New guidelines to help young children get enough sleep and reduce screen time

Avoid screen time during meals and using food as a reward or to soothe. This recommendation for toddlers is among a new set of guidelines, after studies found that young children in Singapore are not getting enough sleep and have too much screen time.

The guidelines, by a workgroup led by the KK Women's and Children's Hospital (KKH), are aimed at supporting parents to instil better daily habits from birth to improve their children's health and well-being in the long term. The workgroup included doctors, allied health professionals, academics, educators and researchers.

Singapore's first set of integrated 24-hour activity guidelines for children under the age of seven offers advice in four main areas - physical activity; sedentary behaviour; sleep; and diet and eating habits.

The report, released in January, noted that early childhood is a critical period for growth and adopting healthy lifestyle behaviours can impact habits later in life.

Dr Benny Loo, chairman of the workgroup, said it had made reference to several local studies in coming up with the guidelines.

A survey of 340 parents with children younger than seven done by KKH in September and October last year reinforced the need for such guidelines.

It had had shown a general lack of awareness of existing health guidelines and positive parenting practices, said Dr Loo, a consultant at KKH's general paediatrics service and sport and exercise medicine service.

"Time allocated for physical activity, sleep and recreational screen viewing time practices were sub-optimal in Singapore's young children, with more than half the parents either underestimating or overestimating the actual duration required for adequate physical activity and recreational screen viewing time," he said.

The set of guidelines was developed by the KKH-led Integrated Platform for Research in Advancing Metabolic Health Outcomes of Women and Children. It is one of the main programmes by the SingHealth Duke-NUS Maternal and Child Health Research Institute.

Ms Carol Loi, a parenting and family coach and digital literacy educator, stressed the importance of role modelling in a child’s development. 

“Parents can be can be mindful of how much time they spend on their own devices, and what they eat in front of their kids," she said. 

A practical tip she gives for bedtime and screen-time struggles is that children need time to transit from one activity to another. 

“Moving from being awake and being asleep and vice versa is about change management. The body needs time to wind down, as well as to be active,” she said. 

Likewise, easing children out of a video or game they are highly engaged in takes time. “Giving children advance notice may help. Let them know of the activities that they will be doing after they stop using their screens.” 

If possible, use a larger tablet rather than a smartphone, so that it would be easier for parents to share a screen with their child and have meaningful conversations about what they are watching, said Ms Loi. 

She also encourages parents to have realistic expectations, noting that each family has different needs. 

“Balancing the need to be intentional in nurturing healthy habits in their children as well as the realities of life may not be easy,” she said. 

Dr Loo acknowledged that the guidelines may seem daunting for parents at first.

"But once one can make this a way of life over each 24-hour day, it will become easier, more natural and you will reap bountiful benefits, both physically and psycho-emotionally," he said.

His advice is to start with one or any combination of the recommended behaviours, and adopt the practices together as a family or with friends while encouraging one another.

Here are the key guidelines for parents.

Physical activity

Infants (0 to 1 year)

- Have at least 30 minutes of tummy time spread throughout the day. Gradually build up the time for those who are not yet mobile.

- This can go up to at least an hour spread throughout the day for infants above three months of age.

Toddlers (1 to below 3)

- Aim for at least 180 minutes a day in a variety of physical activities at different levels of intensity. These should involve movements such as walking, running, crawling, climbing and balancing.

- Daily outdoor play is highly encouraged.

- Playtime has been associated with positive outcomes such as better sleep and developmental skills, as well as reduced risk for obesity.

Pre-schoolers (3 to below 7)

- Have at least 180 minutes of physical activity throughout the day. At least 60 minutes should be of moderate to vigorous intensity, where more is better.

- Older pre-schoolers (five to six years of age) should be exposed to a variety of age-appropriate vigorous-intensity play and engage in muscle- and bone-strengthening activities several times a week. These include running, jumping and climbing.

- Daily outdoor active play is highly encouraged

Sedentary behaviour

Infants (0 to 1 year)

- Infants should not be restrained - like in strollers or high chairs - and left unattended for more than an hour at a time.

- They should not have any screen time, including background, which can be distracting.

- When infants are seated, reclined or lying down, caregivers are encouraged to engage them in singing, reading, storytelling and imaginative play.

Toddlers (1 to below 3)

- Avoid restraining toddlers on a seat for more than an hour at a time.

- For those younger than 18 months, screen time, regardless of the type of device, is not recommended.

- For those aged 18 months and above, screen time should be limited to less than one hour per day.

Pre-schoolers (3 to 7)

- Limit the total daily amount of sedentary behaviour, such as sitting, reclining or lying down.

- Limit recreational sedentary screen time to less than one hour per day.

Sleep

Infants (0 to 1 year)

- Have a total amount of 14 to 17 hours for babies from birth to three months of age and 12 to 15 hours for those four to 11 months of age, including naps.

- Infants should sleep on their back in their own cot, in the same room as their caregivers, for safety.

- Parents can start developing regular bedtime routines when infants are two to three months old and provide a conducive sleep environment.

Toddlers (1 to below 3)

- Have a total amount of 11 to 14 hours of sleep with regular sleep and wake-up times.

- Keep to a bedtime routine and timing, while providing a conducive environment that is dark, quiet and of comfortable temperature.

- Avoid screen time 30 minutes before night-time sleep

Pre-schoolers (3 to 7)

- Have a total of 10 to 13 hours of sleep for those three to five years of age, or nine to 11 hours for six-year-olds.

- Older pre-schoolers may not need to nap if they have slept enough at night.

- Keep to a consistent bedtime and routine, and avoid screen time 30 minutes before going to bed.

Diet and eating habits

Infants (0 to 1 year)

- Breastfeeding is recommended for infants when possible

- From four to six months of age, babies can be introduced to solid foods of various textures and flavours, with no added salt or sugar.

- Have meals spaced two to three hours apart in the day to avoid overfeeding.

- Repeated exposure to a variety of items across all the main food groups is necessary to help infants learn to accept different food types and take in a range of nutrients.

Toddlers (1 to below 3)

- Continue to increase the variety of foods and wean off milk as the main source of nutrition.

- Introduce healthy family meals and offer whole milk and water, while establishing a structured routine for meal and snack times.

- Avoid screen time during meal times and using food as a reward or to soothe.

Pre-schoolers (3 to 7)

- Eat healthily as a family, with caregivers as role models.

- Limit the amount and consumption of sugar-sweetened beverages.

- Provide a structured routine for meal and snack times, and avoid screen time during meals.

For more details on the guidelines, visit this website.