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Objective: To examine children's screen time use and sleep patterns over 2 years of the pandemic and the downstream associations with children's executive functions and behavioural problems, as well as the moderating effects of parental factors. Method: This longitudinal cohort study examined school-aged children's lifestyle and behavioural changes over 2 years of the pandemic across 6 timepoints (November 2020 to August 2022). Latent growth modeling (LGM) was used to identify changes in screen time and sleep duration and multivariate LGM was used to determine how parental stress, positive parenting, changes in children's screen time and sleep over time were associated with children's executive functions and mental health outcomes at the final time point. Results: A total of 198 parents (children's mean age = 9.14 years) were recruited and followed up. Non-school screen time was elevated at the initial timepoint (3.6 ± 2.3 h). Positive parenting at the initial timepoint was associated with lower screen time use in children (ß = -.19, p < .001; ß = -.19, p < .001, in internalizing and externalizing models). Children whose screen time use was constant during the pandemic had shorter sleep durations (ß = -.45, p < .05 in internalizing model). Executive function was predicted by sleep duration at the first timepoint (ß = -.55, p < .001; ß = .73, p < .001, in internalizing and externalizing models) and changes in screen time during the pandemic was associated with both internalizing and externalizing symptoms (ß = .58, p < .05; ß = .54, p < .05, in internalizing and externalizing models). Conclusion: Children's screen time decreased slightly but remained significantly higher than Canadian and International guidelines during 2 years of the pandemic. Positive parenting styles can have a significant impact on children's screen time use. Reducing excessive screen time can help improve sleep patterns and, consequently, cognitive, and emotional well-being in children.

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The goal of this study was to understand how neighborhood greenspace access may support or hinder the effectiveness of community programs and policies (CPPs) aimed at reducing racial and ethnic inequities in screen time among 4598 US children. We found higher CPP intensity was significantly associated with fewer screen time behaviors in high greenspace neighborhoods, but not neighborhoods with low or moderate greenspace. Moreover, there were significant differences in greenspace access by neighborhood-level race and ethnicity. Implementing CPPs without regard for racial and ethnic greenspace inequities may be an underlying cause in the perpetuation of inequities in childhood screen time.

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Lifestyle behaviors, defined as a combination of dietary behavior, physical activity (PA), screen time (ST), and sleep duration indicators, are strongly associated with blood pressure (BP) in students. Our aim was to characterize the joint trajectories of lifestyle behaviors among middle school students and evaluate their association with BP. Data were obtained from the monitoring dataset on common diseases and health factors among students in Jiading District, Shanghai, China, conducted from 2019 to 2023. Lifestyle behavior data were collected annually from middle school students aged 12-18 years through questionnaires covering dietary behavior score, PA, ST, and sleep duration. Students' BP was measured in 2023. Joint trajectories of lifestyle behaviors were determined using group-based multi-trajectory modeling. Associations between lifestyle trajectories and students' BP were examined using multiple linear regression and modified Poisson regression. A total of 1378 middle school students (759 [58.98%] boys, median age 14.36 years [IQR: 13·30-13.28]) with lifestyle behaviors data assessed at least three times were included, and they were categorized into four joint lifestyle trajectories as follows: "remain unhealthy with low PA and increasing ST" (n = 141, 10.46%), "remain unhealthy with only low PA" (n = 305, 22.63%), "change towards unhealthy with decreasing sleep duration" (n = 776, 57.57%), and "relatively healthy" (n = 126, 9.35%). After adjusting for important confounders, the "remain unhealthy with low PA and increasing ST" group was associated with higher diastolic BP (DBP) [ß: 3.49, 95% CI: 0.55-6.44] and higher mean arterial pressure (MAP) [ß: 3.19, 95% CI: 0.37-6.01] in students compared with the "relatively healthy" group. Additionally, compared with the "relatively healthy" group, students in the "remain unhealthy with low PA and increasing ST" group had a 1.12-fold increase in the risk of hypertension (risk ratios: 1.12, 95% CI: 1.03-1.24). All trend p values in DBP, MAP, and hypertension from the "relatively healthy" group to the "remain unhealthy with low PA and increasing ST" group were less than 0.05. Four distinct lifestyle trajectories were identified among middle school students. Students who remained in the "unhealthy with low PA and increasing ST" lifestyle trajectory were associated with later elevations in BP.

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OBJECTIVE: Since COVID-19 pandemic, screen time (ST) seems to have increased among children and young people. There is controversy about its impact in the physical and mental well-being of children. The aim of this study was to analyse the possible influence of excessive ST on child health through a systematic review of the literature. METHODS: Systematic review was done by two independent reviewers. We analysed the medical literature (MEDLINE data base) from 2017 to 2022. Data related to the effects of ST on children´s health were analysed along with strategies that can mitigate those effects. RESULTS: The search identified 3,151 articles, 37 finally selected as they fulfilled the demanded methodological quality criteria. Negative effects on children's health such as obesity, linked to a sedentary lifestyle, sleep disorders or anxiety problems in adolescents were detected. However, a better development of language or memory functioning, when interactive media were used, have also been described. Educational measures have proven useful in controlling exposure time and reducing exposure-related negative effects. CONCLUSIONS: Although high levels of ST could affect children`s health, we have recorded some positive effects that are enhanced when parents get involved in TV watching (co-viewing). Exposure time should be customized according to every child's lifestyle.

OBJETIVO: Desde la pandemia de la COVID-19, el tiempo frente a la pantalla (TP) parece haber aumentado entre niños y jóvenes. Existe controversia sobre su impacto en el bienestar físico y mental de los niños. Este estudio tuvo el objetivo de analizar la posible influencia de un excesivo TP en la salud infantil mediante una revisión sistemática de la literatura. METODOS: Dos revisores independientes realizaron una revisión sistemática. Se analizó la literatura médica (base de datos MEDLINE) desde 2017 hasta 2022. Se analizaron los datos relacionados con los efectos del tiempo frente a la pantalla en la salud infantil junto con las estrategias que pueden mitigar dichos efectos. RESULTADOS: La búsqueda identificó 3.151 artículos, siendo 37 finalmente seleccionados por cumplir los criterios de calidad metodológica exigidos. Se detectaron efectos negativos sobre la salud infantil como la obesidad, ligada a un estilo de vida sedentario, trastornos del sueño o problemas de ansiedad en adolescentes. Sin embargo, también se ha descrito un mejor desarrollo del lenguaje o del funcionamiento de la memoria, cuando se utilizaban medios interactivos. Las medidas educativas han demostrado ser útiles para controlar el tiempo de exposición y reducir los efectos negativos relacionados con la exposición. CONCLUSIONES: Aunque unos niveles elevados de tiempo frente a la pantalla podrían afectar a la salud de los niños, se han registrado algunos efectos positivos que se potencian cuando los padres se implican en el visionado de la televisión (coviewing). El tiempo de exposición se debe personalizar según el estilo de vida de cada niño.

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Myopia is the most frequent kind of refractive error and affects hundreds of millions of people. Growing evidence suggests that extended exposure to digital screens may exacerbate nearsightedness in children and young people. The purpose of this review is to compile data on the link between too much time in front of a screen and nearsightedness in young people so far. The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided the methods used and the format of the resulting report. Articles published between January 1, 2000, and June 30, 2023, were found by searching Medline, PubMed, ScienceDirect, Google Scholar, CINAHL, the Cochrane Library, and Scopus. Studies reporting an association between myopia and time spent in front of screens in children and young adults were considered eligible. The initial search yielded a total of 1,251 studies. After eliminating duplicates and reviewing the titles and abstracts, 64 full-text articles were evaluated for eligibility. Ultimately, 15 of these studies were included in the final analysis. The 15 studies involved a total of 59,775 participants and were conducted in various countries, including China, Singapore, and the United States. Overall, the evidence did not support a significant association between screen time and myopia in school children and young adults. There is conflicting evidence on the link between screen time and myopia in children and adolescents. More research is needed to determine whether or not digital screen use is a risk factor for myopia. The complex association between screen time and myopia is not fully understood at this time because of the variability of the included studies. These results have significant public health implications since they may be used to guide recommendations for screen time use in children and the young population.

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PURPOSE: In childhood cancer survivors (CCS), high physical activity (PA) and low sedentary time may reduce risks of late-effects. PA behaviors and screen time, and how they relate to moderate-to-vigorous PA (MVPA) in CCS, are largely unknown. We examined PA behaviors and screen time, and their cross-sectional associations with MVPA. METHODS: CCS from any cancer diagnosis (≥ l year post-treatment), aged 9-16 years at study, were eligible in the international Physical Activity in Childhood Cancer Survivors (PACCS) study. PA behaviors (school transport, intensity-effort in physical education ("PE intensity"), leisure-time PA) and screen time were assessed by self-report, and MVPA by accelerometers (ActiGraph GT3X-BT). Multivariable linear regressions were used to assess associations between PA behaviors and screen time with MVPA. RESULTS: We included 481 CCS (48% girls, mean age 12.2 years). Passive school transport (prevalence 42%) was associated with 10% lower MVPA/day (ß = 6.6 min, 95% CI 3.3-10.0), low PE intensity (prevalence 21%) with 16% lower MVPA/day (ß = 10.2 min, 95% CI 6.0-14.3), and low leisure-time PA (prevalence 34%) with 15% lower MVPA/day (ß = 9.4 min, 95% CI 1.0-17.7), compared to active school transport, high PE intensity and high leisure-time PA, respectively. High screen time was not associated with MVPA. CONCLUSION: Interventions aiming to increase PA behaviors rather than reducing screen time may be more efficient in promoting a healthy lifestyle in CCS through increased MVPA. Encouraging active transport, high PE intensity, and high leisure-time PA seems important in survivorship care. IMPLICATIONS FOR CANCER SURVIVORS: Young CCS may benefit from engaging in active transport, high PE intensity, and high leisure-time PA.

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In the current pre-registered study, we examined the associations between shared book reading, daily screen time, and vocabulary size in 1,442 12- and 24-month-old Norwegian infants. Our results demonstrate a positive association between shared reading and vocabulary in both age groups, and a negative association between screen time and vocabulary in 24-month-olds. Exploratory analyses revealed that the positive relationship between shared reading and expressive vocabulary in 12-month-olds was stronger in lower SES groups, suggesting that shared reading may act as a compensatory mechanism attenuating potentially impoverished learning environment and parent-infant interactions in low-SES families.

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This article explores the intricate relationship between smartphone usage and mental health and the unintended consequences of the rapid integration of this technology into daily life. It explores the ways in which smartphones disrupt opportunities for introspection and self-reflection, decrease engagement in external reality, increase engagement with realities of the virtual world, precipitate ego destabilization, and interfere with sleep and dreaming. The author explores ways in which the split between the real self and the ideal self is impacted by social media. The influence of smartphones on mental health is a complex and evolving issue, demanding ongoing research, understanding, and a heightened awareness of the potentially deleterious consequences of overusing technology in our ever-changing world.

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BACKGROUND: We aim to discover which, if any, of the subscales of internalizing and externalizing behavioral problems at age 3 are still associated with screen time (ST) at age 2 after adjusting for behavioral problems scores at age 2. METHODS: This study was conducted under the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Information was gathered prospectively, with 7207 mother-child pairs included in the analysis. Children's ST was categorized in hours a day at age 2 (<1, 1-<2, 2-<4, ≥4). We assessed children's behavioral problems using the Child Behavior Checklist for Ages 1½-5 (CBCL) at ages 2 and 3. 'Having behavioral problems' was defined by them being within a clinical range for internalizing behaviors (withdrawn, somatic complaints, anxious/depressed and emotionally reactive) and externalizing behaviors (attention problems and aggressive behaviors) at age 3. Continuous scores on each of the behavioral problem scales at age 2 were used as covariates. RESULTS: Greater ST for children at age 2 was associated with specific subscales for emotionally reactive and aggressive behaviors at age 3. CONCLUSIONS: This study found that ST is prospectively associated with some behavioral scales but not others.

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Adiposity is a chronic disease that must be treated from childhood. Despite the transcendence of improving habits, few interventions report their contribution to decreasing adiposity. METHODS: This cohort enrolled children and teens of any gender, 8-18 years old, and with a body mass index (BMI) z-score of ≥1 into "Sacbe", a comprehensive program to identify which eating habits could reduce BMI z-score. The sample size calculated was 110 participants. We recorded anthropometric measures, clinical history, and habits. A clinically relevant reduction in BMI z-score was defined as ≥0.5 over 12 months or its equivalent according to the months of follow-up. RESULTS: 58.2% were female, the median age was 12 years (range: 9.1-14.7), and the mean BMI z-score was 2.30 ± 0.83. The 82.7% achieved a reduced BMI z-score but 41.8% achieved a clinically relevant reduction with a median follow-up of 6.7 months. Eating out less than once per week was associated with this outcome, even after adjusting for energy intake, other eating patterns, sedentary screen time, physical activity, sleep duration, and sitting time (HR 2.12; 95% CI: 1.07-4.21). CONCLUSIONS: Eating out < once/week implicates less processed food exposition and better quality of food; this habit could be the most effective to reduce childhood adiposity.

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Background: Screen-based activity refers to the use of screened devices, which are changing from stationary devices such as televisions and desktop computers to newer portable devices such as smartphones and electronic tablets. The exposure of younger children to all types of screened devices has increased. Purpose: This review aimed to provide an overview of previous studies and identify the correlations associated with screen-based activities in preschoolers. Methods: We conducted a systematic literature review of databases including PubMed, Embase, and PsycInfo targeting quantitative studies published between 2010 and 2019. We then analyzed the associations between screen time and various individual, familial, and environmental factors in healthy children aged 0-6 years. We specifically included studies that provided a subgroup analysis for this age category to systematically identify the factors influencing screen time patterns among preschoolers. Results: The search yielded 36 articles that met the inclusion criteria. We investigated age, sex, and social, family, and personal factors as well as media parenting. The results suggested that media parenting for screen-based activities was an important protective factor. Conclusion: Limited research has been conducted on preschoolers' screen-based activities with both stationary and portable screened devices. Most factors have been studied using stationary devices and are too infrequent for solid conclusions to be reached. Parental screen time and the setting of appropriate media limits were crucial protective factors against excessive media exposure. However, information about family and personal factors remain scarce, and further research is needed.

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BACKGROUND: Previous studies indicated that excessive engagement in digital devices could lead to negative psychological impacts in general population. We aimed to determine the association of electronic screen exposure with depression among women in early pregnancy. METHODS: A cross-sectional study was conducted from June 2021 to June 2022. A total of 665 women in early pregnancy were recruited and the information included socio-demographic characteristics, screen exposure and Patient Health Questionnaire - 9 depression scale. RESULTS: Among the women in early pregnancy, the total daily smartphone viewing time was the longest (median [P25-P75], 5 [3-6] hours/day) in the three types of electronic screen exposure. The total daily smartphone viewing time (P = 0.015, OR[95%CI] = 1.09[1.11-1.18]), smartphone (P = 0.016, OR[95%CI] = 1.24[1.04-1.47]) and television viewing time (P = 0.006, OR[95%CI] = 1.35[1.09-1.67]) before nocturnal sleep were significantly associated with depression among women in early pregnancy. The thresholds calculated by receiver operator characteristic curves were 7.5 h/day, 1.5 h/day and 1.5 h/day, respectively. In addition, women with higher scores of smartphone addiction were more susceptible to depression (P<0.001, OR[95%CI] = 1.11[1.07-1.16]). The top three smartphone usages in women with depression were watching videos (22.0%), listening to music (20.9%) and playing games (16.7%). CONCLUSIONS: In conclusion, electronic screen exposure, including screen viewing time, smartphone addiction and problematic smartphone use was associated with depression among women in early pregnancy. Further studies are warranted to verify the conclusions.

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BACKGROUND: The increased trends in psychological distress and mental illness have been of great significance in public health concerns. The study aimed to investigate the proportion and correlates of meeting 24-h movement guidelines (including moderate to vigorous physical activity, screen time and sleep duration) and the associations between 24-h movement guidelines met and mental well-being and psychological distress in a large sample of Chinese students. METHODS: All participants received a physical examination and filled out questionnaires in this study. Chi-square tests were used to analyse the proportion of reaching 24-h guidelines by gender and logistic regression was used to analyse correlates of meeting 24-h guidelines. Two binary logistic regression models were used to analyse the association between meeting 24-h guidelines and mental well-being and psychological distress. The back-propagation artificial neural network was used to describe the importance of the independent variables. RESULTS: The findings revealed a generally low rate of meeting the 24-h movement guidelines, particularly concerning moderate to vigorous physical activity (16.5%). Meeting all three guidelines was related to better mental health in both boys and girls. Particularly, meeting screen time guideline and meeting sleep duration guideline appeared to be more important on mental outcomes, compared to meeting moderate to vigorous physical activity guideline. Compared with boys, girls were more susceptible to the influences of 24-h movement guidelines on mental health. CONCLUSIONS: Meeting all three components of the 24-h movement guidelines was associated with the most favourable mental health outcomes for both boys and girls. Thus, maintaining a daily balance of sufficient physical activity, limited screen time, and adequate sleep is crucial for enhancing the mental health status of students.

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OBJECTIVE: This study aims to identify factors associated with excessive screen time among preschoolers in Lima, Peru. METHODS: Cross-sectional analysis from a 2019 panel study in Lima, Peru, was conducted focusing on women, aged 18 and above, who are mothers of 3- to 5-year-olds in mid-high and mid-low districts. There were two outcome variables: excessive TV and excessive electronic devices screen time, defined as ≥ 1 h of screen exposure for each one. Explored factors included the mother's age, education and wealth index and the children's age, sex, physical activity, day care attendance and ultra-processed food consumption. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between associated factors and excessive screen time using the GLM Poisson of with a logarithmic link. RESULTS: Excessive TV screen time and electronic devices prevalence was 74% and 36.9%, respectively. For TV screen time, a high wealth index (aPR 1.13; 95%CI: 1.03-1.23) and children's age (aPR 1.18; 95%CI: 1.08-1.29 for 4 years, PR = 1.17; 95%CI: 1.07-1.28 for 5 years) were significant. For electronic devices, significant associations included mothers with more than 3 children (aPR 0.77; 95%CI: 0.62-0.96), being single (aPR 1.27; 95%CI: 1.01-1.58) and a high wealth index (aPR 1.38; 95%CI: 1.13-1.68). Furthermore, significant associations were found between excessive electronic device screen time and consumption of candies and chocolates (aPR 1.38; 95%CI: 1.08-1.77). CONCLUSIONS: Seven out of 10 preschool children exceeded the recommended television screen time. Certain characteristics of the children, their mothers and the family's socio-economic situation are related to excessive television screen time and excessive electronic device screen time.

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BACKGROUND: Meeting 24-h movement behaviors (24-HMB: physical activity [PA], screen time [ST], and sleep [SL]) recommendations may be associated with positive health outcomes among youth with specific mental, behavioral, and neurodevelopmental (MBD) conditions. However, temporal trends and disparities in meeting 24-HMB guidelines in these higher-risk groups have not been investigated, hampering the development of evidence-based clinical and public health interventions. METHODS: Serial, cross-sectional analyses of nationally National Survey of Children's Health (NSCH) data (including U.S. youth aged 6-17 years with MBD conditions) were conducted. The time-trends survey data was conducted between 2016 and 2021. The prevalence of 24-HMB adherence estimates were reported for the overall sample and for various sociodemographic subgroups. The subgroups analyzed included: age group (children[aged 6 to 13 years], adolescents[aged 14 to 17 years]), sex, socioeconomic status, and ethnicity. RESULTS: Data on 52,634 individuals (mean age, 12.0 years [SD,3.5]; 28,829 [58.0 %] boys) were analyzed. From 2016 to 2021 the estimated trend in meeting PA + ST + SL guidelines declined (-0.8 % [95%CI, -1.0 % to -0.5 %], P for trend <0.001), whereas meeting none of 24-HMB guidelines increased (2.2 % [1.8 % to 2.6 %], P for trend <0.001). White participants, children, and boys reported higher estimated prevalence of meeting full integrated (PA + ST + SL) guidelines. DISCUSSION: The temporal trends observed in this study highlight the importance of consistently monitoring movement behavior among MBD youth and identifying variations by sociodemographic groups in meeting 24-HMB guidelines for health promotion within these vulnerable groups.

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OBJECTIVES: To estimate the prevalence of electronic device usage and its association with mental health status among preschool children aged 3-6 years. METHODS: A cross-sectional study was conducted among preschool children aged 3-6 years in kindergartens in Makkah city in 2023-2024, using an electronic questionnaire. An Arabic version of the Strengths and Difficulties Questionnaire was used to assess mental health. RESULTS: We recruited a total of 399 children. The prevalence of electronic device usage was 91.5%. The number of hours spent using electronic devices ranged from 0 to 12 hour (h)/day, with a mean of 3.1 h/day. We found a significant positive correlation between the number of hours spent using electronic devices and emotional problems (r=0.200, p<0.001), conduct problems (r=0.149, p=0.003), hyperactivity (r=0.279, p<0.001), peer problems (r=0.104, p=0.038), and total difficulty scores (r=0.263, p<0.001). We also found a significant negative correlation between the number of hours spent using electronic devices and the prosocial score (r= -0.128, p=0.011), and most of the included children had scores within the "close to average" category across all scales of mental health status. CONCLUSION: There was a high prevalence of electronic device usage among preschool children, which exceeded the recommended time limit. A significant correlation was observed between electronic device use and mental health scores. Further longitudinal studies are required to understand the nature of this association and its implications for child development.

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PURPOSE: Emerging research evidence suggests positive relationships between higher screen time and eating disorders. However, few studies have examined the prospective associations between screen use and eating disorder symptoms in early adolescents and how problematic screen use may contribute to symptom development. METHODS: We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,246, 2016-2020, ages 9-14). Logistic regression analyses were used to estimate the longitudinal associations between baseline self-reported screen time and eating disorder symptoms in year two. Logistic regression analyses were also used to estimate cross-sectional associations between problematic screen use in year two (either problematic social media or mobile phone use) and eating disorder symptoms in year two. Eating disorder symptoms based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) included fear of weight gain, self-worth tied to weight, engaging in compensatory behaviors, binge eating, and distress with binge eating. RESULTS: Each additional hour of total screen time and social media use was associated with higher odds of fear of weight gain, self-worth tied to weight, compensatory behaviors to prevent weight gain, binge eating, and distress with binge eating two years later (odds ratio [OR] 1.05-1.55). Both problematic social media and mobile phone use were associated with higher odds of all eating disorder symptoms (OR 1.26-1.82). CONCLUSIONS: Findings suggest greater total screen time, social media use, and problematic screen use are associated with more eating disorder symptoms in early adolescence. Clinicians should consider assessing for problem screen use and, when high, screen for disordered eating. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

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Youth screen media activity is a growing concern, though few studies include objective usage data. Through the longitudinal, U.S.-based Adolescent Brain Cognitive Development (ABCD) Study, youth (mage = 14; n = 1415) self-reported their typical smartphone use and passively recorded three weeks of smartphone use via the ABCD-specific Effortless Assessment Research System (EARS) application. Here we describe and validate passively-sensed smartphone keyboard and app use measures, provide code to harmonize measures across operating systems, and describe trends in adolescent smartphone use. Keyboard and app-use measures were reliable and positively correlated with one another (r = 0.33) and with self-reported use (rs = 0.21-0.35). Participants recorded a mean of 5 h of daily smartphone use, which is two more hours than they self-reported. Further, females logged more smartphone use than males. Smartphone use was recorded at all hours, peaking on average from 8 to 10 PM and lowest from 3 to 5 AM. Social media and texting apps comprised nearly half of all use. Data are openly available to approved investigators ( https://nda.nih.gov/abcd/ ). Information herein can inform use of the ABCD dataset to longitudinally study health and neurodevelopmental correlates of adolescent smartphone use.

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BACKGROUND: It is recommended that children should avoid eating dinner, being physically active, or using screens in the hour before bed to ensure good sleep health. However, the evidence base behind these guidelines is weak and limited to cross-sectional studies using questionnaires. OBJECTIVE: The aim of this randomized crossover trial was to use objective measures to experimentally determine whether recommendations to improve sleep by banning electronic media, physical activity, or food intake in the hour before bed, impact sleep quantity and quality in the youth. METHODS: After a baseline week to assess usual behavior, 72 children (10-14.9 years old) will be randomized to four conditions, which are (1) avoid all 3 behaviors, (2) use screens for at least 30 minutes, (3) be physically active for at least 30 minutes, and (4) eat a large meal, during the hour before bed on days 5 to 7 of weeks 2 to 5. Families can choose which days of the week they undertake the intervention, but they must be the same days for each intervention week. Guidance on how to undertake each intervention will be provided. Interventions will only be undertaken during the school term to avoid known changes in sleep during school holidays. Intervention adherence and shuteye latency (time from getting into bed until attempting sleep) will be measured by wearable and stationary PatrolEyes video cameras (StuntCams). Sleep (total sleep time, sleep onset, and wake after sleep onset) will be measured using actigraphy (baseline, days 5 to 7 of each intervention week). Mixed effects regression models with a random effect for participants will be used to estimate mean differences (95% CI) for conditions 2 to 4 compared with condition 1. RESULTS: Recruitment started in March 2024, and is anticipated to finish in April 2025. Following data analysis, we expect that results will be available later in 2026. CONCLUSIONS: Using objective measures, we will be able to establish if causal relationships exist between prebedtime behaviors and sleep in children. Such information is critical to ensure appropriate and achievable sleep guidelines. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12624000206527; https://tinyurl.com/3kcjmfnj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63692.

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BACKGROUND: The WHO issued recommendations about the ideal amount of physical activity, sedentary behaviour and sleep in infants, toddlers and preschool children. To facilitate their interpretation and translation into public health policies, we analysed the quantity and quality of the evidence that supported the development of each WHO recommendation. METHODS: All data for each exposure-outcome pair analysed in the studies informing WHO guidelines were extracted, and predefined criteria, based upon GRADE methodology, were used to classify each outcome and study result. RESULTS: Among the 237 studies that could be included, 37 were experimental and 200 were observational, yielding 920 analyses of exposure-outcome associations. Sixty-two analyses used a relevant outcome, with or without significant results. Five of the 10 WHO recommendations were based upon zero analyses with significant results on relevant health outcomes. The remaining recommendations were mostly based upon analyses evaluating obesity-related outcomes. Eight of the 10 GLs thresholds were not supported by any significant analysis on clinically relevant outcomes. CONCLUSION: While these findings should not be interpreted as an attempt to disprove the benefits of healthy lifestyle habits in early childhood, neither to minimize the work of the experts in this complex research field, very limited evidence currently supports the adoption of recommended thresholds as behavioural surveillance and public health interventions targets. Therefore, until further data are available, public health interventions should be developed balancing whether to focus on the achievement of specific targets that are still not supported by high-quality evidence or on the general promotion of healthy behaviours.