Prescription for Playtime

By Hillary Eames
Thursday, May 14, 2020

To further illustrate the mental and physical health benefits of exercise, the American Academy of Pediatrics recommends pediatricians encourage physical activity in patients.

Only One in four children currently meets the recommended guidelines of 60 minutes of physical activity per day, the American Academy of Pediatrics (AAP) reports, including children as young as preschoolers. The typical preschooler spends roughly six hours in sedentary activity. This pattern continues into adolescence, with the average 8- to 18-year-olds spending more than seven hours in front of a screen.

As in adults, the health effects of sedentary behavior in children is preventable; however, habits learned in childhood can be difficult to break. As a response, the AAP is encouraging pediatricians to help combat the effects of sedentary activity in children’s health while also guiding them to build healthy lifestyle habits they can carry into adulthood. A recent clinical report published by the AAP encourages physicians prescribe the recommended physical activity for patients as needed.

The health risks of a lack of physical activity are well documented for adults, but pediatricians are starting to see the same health concerns appear in pediatric patients. In a press release, Natalie D. Muth, MD, MPH, FAAP, FACSM, coauthor of the AAP report, states that pediatricians are diagnosing children with obesity, fatty liver disease, diabetes and depression with startling frequency. Additionally, pediatricians may be unfamiliar with the assessment and guidance of how to recommend physical activity to children, which can exacerbate the problem. According to the report, pediatricians are encouraged to assess the physical activity levels and literacy during annual visits, advocate for opportunities for children to remain physically active in their communities, and incorporate physical activity assessments and prescriptions.

Physical Activity Guidelines and Recommendations for Pediatricians

As stated, the 2018 Physical Activity Guidelines Advisory Committee recommends at least 60 minutes of physical activity per day for children between the ages of 6 and 17. Children should perform these activities, which include vigorous, muscle-building and bone-strengthening exercises, at least three days each week. Children younger than age 6 should remain physically active, as well, though less time is necessary for optimal health. Toddlers should have roughly 15 minutes of free play and physical activity for every hour they are awake, averaging roughly three hours per day. This includes free play and neighborhood walks, according to the APP. Infants need at least 30 minutes of activity a day, including interactive floor-based playtime (tummy time) while they are awake.

Free play and organized sports are both recommended options for young children and adolescents; however, children should be discouraged from specializing in one sport to avoid the risk of repetitive use injuries and eventual loss of interest. Instead, pediatricians as well as parents can encourage variety in physical activity, or provide sports and free play as forms of socialization with friends and peers.

When polled, the AAP reports that 98% of pediatricians ask general questions about a child’s physical activity, but only 66% follow up with more specified questions about type, duration and intensity, and less than 10% used a standardized written questionnaire. The AAP reports that, while it is encouraging in principle that pediatricians ask about physical activity, the methods used to do so could be improved.

Additionally, one third of pediatricians were able to correctly identify the recommended guidelines for pediatric physical activity. As a remedy, the case study recommends each pediatrician find practical, valid and reliable methods for learning about a patient’s physical activity level. Pediatricians should also seek insight into a child’s physical literacy — e.g., their enjoyment and confidence in physical activity. It is a necessary step to not only gain insight into current levels of physical activity but to also help set achievable, realistic and enjoyable goals to encourage children to meet physical activity guidelines moving forward.