COVID lockdowns affect preschoolers' eating, activity and sleep routines, parents say

The coronavirus disease 2019 (COVID-19) pandemic brought in its wake a slew of restrictions on leaving the house, social interactions and educational or business opportunities. For very young children growing up under these conditions, the change is marked. A new study from the UK reports the effect of these changes in the typical pattern of life on preschool children.

Background

The UK experienced several lockdowns, beginning March 2020, with freedoms being curtailed severely when it came to leaving the house. After over two months, some relaxation of lockdown measures occurred in late May 2020. Preschools were allowed to reopen in June 2020, but the attendance was less than half, at 37%, compared to 2019.

Medically, children have been spared by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but their lifestyle has undergone marked disruptions. Some areas of disturbance include exercise or physical activity, social interactions, sleep, eating patterns, and screen time.

An earlier study called the Covid-19: Supporting Parents and Young Children during Epidemics (Co-SPYCE) study reported that among 2-4-year-old children, over a quarter were watching their screens for three or more hours a day, but only about a fifth were having the requisite amount of physical exercise.

Another survey by Public Health Scotland, the COVID-19 Early Years Resilience and Impact Survey found that among children aged 2-7 years in Scotland, eating behaviors had deteriorated in a third of cases. About half the children were reported to have become more sedentary, with a quarter apparently having increased their level of activity.

What Did the Study Show?

The current paper, published in the journal BMJ Open, describes the impact of the pandemic restrictions on these areas of children’s health.

The researchers conducted detailed qualitative interviews with the parents of children aged 3-5 years to understand what was happening in these areas. There were 20 parents, 16 mothers, and four fathers, with a mean age of 34 years.

Of the group, 60% were White British, with half living in the most deprived areas. Five of them were single parents. In 13 of the cases, one parent at least was non-working, but in 3, neither had a job at the time. Two parents said they had no garden for the child.

Surprisingly, there was little difference in the impact of the lockdown in different socioeconomic groups or even other attributes of the participants.

Eating

Children should have healthy eating behaviors established in their early years. However, a quarter of primary school children have excessive body weight, with higher rates among deprived children.

Parents spent more on food, especially snacks, with the lockdown while cutting down on shopping trips. In most cases, children were reported to be eating more snacks, either because of boredom, lack of routines, or because the parents bought them treats to compensate for what they were missing due to the restrictions.

Some children were taking too long to eat compared with pre-pandemic days, while others were unwilling to eat. This was often related to snacking. However, many parents found that they could eat with their children due to the lockdown, and enjoyed cooking and sharing the meal prep time with their children.

Takeaway meals were also reduced in some cases because of concerns related to hygiene. Others said they took out more takeaways as a special thing to anticipate.  

Spending on food increased during the lockdown due to the presence of the whole family at home and more snacking – though one mother said they spent less on junk food to save money. Price increases were an issue, while for one child, the closure of the nursery led to the loss of free meals for the family. Online shopping became the go-to in some cases because the supermarkets nearby, though cheaper, did not offer this service.

Physical activity

Children under the age of five should ideally have 180 minutes of physical activity every day. Unfortunately, the lockdown of playgrounds and preschools led to reduced chances of physical activity for children, increasing the risk of sedentary behavior in most cases.

Walking to school and back was one route of activity that vanished with the lockdown, along with normal play at school and with friends. Children with siblings tended to play more because they had someone to play with, as did those who could use equipment such as a bicycle, scooter, pool, or trampoline.

Having a yard was important. Those who did not, as two parents described, found it a challenge to cope with active children in a block of flats without disturbing neighbors or going outside. Of course, good weather helped as well.

Some parents coped by exploring the neighborhood with their children, often finding new spots to enjoy. If one parent was not working, there was someone to put effort into keeping the child active – an option not always possible during work hours.

Screen Time

Preschoolers are naturally active and curious, besides having to be trained in social interactions. This means they must be supervised almost constantly. Lockdowns brought in situations where children were confined to their homes.

Especially if homes were crowded, lacked their own grounds or yards, and if parents were working or the family was under other stress, the mix was right for behavioral challenges to arise among these young children and their caregivers.

Many families found that being unable to go out or interact socially with others resulted in increased screen time. The device became a friend in some cases, replacing friends and family who were out of reach. Other parents used screen time to get important office or housework done without interruptions from the child.

Parents also used screen time to give themselves a break from intensive parenting, even while feeling guilty because they did not really approve of using it as a means to keep the child happy and quiet. In some cases, educational screen time was seen as a compromise since it kept the child intellectually engaged.

Rather than the sedentary aspect of screen time, parents tended to worry about the impact on the child’s intelligence and initiative. Some thought it made the children unable to enjoy other aspects of a normal childhood. Others enforced rules as to the content, time of day, and total watching time.

Sleep Behavior

Children aged 3-4 years are advised to have 11-13 hours of sleep over 24 hours. However, half the parents said their children were not sleeping as well as before, with some staying up very late. The reasons offered included being less active, boredom leading to more screen time, and lack of routine. Some wondered if anxiety or worry on the child’s part was a contributor to the disturbed sleep patterns.

What Are the Implications?

Parents generally did not attach much weight to changes in snacking patterns. Still, one mother whose child had returned to nursery confessed the difficulty of creating a healthy eating pattern after the earlier lack of routine or rules. They also wished to retain the good habits of cooking at home and eating together and looked forward to outside activities like gymnastics and swimming while acknowledging that it would take conscious effort to make changes in their pre-pandemic routines and keep safe.

Some did note that children were more cautious about their motor activities involving some degree of skill, such as swimming or bicycling. Most thought that the increased screen time would return to normal once school routines were in place, but some doubted whether this process would be straightforward.

When parents encouraged and participated in physical activity with their children, it was likely that the children would be very active. The lockdown took its toll in closing down many opportunities for play, physically via playground non-availability and by restricting interactions between children not belonging to the same household.

The lack of significant disparity in the impact on children could be due to the sample characteristics such as the low level of unemployment and the fact that most families had access to a yard or garden. However, the findings support the need to provide parents with help to establish new healthy routines that incorporate physical activity for young children and restrict unhealthy food and screen time.

Parents must also be helped in a manner that does not exacerbate existing guilt during this stressful period when most spend all day with their children the whole day long for the first time in their lives, at least since infancy. In fact, about 70% of parents were already feeling guilty and ashamed, with a significant impact on their mental well-being.

“While some positive changes were reported, there were widespread examples of lack of routines, habits and boundaries which, at least in the short term, were likely to have been detrimental for child health and development. Guidance and support for parents and families could be valuable to protect child health.”

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.