ABSTRACT
Aim
To investigate physical activity (PA), sedentary time, and screen time by age, sex, and parental education in a national sample of young children.
Method
This cross‐sectional study, conducted 2021–2024, of Swedish children recruited via their parents, included 1078 children aged 18 months, mean 1.5 ± 0.1 years, and 750 aged four, mean 4.1 ± 0.1 years. PA, sedentary time, and screen time were measured with accelerometry and questionnaire.
Results
PA guidelines were met by 94% of the 18‐month‐old children and 51% of those 4 years old. Among 18‐month‐old children, 22% met screen time guidelines on weekdays and 17% on weekends; corresponding percentages among children 4 years old were 60% and 28%. Device‐measured PA levels were consistently lower for girls than boys at age four, but sex differences were small among 18‐month‐old children. More children whose parents were highly educated participated in organised activities and used active transport modes; they also had lower screen time than children whose parents had low education.
Conclusion
Nearly all 18‐month‐old children met PA guidelines, versus only half of those aged 4 years. Many children in both age groups exceeded screen time guidelines. Age, sex, and parental education were associated with children's PA and screen time, suggesting targeted interventions.
Keywords: accelerometry, active transport, organised activities, screen guidelines, sedentary time
Abbreviations
- Cpm
Counts per minute
- PA
physical activity
- WHO
World Health Organization
Summary.
This is the first national survey on device‐measured physical activity (PA) and screen time among young children in Sweden.
Nearly all children aged 18 months and half of those aged 4 years met PA guidelines, while many exceeded screen time guidelines.
Age, sex and socioeconomic differences in PA and screen use were evident at this young age, highlighting the need for targeted strategies to promote PA and limit screen time.
1. Introduction
Physical activity (PA) is essential for health and well‐being among children and adolescents, including young children [1, 2]. Establishing healthy PA and sedentary behaviours during early stages of life may provide opportunities to further shape these behaviours through childhood, adolescence, and into adulthood.
PA has been associated with the improvement of several health indicators in children up to the age of 4 years, including bone and skeletal health, cardiometabolic health, and motor skills development [2]. Guidelines from the World Health Organization (WHO) recommend that children aged 1–2 years engage in 180 min per day of PA at any intensity. For children aged 3–4 years, a similar amount of PA is recommended, but in addition, 60 of these 180 min should be spent in moderate‐to‐vigorous PA. The PA may be spread throughout the day for both age groups [3].
Previous international studies have suggested that most young children aged 1–3 years exceed the recommended 180 min per day of PA, yet only 25% reach the 60 min of moderate‐to‐vigorous PA [4]. International estimates have suggested that 78% of children aged 3–5 years met the guidelines for PA at any intensity, that 90% met those for moderate‐to‐vigorous PA, and that 60% met the overall PA guidelines [5].
In Sweden, relatively few studies with accelerometer‐based data on young children are available [6, 7]. However, studies have found that about one‐third of four‐year‐old children engaged in at least 60 min per day of moderate‐to‐vigorous PA [8]. Together, available studies have reported somewhat mixed findings for PA and sedentary time in terms of sex. For example, a European study that included Swedish children aged 2–4 years showed that boys were more physically active and less sedentary than girls [9, 10]. Data from the Early Stockholm Obesity Prevention Project showed that two‐year‐old boys and girls engaged in similar amounts of PA, and that most of the day was spent sedentary [11]. Another study showed that four‐year‐old boys were more physically active and less sedentary than girls of the same age and that both boys and girls were more physically active and less sedentary on weekdays compared with weekend days [12]. In addition, two studies have found a positive association between organised sport and accelerometer‐determined PA [13, 14], but also that participation in organised sports differed depending on socioeconomic status [14].
The Public Health Agency of Sweden recently developed screen time guidelines for different age groups. The guidelines advise that children younger than 2 years should preferably not use screens at all, whereas children aged 2–5, as a rule of thumb, should accumulate a maximum of 1 h of screen time per day [15]. International data suggest that approximately 35% of children aged 2–5 years met these guidelines [16]. In addition, one previous study from Sweden showed that four‐year‐old children engaged in approximately 100 and 150 min of screen time outside preschool hours on weekdays and throughout the day on weekend days, respectively, with no significant sex differences [12].
The studies cited above predominantly involved young children from delimited geographical areas, such as the region of Stockholm. There has been a lack of population‐based Swedish studies that have investigated accelerometer‐measured PA and sedentary time among young children aged up to 4 years [17]. Studies with representative data for this age group may provide researchers, policy makers, and other stakeholders with reference data to identify potential risk groups with low levels of PA and high levels of sedentary time, groups for which appropriate intervention strategies need to be developed.
The aim of this study was to investigate accelerometer‐based PA and sedentary time, PA behaviours, and screen time by age, sex, and socioeconomic status in a representative sample of Swedish young children.
2. Methods
2.1. Recruitment
This cross‐sectional study was based on data from the national Swedish dietary survey Riksmaten Young Children 2021–2024, that was conducted by the Swedish Food Agency [18, 19]. A total of 16 800 children were randomly selected from a population register by the government agency Statistics Sweden, based on the level of education achieved at the household level. Parents of 18‐month‐old children and four‐year‐old children were invited to participate in the study by post, text message, and telephone. A total of 1078 children aged 18 months and 750 aged 4 years participated in the study after parental consent (12% participation rate). The data collection took place during all months of the year, but fewer children participated in July and August. The study sample represented all geographical regions and types of municipalities in Sweden and was also representative in terms of the children's sex, parental country of birth, and family structure. However, participating households had a higher education level compared to the Swedish population: 77% had a university degree compared to 55% in the Swedish population within the same age groups. Participating households also had higher income. The study design, participants, and methods are described in greater detail elsewhere [18].
2.2. Ethics Statement
Written informed consent was obtained from all parents/guardians. Ethical approval for the survey Riksmaten Young Children 2021–2024 was obtained from the Swedish Ethical Review Authority (2020–05293 and 2021–03591).
2.3. Data Collection
2.3.1. Physical Activity and Sedentary Time
PA and sedentary time were measured with Actigraph tri‐axial accelerometers (Actigraph model GT3X+, LCC, Pensacola, Florida, USA). The accelerometers were sent to the home address along with instructions that they were to be worn at the hip for seven consecutive days while the participants were awake, except during water‐based activities. In approximately 50 cases, the accelerometer appeared to have been worn for more than 960 min per 24 h. In these cases, diary data were used to remove plausible sleep time based on the latest sleep time and earliest wake time reported in the diary. The accelerometer data were processed using Actilife version 6.13.3, using 15‐s epoch time intervals at a sample rate of 30 Hz. Non‐wear time was removed and defined as 60 min of zero counts and no spike tolerance. Cut points for activity levels were defined in counts per minute (cpm). For children 18 months old, sedentary time was 0–192 cpm, light PA > 192–1672 cpm, and moderate‐to‐vigorous PA > 1672 cpm. For children 4 years old, sedentary time was 0–148 cpm, light PA > 148–1676 cpm, moderate PA > 1676–3364 cpm, and vigorous PA > 3364 cpm. A valid day was defined as a minimum of 500 min of wear time. Participants with at least three valid days, of which at least one was during the weekend, were included in the weekly analyses. A minimum of two valid days was required for the analyses of weekdays and one valid day for weekend days. A weekly average of at least 180 min of light and moderate PA per day for 18‐month‐old children and an average of at least 180 min of light to moderate PA, including at least 60 min at an intensity of moderate‐to‐vigorous intensity per day, were used to categorize participants into reaching or not reaching the guidelines of PA.
2.3.2. Participation in Organised Activities
Parents reported whether their child participated in organised activities or clubs outside of childcare through a questionnaire. Parents who answered yes were given an open‐response follow‐up question about the types of activities and how many times per week the child participated.
2.3.3. Mode of Transport to and From Preschool
The parents self‐reported their usual means of transportation to and from preschool. Three categories were created: active child and parent if both walked or used a bike; passive child and active parent if the parent transported the child on a bike or push‐chair; and passive child and parent, if transportation was by car. As only two parents indicated use of public transportation, these cases could not be analysed separately, and the transport was categorised as passive.
2.3.4. Screen Time
The children's screen time was self‐reported by the parents using questions about the amount of time spent on a computer, tablet, mobile phone, or watching television on a typical weekday and weekend outside of any childcare. The response alternatives ranged from 0 to > 3.5 h with 15‐min intervals. The answers were categorised into none, 15–60 min and > 60 min for 18‐month‐old children, and into ≤ 1, 1.5–2, and ≥ 2.5 h for 4‐year‐old children. Children 18 months old were considered to have met screen time guidelines if their parents reported no screen time at all. For those 4 years old, the corresponding cut‐off was 1 h of screen time.
2.3.5. Background Information
The highest level of education achieved by either the mother or the father was provided by Statistics Sweden and was used as an indicator of socioeconomic status. Education level was dichotomised into low and high at less or more than 12 years of schooling. The children's addresses were used to classify municipalities as rural, semi‐urban or urban based on the definition by Swedish Association of Local Authorities and Regions. The questionnaire responses regarding the parental country of birth were categorised into three groups: both parents, one parent, and neither parent born in Sweden.
2.4. Statistics
Data were analysed using StataSE 18 (StataCorp, College Station, Texas, USA). Descriptive statistics are presented as means, standard deviations for continuous variables and proportions for categorical variables. An independent samples t‐test was used for continuous data and a chi‐square test for categorical data to test for differences related to sex and parental education.
3. Results
The study included 1078 children aged 1.5 ± 0.1 years and 750 aged 4.1 ± 0.1 years (Table 1). Among the children aged 18 months and 4 years, respectively, 47% and 49% were girls, 13% and 14% had parents with low education, 83% and 86% lived in semi‐urban or urban areas, and 76% and 79% had both parents born in Sweden. Among the children 18 months old, 69% attended preschool at least twice a week, compared to 99% of those aged 4 years.
TABLE 1.
Descriptive characteristics among boys and girls, stratified by age group.
| 18 months old | 4 years old | |||||
|---|---|---|---|---|---|---|
| Total | Girls | Boys | Total | Girls | Boys | |
| n (%) | n (%) | |||||
| n = 1078 | n = 507 | n = 571 | n = 750 | n = 368 | n = 382 | |
| Age in years (Mean (SD)) | 1.5 (0.1) | 1.5 (0.1) | 1.5 (0.1) | 4.1 (0.1) | 4.1 (0.1) | 4.1 (0.1) |
| Parental education | ||||||
| Low | 139 (12.9) | 49 (9.6) | 90 (15.9) | 102 (13.6) | 56 (15.3) | 46 (12.0) |
| High | 939 (87.1) | 462 (90.4) | 477 (84.1) | 648 (86.4) | 311 (84.7) | 337 (88.0) |
| Parental country of birth | ||||||
| Both Swedish born | 816 (75.7) | 389 (76.1) | 427 (75.3) | 592 (79.0) | 294 (80.1) | 298 (78.0) |
| One Swedish born | 180 (16.7) | 89 (17.4) | 91 (16.1) | 109 (14.6) | 49 (13.4) | 60 (15.7) |
| Both non‐Swedish born | 82 (7.6) | 33 (6.5) | 49 (8.6) | 48 (6.4) | 24 (6.5) | 24 (6.3) |
| Type of municipality | ||||||
| Rural | 187 (17.4) | 84 (16.4) | 103 (18.2) | 109 (14.6) | 60 (16.3) | 49 (12.8) |
| Semi‐urban | 392 (36.4) | 200 (39.1) | 192 (33.9) | 279 (37.3) | 147 (40.1) | 132 (34.6) |
| Urban | 499 (46.3) | 227 (44.4) | 272 (48.0) | 361 (48.2) | 160 (43.6) | 201 (52.6) |
| Attends preschool | 747 (69.4) | 361 (70.8) | 386 (68.1) | 733 (98.5) | 360 (98.4) | 373 (98.7) |
| Has older siblings | 566 (53.0) | 260 (51.1) | 306 (54.6) | 381 (51.9) | 187 (52.5) | 194 (51.3) |
| Has younger siblings | 48 (4.5) | 13 (2.6) | 35 (6.3) | 343 (46.5) | 157 (43.6) | 186 (49.2) |
3.1. Physical Activity and Sedentary Time by Accelerometry
Among the 18‐month‐old children, 746 participated in PA measurements, and of these, 584 (78%) had valid data. Among those 4 years old, 561 participated, and of these, 379 (68%) had valid data. The 18‐month‐old children, for whom valid accelerometer data were available, differed significantly from those without valid data in that more of the former had parents with high education (p = 0.04), and that one or both parents were born in Sweden (p = 0.01). There were no between‐sex differences and no differences in any of the variables for 4‐year‐old children.
3.2. Physical Activity and Sedentary Time by Age Group and Sex
Among 18‐month‐old children, no sex differences were seen in moderate‐to‐vigorous PA, light PA, or sedentary time during the whole week or on weekdays (Table 2). However, there was a significant difference in moderate‐to‐vigorous PA during weekends, with boys showing a mean of 56 ± 24 min compared to 52 ± 22 min for girls (p = 0.034). The 18‐month‐old children were sedentary on average almost 7 h/day (418 min/day).
TABLE 2.
Device‐measured sedentary time and physical activity among boys and girls, stratified by age group.
| 18 months old | 4 years old | |||||||
|---|---|---|---|---|---|---|---|---|
| Total | Girls | Boys | p | Total | Girls | Boys | p | |
| Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||
| Whole week | n = 584 | n = 271 | n = 313 | n = 379 | n = 188 | n = 191 | ||
| Sedentary time, min/day | 418 (70) | 419 (70) | 419 (70) | 0.770 | 540 (50) | 549 (46) | 531 (51) | < 0.001 |
| Light PA, min/day | 202 (35) | 199 (36) | 204 (35) | 0.069 | 92 (15) | 89 (15) | 95 (15) | < 0.001 |
| Moderate PA, min/day | — | — | — | — | 67 (18) | 63 (15) | 71 (19) | < 0.001 |
| Vigorous PA, min/day | — | — | — | — | 24 (11) | 23 (10) | 26 (12) | 0.015 |
| Moderate‐to‐vigorous PA, min/day | 51 (19) | 50 (18) | 52 (19) | 0.116 | 91 (27) | 86 (24) | 97 (28) | < 0.001 |
| Weekdays | n = 600 | n = 276 | n = 324 | n = 396 | n = 198 | n = 198 | ||
| Sedentary time, min/day | 424 (74) | 424 (75) | 424 (74) | 0.992 | 547 (55) | 555 (52) | 539 (56) | 0.004 |
| Light PA, min/day | 200 (37) | 198 (37) | 202 (38) | 0.221 | 93 (18) | 90 (17) | 97 (18) | < 0.001 |
| Moderate PA, min/day | — | — | — | — | 68 (20) | 64 (17) | 72 (21) | < 0.001 |
| Vigorous PA, min/day | — | — | — | — | 24 (12) | 23 (11) | 26 (13) | 0.017 |
| Moderate‐to‐vigorous PA, min/day | 50 (19) | 49 (18) | 50 (19) | 0.331 | 92 (29) | 86 (26) | 98 (32) | < 0.001 |
| Weekends | n = 589 | n = 276 | n = 313 | n = 399 | n = 197 | n = 202 | ||
| Sedentary time, min/day | 403 (80) | 405 (79) | 401 (81) | 0.603 | 527 (66) | 533 (62) | 520 (69) | 0.039 |
| Light PA, min/day | 203 (42) | 200 (44) | 206 (41) | 0.100 | 88 (19) | 85 (19) | 91 (18) | 0.003 |
| Moderate PA, min/day | — | — | — | — | 64 (20) | 60 (20) | 68 (21) | < 0.001 |
| Vigorous PA, min/day | — | — | — | — | 25 (15) | 24 (13) | 27 (16) | 0.036 |
| Moderate‐to‐vigorous PA, min/day | 54 (23) | 52 (22) | 56 (24) | 0.034 | 89 (32) | 84 (30) | 94 (33) | 0.001 |
Note: The results for time per day in the two age groups are not directly comparable as different cut points were used for each group. Results in bold are significant at α < 0.05.
At age four, boys spent more time in moderate‐to‐vigorous PA compared to girls across all time periods: the whole week (97 vs. 86 min, p < 0.001); weekdays (98 vs. 86 min, p < 0.001); and weekends (94 vs. 84 min, p = 0.001). Boys also spent more time in light PA during the whole week (95 vs. 89 min, p < 0.001), on weekdays (97 vs. 90 min, p < 0.001), and on weekends (91 vs. 85 min, p = 0.003). In addition, boys had less sedentary time during the whole week (531 vs. 549 min, p < 0.001), on weekdays (539 vs. 555 min, p = 0.004), and on weekends (520 vs. 533 min, p = 0.04). The four‐year‐old children were sedentary on average 9 h/day (540 min/day). The results from the device‐measured PA and sedentary time are shown in Table 2.
3.3. Proportions That Met the Physical Activity Guidelines
The results showed that 94% of the 18‐month‐old children and 51% of the four‐year‐old children met the guidelines of PA. There was no sex difference among the 18‐month‐old children (Figure 1). However, among the four‐year‐old children, a higher proportion of boys than girls met the guidelines (60% vs. 42%, p < 0.001).
FIGURE 1.
Meeting physical activity guidelines across age groups, stratified by sex (A) and parental education (B).
3.4. Physical Activity and Sedentary Time During Winter and Summer Months
We observed no differences in moderate‐to‐vigorous PA between winter and summer for children in either age group. However, the 18‐month‐old children spent more time in light PA during weekdays in summer than in winter (206 vs. 196 min, p = 0.001). In addition, sedentary time was significantly higher in winter compared to summer during the whole week (424 vs. 411 min, p = 0.02) and on weekdays (430 min vs. 416 min, p = 0.02), but there was no significant difference on weekends.
The 4‐year‐old children spent more time in light PA in summer than in winter during the whole week (94 vs. 90 min, p = 0.02) and on weekdays (95 vs. 91 min, p = 0.049), but not on weekends. These results are presented in Appendix S1.
3.5. Organised Activities
Approximately 7% of the parents of 18‐month‐old children reported that their children participated in organized activities during their leisure time, with no sex differences observed.
Among the 4‐year‐old children, 46% participated in organised activities. There was a significant difference by sex, with a higher proportion of girls participating compared to boys (51% vs. 41%, p = 0.005; Table 3). The most common activities for 18‐month‐old girls were swimming and dancing, while boys the same age mostly participated in swimming and gymnastics. Children aged 4 years mainly participated in gymnastics and swimming, plus dancing for girls and ball sports for boys.
TABLE 3.
Physical activity and sedentary behaviour across sex and parental education, stratified by age groups.
| 18 months old | 4 years old | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total | Sex | Education | Total | Sex | Education | |||||||||
| Girls | Boys | p | Low | High | p | Girls | Boys | p | Low | High | p | |||
| n (%) | n (%) | n (%) | n (%) | |||||||||||
| Participates in organised activities | 74 (7) | 31 (6) | 43 (8) | 0.322 | 8 (6) | 66 (7) | 0.569 | 341 (46) | 187 (51) | 154 (41) | 0.005 | 36 (36) | 305 (47) | 0.029 |
| Meeting screen time guidelines on weekdays | 235 (22) | 119 (23) | 116 (21) | 0.254 | 14 (10) | 221 (24) | < 0.001 | 449 (60) | 233 (64) | 216 (57) | 0.064 | 48 (48) | 401 (62) | 0.005 |
| Meeting screen time guidelines on weekends | 185 (17) | 88 (17) | 97 (17) | 0.959 | 13 (9) | 172 (18) | 0.009 | 211 (28) | 118 (32) | 93 (25) | 0.020 | 23 (23) | 188 (29) | 0.189 |
| Transport type to preschool | ||||||||||||||
| Active child and parent | 73 (10) | 38 (11) | 35 (9) | 0.805 | 10 (9) | 63 (10) | 0.001 | 258 (36) | 128 (36) | 130 (35) | 0.595 | 25 (27) | 233 (37) | < 0.001 |
| Passive child and active parent | 361 (49) | 174 (49) | 187 (49) | 36 (34) | 325 (52) | 147 (20) | 76 (22) | 71 (19) | 5 (5) | 142 (23) | ||||
| Passive child and parent | 301 (41) | 144 (41) | 157 (41) | 60 (57) | 241 (38) | 320 (44) | 150 (42) | 170 (46) | 64 (68) | 256 (41) | ||||
Note: Results in bold are significant at α < 0.05.
3.6. Mode of Transport
In total, 10% of the parents of 18‐month‐old children and 36% of the 4‐year‐old children reported that both they and their child used active transport to preschool, with no sex differences observed (Table 3).
3.7. Proportions That Met the Screen Time Guidelines
In total, 22% of the 18‐month‐old children met the screen time guidelines on weekdays and 17% on weekends, with no sex differences observed (Table 3). Corresponding percentages among 4‐year‐old children were 60% on weekdays and 28% on weekends. At this age, significantly more girls than boys met the screen time guidelines (32% vs. 25%, p = 0.02).
3.8. Socioeconomic Status
There were no differences between the groups of high and low parental education in device‐measured PA, sedentary time, or meeting the PA guidelines in either age group (Tables 3 and 4; Figure 1). However, a larger proportion of the highly educated parents reported that their four‐year‐old child participated in organised activities compared to parents with low education (47% vs. 36%, p = 0.03; Table 3).
TABLE 4.
Device‐measured sedentary time and physical activity among children of parents with high and low levels of education, stratified by age group.
| 18 months old | 4 years old | |||||||
|---|---|---|---|---|---|---|---|---|
| Total | Low | High | p | Total | Low | High | p | |
| Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||
| Whole week | n = 584 | n = 64 | n = 520 | n = 379 | n = 46 | n = 333 | ||
| Sedentary time, min/day | 418 (70) | 408 (74) | 419 (69) | 0.229 | 540 (50) | 534 (54) | 541 (49) | 0.407 |
| Light PA, min/day | 202 (35) | 207 (35) | 201 (36) | 0.233 | 92 (15) | 91 (15) | 92 (15) | 0.594 |
| Moderate PA, min/day | — | — | — | — | 67 (18) | 65 (17) | 67 (18) | 0.304 |
| Vigorous PA, min/day | — | — | — | — | 24 (11) | 23 (11) | 25 (11) | 0.368 |
| Moderate‐to‐vigorous PA, min/day | 51 (19) | 54 (18) | 51 (19) | 0.136 | 91 (27) | 88 (27) | 92 (27) | 0.292 |
| Weekdays | n = 600 | n = 66 | n = 534 | n = 396 | n = 50 | n = 346 | ||
| Sedentary time, min/day | 424 (74) | 413 (74) | 425 (74) | 0.216 | 547 (55) | 545 (61) | 548 (54) | 0.782 |
| Light PA, min/day | 200 (37) | 205 (37) | 200 (38) | 0.348 | 93 (18) | 90 (19) | 94 (17) | 0.215 |
| Moderate PA, min/day | — | — | — | — | 68 (20) | 64 (19) | 69 (20) | 0.148 |
| Vigorous PA, min/day | — | — | — | — | 24 (12) | 22 (11) | 25 (12) | 0.220 |
| Moderate‐to‐vigorous PA, min/day | 50 (19) | 53 (19) | 49 (19) | 0.125 | 92 (29) | 87 (28) | 93 (29) | 0.142 |
| Weekends | n = 589 | n = 524 | n = 65 | n = 399 | n = 50 | n = 349 | ||
| Sedentary time, min/day | 403 (8) | 398 (89) | 404 (79) | 0.582 | 527 (66) | 512 (78) | 529 (64) | 0.090 |
| Light PA, min/day | 203 (42) | 205 (48) | 203 (42) | 0.657 | 88 (19) | 90 (18) | 88 (19) | 0.477 |
| Moderate PA, min/day | — | — | — | — | 64 (20) | 66 (21) | 64 (20) | 0.428 |
| Vigorous PA, min/day | — | — | — | — | 25 (14) | 26 (15) | 30 (15) | 0.793 |
| Moderate‐to‐vigorous PA, min/day | 54 (23) | 57 (21) | 54 (23) | 0.420 | 89 (32) | 92 (33) | 89 (32) | 0.533 |
Note: The results for time per day in the two age groups are not directly comparable, as different cut points were used for each group.
Concerning transport mode, 10% of parents with high and 9% of those with low education levels reported that both they and their 18‐month‐old child used active transportation to preschool. However, a larger proportion of parents with high education (52%) than of those with low education (34%) reported using active transport themselves while their child was transported passively (p = 0.001). Among parents of 4‐year‐old children, 37% of the high education group and 27% of the low education group reported that both they and their child used active transport. Additionally, 23% of parents with high education and 5% of those with low education used active transport themselves while their child was transported passively (p < 0.001).
Lastly, a greater proportion of parents with high than with low education levels reported that their 18‐month‐old child met screen time guidelines on both weekdays (24% vs. 10%, p < 0.001) and weekends (18% vs. 9%, p = 0.009). A similar result was obtained for four‐year‐old children on weekdays: 62% of highly educated parents reported that the child met screen time guidelines, versus 47.5% of less highly educated parents (p = 0.005; Table 3; Figure 2).
FIGURE 2.
Screen time on weekdays and weekends, by age group and educational level. Note that the lowest category corresponds to the screen time guidelines in each age group. (A) Screen time on weekdays among children 18 months old; (B) Screen time on weekends among children 18 months old; (C) Screen time on weekdays among children four years old; (D) Screen time on weekends among children four years old.
4. Discussion
This is the first national study to examine device‐measured PA, sedentary time, and screen time in Swedish toddlers and young children. The results showed that most 18‐month‐old children met the PA guidelines, while only about half of four‐year‐old children did. The majority of children in both age groups exceeded screen time guidelines, especially on weekends. Variations were observed depending on age, sex, and parental education.
These findings aligned with previous studies that have used device‐based measures of PA, which reported low proportions of young children meeting the recommended levels of PA [4, 5]. While this study showed that the majority of 18‐month‐old children were sufficiently active, only about half of the four‐year‐old children met the PA guidelines.
The sex differences observed by age four, when boys were more active and less sedentary than girls, were consistent with previous findings [10, 12]. Interestingly, although boys were more active overall and a higher proportion met PA guidelines, girls more often participated in organised activities at age four. Furthermore, girls more frequently adhered to screen time guidelines, particularly on weekdays. This may reflect that boys engage in more unstructured, higher‐intensity activities. Supporting this, a study of 2–4‐year‐old children in Britain found that boys spent significantly more time playing outdoors than girls [20]. It is also possible that the organised activities girls participated in, often limited to one or a few structured sessions per week, did not substantially contribute to their overall PA levels.
There was no sex difference among 18‐month‐old children, which aligned with another Swedish study conducted in 2‐year‐old children [11]. Notably, however, our results revealed differences during weekends, suggesting that parents may play an early role in shaping PA behaviours [21], particularly in encouraging boys to be more active. Sex‐specific activity patterns may begin to develop already in early childhood, highlighting the importance of promoting equal opportunities for PA from a young age.
The accelerometer data showed no significant differences in PA or sedentary time based on parental education, suggesting that socioeconomic background may have little impact on PA levels in early childhood [22]. Similarly, in the study Riksmaten Adolescents, no clear socioeconomic differences in device‐measured PA were observed among younger children, whereas disparities were more evident in self‐reported PA [23, 24]. However, the lower proportion of valid accelerometer data among children of parents with lower education may have reduced the representativeness of our results for this group.
In contrast to accelerometer data, self‐reported data showed significant differences between socioeconomic groups. A larger proportion of children of parents with higher education participated more in organised physical activities, already at age four, and in both age groups, they more often used active transport modes. The early engagement in organised activities among children with more highly educated parents may contribute to long‐term participation in organised PA, reinforcing socioeconomic disparities in health behaviours over time. Previous research indicated that early involvement in sports clubs generally was associated with higher PA levels later in life [25].
Furthermore, screen time differed significantly depending on parental education level. Children of more highly educated parents had lower screen time, especially on weekdays, and these differences were already evident in 18‐month‐old children during weekends. These findings suggest that socioeconomic disparities in behaviour may emerge early, through choices made by parents. The early emergence of socioeconomic differences in screen time and activity behaviours highlights the need for interventions starting already at a young age. Early childhood is a critical period for the development of long‐term health behaviours, as movement behaviours are often established during this time and tend to track into later childhood and adolescence [26].
5. Limitations and Strengths
This study was the first to examine device‐measured PA, sedentary time, and screen time in a national sample of young children in Sweden. A major strength of this study was the large sample size and representativeness regarding sex and geographical location. Another strength was the use of accelerometers to obtain robust and detailed assessments of PA and sedentary time, thereby avoiding biases associated with self‐reporting. However, the study also had some limitations. Parents with higher education participated to a higher degree. Non‐wear of the accelerometers was higher among children whose parents had low education or were born outside Sweden, potentially leading to bias in the PA results. It is possible that there were differences between these groups in device‐measured PA that were not captured. In addition, different accelerometer cut points were used for the two age groups, limiting the possibility to make direct comparisons across ages. The study also relied on parent‐reported screen time and participation in activities, which may be subject to recall or social desirability bias. Finally, the cross‐sectional design prevented any conclusions about causality.
6. Conclusion
This national study showed that while most 18‐month‐old children met PA guidelines, only about half of 4‐year‐old children did, and screen time was high in both age groups. There were sex differences in device‐measured PA and sedentary time by age four, with boys being more active and less sedentary than girls. Socioeconomic differences in screen time and activity behaviours were already found at the age of 18 months. These early disparities highlight the need for targeted interventions already at a young age to promote healthy movement behaviours and reduce future inequalities.
Author Contributions
Gisela Nyberg: conceptualisation, writing – original draft, methodology, writing – review and editing. Björg Helgadóttir: methodology, data curation, formal analysis, writing – review and editing. Lotta Moraeus: project administration, methodology, investigation, writing – review and editing. Jessica Petrelius Sipinen: methodology, investigation, writing – review and editing. Anna‐Karin Lindroos: methodology, investigation, writing – review and editing. Andreas Fröberg: writing – original draft, methodology, writing – review and editing.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Appendix S1: Device measured sedentary time and physical activity during winter and summer months, stratified by age groups.
Acknowledgements
We thank all the participating families for taking the time to provide information to the survey.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Appendix S1: Device measured sedentary time and physical activity during winter and summer months, stratified by age groups.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.