. P., Fong, D., Wong, S. H., Chan, D. K. C., Capio, C. M., Yu, C. C.-W., Wong, S. W. S., et al. (2025) · Journal of Exercise Science & Fitness · doi:10.1016/j.jesf.2025.03.001 · Cited by 7 · see citing works
“…population, 61,66,67 and highly heterogenous study designs limited the certainty and implication of effect sizes pooled in reviews, 55,56,130 and 2) despite limited compa-rability to our intervention design, a review that conducted a subgroup analysis with interventions incorporating structured…”
Stage, V. C., Dixon, J. B., Grist, P., Wu, Q., Hegde, A. V., Lee, T., Lundquist, R., & Goodell, L. S. (2025) · Nutrients · doi:10.3390/nu17091523 · Cited by 4 · see citing works
Wang, X., Huang, Y., Meng, N., Zhang, J., Wu, Q., & Zhang, Y. (2023) · Journal of Global Health · doi:10.7189/jogh.13.04110 · Cited by 4 · see citing works
Integrating Fundamental Movement Skills and Mathematics in Early Childhood: A Pilot Study
Capio, C. M., Cheung, S. K., Fung, S. S. W., & Hu, X. (2024) · Children · doi:10.3390/children11040457 · Cited by 8 · see citing works
“Despite such associated benefits, insufficient PA continues to be a global health problem contributing to obesity and overall mortality [4].”
BackgroundHewitt, L., Frohmuller, C., Wall, J., & Okely, A. D. (2021) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2022.06.010 · Cited by 4 · see citing works
Akpan, I. J., Warner, T., Cardona, T. L. C., Schlosser, N., & Hennis, B. (2024) · European Early Childhood Education Research Journal · doi:10.1080/1350293x.2024.2305410 · Cited by 4 · see citing works
“The primary purpose is to improve children ’ s overall well-being and enhance development, encompassing social, cognitive, emotional, and physical growth (Dankiw et al. 2020; Pascal and Bertram 2001; Bartlett and Smith 2019; Willumsen and Bull 2020).”
Wilson, N., Cale, L., & Casey, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20105880 · Cited by 4 · see citing works
An Effective and Playful Way of Practicing Online Motor Proficiency in Preschool Children
Adamopoulou, E., Καρατράντου, Κ., Kaloudis, I., Κrommidas, C., & Gerodimos, V. (2024) · Children · doi:10.3390/children11010130 · Cited by 3 · see citing works
Al-walah, M. A., Donnelly, M., Alhusaini, A. A., & Heron, N. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1379582 · Cited by 3 · see citing works
Vanderloo, L. M., Puchiele, A. A., Bruijns, B. A., Carsley, S., & Tucker, P. (2025) · International journal of child care and education policy/International journal of child care and education · doi:10.1186/s40723-025-00158-x · Cited by 3 · see citing works
“…these important documents resulted in a ripple effect, whereby other countries developed their own respective guidelines (New Zealand Ministry of Health, 2017; Okely et al., 2017; Tremblay et al., 2017), including the World Health Organization (WHO) (Trem-blay et al., 2017; Willumsen & Bull, 2020).”
Marent, P.-J., Cardon, G., Dumuid, D., Albouy, G., & van Uffelen, J. G. Z. (2025) · Scientific Reports · doi:10.1038/s41598-025-22541-x · Cited by 3 · see citing works
“This approach has recently gained increasing attention in public health promotion 31 and has already been incorporated into 24-hour movement guidelines for general health 32,33 .”
Zhou, W., Saiz-González, P., Aragon, R. R., Adams, K. T., & Gao, Z. (2023) · Quest · doi:10.1080/00336297.2023.2217361 · Cited by 3 · see citing works
“The World Health Organization (WHO) announced More Active People for a Healthier World to initiate a global action with a target of a 15% relative reduction in physical inactivity among adolescents and adults by 2030 (Bull et al., 2020).”
BackgroundMethodWysocka, R., Sołtys, J., Mikuś-Nowak, M., Klein, E. G., Jaunich, A., & Brzęk, A. (2024) · Annales Academiae Medicae Silesiensis · doi:10.18794/aams/190425 · Cited by 3 · see citing works
Capio, C. M., Jones, R. A., Ng, C. S. M., Sit, C. H. P., & Chung, K. K. H. (2025) · International journal of child care and education policy/International journal of child care and education · doi:10.1186/s40723-025-00149-y · Cited by 2 · see citing works
Huang, Y., Feng, J., Sit, C. H. P., Reilly, J. J., & Khan, A. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70162 · Cited by 2 · see citing works
Arts, J., Altenburg, T. M., Lettink, A., Verhoeff, A. P., Gubbels, J. S., & Chinapaw, M. J. M. (2025) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-025-00085-9 · Cited by 2 · see citing works
“To support the healthy growth and development of young children, the World Health Organization (WHO) has formulated 24-hour movement guidelines tailored to different age subgroups: infants (0–1 year), toddlers (1–3 years), and preschoolers (3–5 years) [14, 15].”
Khosravi, A., Kelishadi, R., Selk-Ghaffari, M., Hassanmirzaei, B., & Kordi, R. (2022) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_705_20 · Cited by 2 · see citing works
“[1] Engaging in physical activity programs during childhood is a golden opportunity to achieved active lifestyle habits.[2] Based on the World Health Organization (WHO) guidelines, children and youth aged 5–17 years should engage in a minimum of 60 minutes of moderate to vigorous intensity daily physical activity.”
BackgroundGhaderi, D. (2024) · Asian Journal of Sports Medicine · doi:10.5812/asjsm-147095 · Cited by 2 · see citing works
Ding, H., Jiang, L., Seo, H., & Chun, B. (2025) · Journal of Sports Sciences · doi:10.1080/02640414.2025.2547160 · Cited by 2 · see citing works
“Previous research has similarly high-lighted the limitations of single-behavior analyses (Julian et al., 2021; Rollo et al., 2020; Willumsen & Bull, 2020).”
Childhood obesity prevention: what can be achieved?
Gomahr, J., Julian, V., Thivel, D., Maruszczak, K., Schneider, A.-M., & Weghuber, D. (2022) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000831 · Cited by 2 · see citing works
“1), taking the formof supervised games promoting reaching, stretching, crawling, running, kicking, throwing and catching [38,39].”
BackgroundStampfer, B., Weiss, E. M., & Canazei, M. (2023) · Lernen und Lernstörungen · doi:10.1024/2235-0977/a000403 · Cited by 2 · see citing works
Granat, M. H., Ahmadi, M. N., Stamatakis, E. A., & Hamer, M. (2024) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14684 · Cited by 1 · see citing works
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“The World Health Organization (WHO) have provided age-specific recommendations on combinations of these movement behaviours in a 24-h day for children under 5 years [4].”
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“Understanding the impact of sleep and other daily behaviours on health outcomes requires analytic methods that reflect the co-dependent nature of time-use (Willumsen and Bull 2020; Pedišić et al. 2017).”
Lifespan approaches for the prevention and management of steatotic liver disease
Zelber‐Sagi, S., Ivancovsky-Wajcman, D., Kugelmas, C., Weinstein, A. A., Wong, V. W., Castéra, L., Moore, J. B., Mouzaki, M., Hallsworth, K., Paik, J. M., et al. (2026) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-026-01198-5 · Cited by 1 · see citing works
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“In support of this 24-h framework, the World Health Organization (WHO) published comprehensive movement guidelines in 2019 for children under five years of age, offering distinct recommendations specifically tailored for infants, toddlers, and preschool-aged children [8].”
Relationship between Physical Activity and Medicine Use in the Spanish Population
Denche-Zamorano, Á. M., García-Gordillo, M. Á., Pastor-Cisneros, R., Contreras-Barraza, N., Carlos‐Vivas, J., Colmenarez-Mendoza, A., & Adsuar, J. C. (2022) · Sustainability · doi:10.3390/su142013615 · Cited by 1 · see citing works
Physical and Motor Development in Early Childhood Education
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It is Feasible for 3 to 5‐Year‐Old Children to Use Smartwatch Activity Trackers: A Systematic Review
Davey, R. J., Zabatiero, J. G., Beynon, A. M., Wood, G., Sy, S., Rasmussen, C. L., Hendry, D., Stearne, S., Harris, C. J., Straker, L. M., et al. (2025) · Acta Paediatrica · doi:10.1111/apa.70137 · Cited by 1 · see citing works
LATIHAN BOOTCAMP MEMBANTU MENINGKATKAN KEBUGARAN KARYAWAN INDOFOOD
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Influence of sedentary behaviour on posture symmetry and type among 4–7-year-old children in Riga
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“lifestyle routines are open to changes and adaptations [8].”
- Authors
- Willumsen, J., & Bull, F.
- Affiliations
- World Health Organization (CH)
- Venue
- Journal of Physical Activity and Health
- Publisher
- Human Kinetics
- Published
- 2020-01-01
- Volume
- 17
- Issue
- 1
- Pages
- 96-100
- ISSN
- 1543-3080 (ISSN-L)
- 1543-5474
- OpenAlex
- W2996781162
- Cited by
- 131
- References
- 8
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 17 · 2023: 17 · 2022: 22 · 2021: 22 · 2020: 17
- FWCI
- 10.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Physical Activity and Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Public Health Agency of Canada
- Public Health Agency
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
- Keywords
- physical activity guidelines, sedentary behavior, sleep duration, children under five, infants, toddlers, preschool children, screen time, childhood obesity, GRADE framework, early childhood development
- MeSH terms
- Child, Preschool, Female, Humans, Male, Risk Factors, Sleep, World Health Organization, Exercise, Sedentary Behavior
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