Guidance recommends no screen time for under-twos

The first ever World Health Organisation (WHO) physical activity guidelines for under-fives, recommend no screen time for one-year-olds and no more than an hour for two- to-four-year-olds.

They also advise that under-fives spend no more than an hour at a time restrained in a pram, high chair or strapped on a care giver's back.

Published today, the guidelines set out recommendations for physical activity, sedentary time – including screen time and sleep for under one-year-olds, one- to-two-year-olds and three- to-four-year-olds.

They have been developed in response to a request by the Commission on Ending Childhood Obesity.

The recommendations on physical activitity echo that of the UK Physical Activity Guidelines from the Chief Medical Office, which are expected to be updated in September.

Additional resources and tools will be developed to support early childhood educators, carers and parents to help children achieve the recommendations.

Under the age of one

The guidelines say that babies under one should be physically active several times a day in a variety of ways, particularly through interactive floor-based play. For those not mobile, this includes at least 30 minutes of tummy time spread throughout the day, while awake.

The WHO does not recommend screen time for this age.

For sleep, the guidance says that children from birth- to three months should get 14-17 hours of good quality sleep, including naps, and for children aged four- to-11 months, 12-16 hours.

 One- to-two-year-olds

The WHO says that at this age, children should spend at least 180 minutes in a variety of types of physical activities at any intensity including moderate to vigorous, spread throughout the day, but that more is better.

It does not recommend sedentary screen time for one-year-olds. For two-year-olds, sedentary screen time should be no more than one hour.

One- to-two-year-olds should have 11-14 hours of good quality sleep, including naps.

Three- to-four-year-olds

The guidelines recommend at least 180 minutes in a variety of types of physical activity at any intensity, of which at least 60 minutes is moderate to vigorous intensity.

Sedentary screen time should be no more than one hour, says the WHO.

Children should have 10-13 hours of good quality sleep.

Sector response

Physical development expert Dr Lala Manners, told Nursery World, ‘These guidelines are the most comprehensive, accessible and manageable of all the versions published so far.

'A really useful document  - that gives us time and impetus to determine how the UK version will be updated in September.’

The Royal College of Paediatrics and Child Health (RCPCH) called the guidelines ‘useful benchmarks’, but warned they required ‘cautious interpretation’.

Dr Max Davie, officer for health improvement, said, ‘We welcome the WHO's focus on these important health issues and hope that this attention can lead to more research and interventions to help children and families live healthy lives.

‘However, recommendations alone can have a number of unintended consequences, and simply proposing standards without providing the right support could discourage families rather than motivate.

'While it is important for children to be as active as possible, the barriers are more frequently to do with housing, work patterns, family stress, and lack of access to play spaces rather than actively choosing to be sedentary.

‘Likewise, the restricted screen time limits suggested by the WHO do not seem proportionate to the potential harm. Our research has shown that currently there is not strong enough evidence to support the setting of screen time limits, and that screen use should be considered alongside a range of activities to assess its impact. Also, it is difficult to see how a household with mixed-age children can shield a baby from any screen exposure at all, as is recommended. 

‘Similarly, comparing an individual child’s sleep to the quantities recommended by the WHO should be done with caution. All children have unique needs – some sleep relatively little with no ill effects while others need much more. Individual assessment is paramount.

‘Overall, these WHO guidelines serve as useful benchmarks to help steer families towards active and healthy lifestyles, but without the right support in place, striving for the perfect could become the enemy of the good.’

  • The guidelines are available here

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