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Toddler - Physical Activity

Desired Behaviors
Based upon evidence, a number of desired behaviors were identified as critical to helping families foster healthy active living for their toddler. For each desired behavior you can explore the evidence, learn what parents told us about these behaviors, identify opportunities to promote healthy behaviors at the point of care, review how to start conversations and access messages and resources to support families. Also available to inform your counseling is the Onset and Patterns of Risk Behaviors for Toddlers Timeline located above this section.

Onset and Patterns of Risk Behaviors

This timeline illustrates when and what kind of risk behaviors associated with overweight and obesity develop during the toddler years. Use this tool to help prioritize anticipatory guidance for families.​
To use: Point at the timeline dots below to see valuable information, click and hold a dot for Evidence. Important patient care information is available using the Acute/Medical Opportunities button at the bottom left. There is a close box at the top right of this window.
opportunities for care

Acute/Medical Opportunities

Acute/Medical Opportunities: Below are additional opportunities to explore healthy active living with families.

  • (range month 12-24) Oral health: Oral health screening/preventative visit is recommended between months 12-24. Note poor oral health and obesity share a cluster of risk factors.12 Children presenting with poor oral health should receive healthy active living guidance as well.
  • Asthma. There is a positive association between asthma and overweight/obesity. Children presenting with asthma should be flagged for ongoing follow-up related to healthy active living. 13 /14

 

(12)Tripathi S, Kiran K, Kamala BK. Relationship between obesity and dental caries in children – a preliminary study. J Int Oral Health. 2010;2(4).

(13)Sheikh J, Kaplan MS. Association of being overweight with greater asthma symptoms in inner-city black and Hispanic children. Pediatrics. 1999;104:376. Also, Gennuso J, Epstein LH, Paluch RA, Cerny F. The relationship between asthma and obesity in urban minority children and adolescents. Arch Pediatr Adolesc Med. 1998;152(12):1197-1200.


Parenting

​Most parents do not fully understand BMI, BMI percentiles or growth charts. The color coded (green, yellow, red) growth charts have been shown to improve understanding (11).

Evidence

​11. Ben-Joseph EP, Dowshen SA, Izenberg P. Do parents understand growth charts? A national, internet-based survey. Pediatrics. 2009;124(4).

Parenting

​Evidence suggests a decrease in sleep duration across all age groups over the past 20 years. The most pronounced decrease is in children younger than 3 (10).

  • Toddlers between 12-36 months should sleep 12-14 hours in a 24 hour period
  • Good sleep hygiene should be fostered

Evidence

​10. Dollman J, Ridley K, Olds T, Lowe E. Trends in the duration of school-day sleep among 10- to 15-year-old south Australians between 1985 and 2004. Acta Paediatr. 2007; 96(7):1011-1014. Also, Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from infancy to adolescence: Reference values and generational trends. Pediatrics. 2003;111(2):302-307.

Physical Activity

​Children under age 5 fail to meet physical activity guidelines (3).

  • For 1-2 year olds this should be at least 30 minutes of structured activity and at least 60 minutes and up to several hours of unstructured play (4).
  • Concerning behavior at this age is regular stroller use. Encourage parents to have their toddlers walk more during outings.

Evidence

​3. National Association for Sport and Physical Education. Active Start: A Statement of Physical Activity Guidelines for Children Birth to Five. Reston, VA:  NASPE Publications: 2009.

4. National Association for Sport and Physical Education. Active Start: A Statement of Physical Activity Guidelines for Children Birth to Five Years. Reston, VA:  NASPE: 2002;5-11.

Physical Activity

​Playing outside in this age group usually results in more physical activity than indoor play (9).

Evidence

​9. Brown WH, Pfeiffer KA, McIver KL, Dowda M, Addy CL, Pate RR. Social and environmental factors associated with preschoolers’ nonsedentary physical activity. Child Dev. 2009;80(1):45-58.

Media

​39% of families with children this age have the television on constantly (6).

  • Research indicates this can disrupt play and activity levels for young children and interferes with language development and displaces time spent reading.

Evidence

​6. Vandewater EA, Park SE, Huang X, Wartella EA. No: You can’t watch that – parental rules and young children’s media use. Am Behav Sci. 2005;48(5):608–623.

Media

​By age 3, 30% of children have TVs in their bedroom (5).

  • Parent's number one reason for placing TVs in the bedroom is as a sleep aid. TVs are often introduced into the bedroom during the transition from crib to bed which often occurs between 12 months and 24 months.

Evidence

​5. Rideout VJ, Hamel E. The Media Family: Electronic Media in the Lives of Infants, Toddlers, Preschoolers, and Their Parents. Menlo Park, CA: Kaiser Family Foundation; 2006.

Media

​73% of 2- to 4-year-olds watch TV daily (7).

  • Parents report that they view television as a peacekeeper and a safe activity for their children while they are preparing dinner, getting ready for work, or doing household chores (5).
  • Many parents report feeling better knowing that the programming their children watch has been described as educational. Parents who believe that educational television is “very important for healthy development” are twice as likely to have the television on all or most of the time (8).

Evidence

​5. Rideout VJ, Hamel E. The Media Family: Electronic Media in the Lives of Infants, Toddlers, Preschoolers, and Their Parents. Menlo Park, CA: Kaiser Family Foundation; 2006.
7. Zero to eight: Children’s media use in America. A Common Sense Media Research Study. 2011.

8. Vandewater EA, Bickham DS, Lee JH, Cummings HM, Wartella EA, Rideout VJ. When the television is always on: Heavy television exposure and young children’s development. Am Behav Sci. 2005;48(5):562–577.

Media

​39% of children at this age are using mobile devices (7).

Evidence

​7. Zero to eight: Children’s media use in America. A Common Sense Media Research Study. 2011.

Feeding

​As children transition out of pureed foods, the consumption of the most nutrient rich vegetables such as rich dark green, yellow, and orange vegetables decreases and the consumption of starchy vegetables (esp potatoes) increases (1).

Evidence

​1. Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food consumption patterns of young preschoolers: Are they starting off on the right path? J Am Diet Assoc supplement. 2011.

Feeding

​10% of 2-year-olds consume flavored milk (1).

Evidence

​1. Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food consumption patterns of young preschoolers: Are they starting off on the right path? J Am Diet Assoc supplement. 2011.

Feeding

​27% of children at this age are still consuming whole milk (1).

Evidence

​1. Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food consumption patterns of young preschoolers: Are they starting off on the right path? J Am Diet Assoc supplement. 2011.

Feeding

​14% of children at this age consume flavored milk (1).

Evidence

​1. Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food consumption patterns of young preschoolers: Are they starting off on the right path? J Am Diet Assoc supplement. 2011.

Feeding

​25% of children at this age do not eat any vegetables daily. Of those that do eat vegetables daily, French fries and other fried potatoes were the most commonly consumed vegetable (1).

Evidence

​1. Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food consumption patterns of young preschoolers: Are they starting off on the right path? J Am Diet Assoc supplement. 2011.

Feeding

​The top five energy sources for this age group were whole milk, fruit juice, reduced-fat milk, and pasta/pasta dishes (2).

Evidence

​2. Reedy J, Krebs-Smith SM. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc. 2010;110(10).

Feeding

​86% consumed some type of sweetened beverage, dessert, sweet or salty snack in a day. Thus, more children in this age range consumed sweetened beverages, desserts, and non-nutrient snack foods in a day than consumed distinct portions of fruits or vegetables (independently) (1).

Evidence

​1. Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM. Food consumption patterns of young preschoolers: Are they starting off on the right path? J Am Diet Assoc supplement. 2011.

​Active Play:

  • Dedicate time every day for active play
click for full information

Evidence

​Many children less than 5 years of age fail to meet the the physical activity CDC guideline of at least 60 minutes of moderate to vigorous activity per day.

Sedentary activity for young children has been shown to range from 32.8 to 56.3 minutes per hour.

Some research indicates that 2 to 5-year-olds should engage in 2 or more hours per day of physical activity.

Opportunities for Care

​A knowledge gap exists about need for toddlers to be active. Educate parents that even busy toddlers need to develop large motor skills and foster coordination, and this is accomplished through active play.

Share developmentally appropriate strategies for active play time.

Encourage physically active family activities. Discuss ways to make it part of the daily routine.

Encourage both structured and unstructured play.

Counsel parents on the excessive use of strollers.

Conversation Starters

​What kind of activities does your toddler enjoy?

What do you enjoy doing with your toddler?

Can you tell me about outdoor play spaces that are available for you and your toddler?

What types of activities are available to your toddler in childcare?

Can you tell me more about the quiet activities your toddler likes?

Related Parent Resources

​HALF Message(s):

Because they are so naturally active, it’s easy to overlook the fact that toddlers need daily physical activity — just like you do! Toddlers need time every day to run, climb, and jump!

Good habits start early in life, so make play time active time.

HALF Resources:

For realistic parent derived strategies for active play, refer parents to the following sections on healthychildren.org/growinghealthy:
  • Quick Tips: Keep Your Child Healthy widget. Simply select Physical Activity to generate the results.
  • Physical Activity for Toddlers

Also take advantage of the Healthy Active Living for Families app to create personalized patient education for your patient.

​Screen Time

  • Limit TV exposure to less than 2 hours/day
  • Avoid commercials and advertisements
  • No TV’s in children’s bedrooms
click for full information

Evidence

​61 percent of children younger than 2 are exposed to television and spend approximately 1 hour and 20 minutes a day in this activity

30 percent of children aged 0 to 3 have televisions in their bedrooms.

In children aged 2-5, exposure to more than 2 hours per day of television significantly increases the risk for obesity.

Televisions in children’s bedrooms increase the impact of television on weight status.

Parents often place televisions in bedrooms because they believe it will help the child sleep.

Opportunities for Care

​It is important to ascertain current family values around TV and offer alternatives to TV time.

Remind parents that one of the best ways for children to learn is through play and human interaction.

Also discuss the importance of sleep routines and that TV can actually disrupt healthy sleep.

For this age group, help parents identify strategies to limit:

  • the amount of TV watched
  • exposure to advertisements

Caution against:

  • placing a TV in their child’s bedroom
  • replacing TV time with screen time (smart phones/tablets/computer)


Explain that setting limits now regarding screen time establishes expectations about screen use that can carry forward and help to eliminate negotiations and battles as children grow.

Conversation Starters

​Can you tell me about your toddler and TV watching? 

Can you tell what programs your toddler is watching?

Did you know that commercials are a link between TV watching, weight gain, and unhealthy eating habits?

Would you like to talk about ways to reduce exposure to commercials?

Many parents think TVs in the bedroom are a good thing. How do you feel about it?

Does your child enjoy computer time or play on your phone or tablet?

Related Parent Resources

​HALF Message(s):

We understand that managing your kids’ TV time can be a struggle. Even if you can’t cut out TV completely, cutting back on TV will help.

HALF Resources:

For realistic parent derived strategies for managing screen time refer parents to the following sections on healthychildren.org/growinghealthy:

  • Quick Tips: Keep Your Child Healthy widget. Simply select Screen Time to generate the results.
  • Physical Activity for Toddlers

Also take advantage of the Healthy Active Living for Families app to create personalized patient education for your patient.


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