Assessment and counseling to promote physical activity in children

Assessment of sedentary behaviors	Examples of goals^*	Counseling tips
Recreational screen time, including: Television, videos, or movies Video games Other internet, such as tablets Social media and smartphones	Goals vary by age^[1]: <2 years – Little or no screen time ≥2 years – Maximum 1 hour daily	Household rules that may help to limit screen time: Set a specific screen time limit, which applies to all family members No television viewing during meals No television in child's bedroom No smartphone in bedroom at night Develop a "Family Media Agreement" that outlines family rules and objectives for online and media use (example available from HealthyChildren.org in English and Spanish)^[2] Include children/adolescents in the goal-setting process; this is important because caregivers cannot continuously monitor and enforce these rules
Educational screen time: Homework Reading Computer-based learning		Educational screen time is not restricted. However, advise the family to: Track these activities for the purposes of awareness Do not mix with recreational screen time Balance with physical activity
Assessment of physical activity	Examples of goals^*	Counseling tips
Record type, frequency, and duration of: Unstructured activity/active play Time outdoors Routine activity, such as walking to school, work, or chores in yard or house Spontaneous active games with friends and family Structured physical activity Sports Activity classes, such as dance, yoga, or martial arts Physical conditioning	Goals vary by age: Preschool-aged – ≥2 hours of unstructured activity daily^[3] School-aged and older – ≥1 hour moderate or vigorous structured physical activity daily^[4,5] The daily total can consist of several shorter periods of activity	Strategies to promote physical activity^[6,7]: Include family-based physical activity for modeling and encouragement ("game night," walks, hikes, family sports) Start with low-key recreational activities and progress to more structured, physically challenging activities as tolerated Offer options – Team-based or individual sports, coached or self-directed, competitive or noncompetitive Encourage children to participate in choice of activity A step counter (pedometer) may interest and motivate some children Consider physical activity levels when choosing daycare or afterschool programming To elicit practical options, ask the family about: Barriers to physical activity, including cost and access What opportunities are available (eg, school- or community-based programs or facilities)

Examples of questions to ask for a brief semiquantitative assessment of physical activity in children, as well as tips for helping families achieve recommended goals. Evaluating activity in each of these areas provides an estimate of the child's overall activity level and helps identify areas for potential improvement.

* These are examples of optimal goals. Actual goals for counseling depend on the child's age, degree of obesity, current habits, and other considerations including family finances and local resources. In general, more stringent goals should be set as counseling progresses.

References:

Daniels SR, Hassink SG, Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics 2015; 136:e275.
Family Media Plan. American Academy of Pediatrics. https://www.healthychildren.org/english/fmp/pages/mediaplan.aspx (Accessed on October 2, 2023).
World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. 2019. https://apps.who.int/iris/handle/10665/311664 (Accessed on July 1, 2022).
Spear BA, Barlow SE, Ervin C, et al. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007; 120:S254.
United States Department of Health and Human Services. Physical activity guidelines for Americans, 2nd edition (2018). https://health.gov/our-work/physical-activity/current-guidelines (Accessed on August 06, 2021).
Foster C, Moore JB, Singletary CR, Skelton JA. Physical activity and family-based obesity treatment: a review of expert recommendations on physical activity in youth. Clin Obes 2018; 8:68.
Brown HE, Atkin AJ, Panter J, et al. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obes Rev 2016; 17:345.

General guidance from: Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 2023; 151:e2022060640.

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Assessment and counseling to promote physical activity in children