May 17, 2026
Pediatric Research Update: Physical Activity Patterns and Associations in Infants and Toddlers
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Key Takeaways
- The most increase in physical activity (PA) was found to be from infancy to 24 months and then tended to plateau.
- Greater screen time exposure was associated with a slower rate of PA increase between 6 and 24 months of age.
- Based on these findings, clinicians should consider integrating PA anticipatory guidance into well-child visits beginning in early infancy, with attention to screen time limits and opportunities for active play.
Article Summary #
A longitudinal study of 124 infants found physical activity rises ~45% by 24 months, then plateaus. Screen time slowed PA growth; older siblings boosted it. Early counseling on active play and screen limits is a key obesity prevention opportunity.
Article review #
Recommendations for infants and toddlers under age 3 are not included in national public health guidelines for Physical Activity (PA), due to lack of data surrounding level of activity norms and their correlations to health benefits and negative associations. In their original article, Longitudinal Change in Physical Activity in Children 6 to 36 Months of Age, Pate and colleagues not only present the developmental pattern for PA in this age group but also highlight factors that may hinder or promote PA development.
It is well known that PA at any age, including children, is associated with a wide range of health benefits. Little is known, however, about PA in children under age 3 years. The authors gathered data from the Linking Activity, Nutrition and Child Health (LAUNCH) Study and acquired objective data using an accelerometer to measure PA, as well as subjective reports on commonly hypothesized correlates of PA, namely screen time and others.
From 6 months, the stages of motor development are predictable and progress quickly, starting often with tripod sitting to a stiff-legged run by 36 months. Health care professionals providing pediatric care have the unique opportunity to give anticipatory
guidance on PA for this age group to encourage natural movement based on their child's abilities. Discussions at health maintenance visits offer chances to promote, over time, parents fostering a love for PA with their children and reinforcing positive outcomes such as improved sleep, socialization with peers, and increased energy. Given that PA is one of the main pillars of lifestyle counseling for those with obesity, promoting active movement from the earliest months of life may influence the developmental trajectory toward or away from obesity and its complications. This makes these early conversations not only appropriate but clinically essential.
The researchers found that PA increased at a significant rate from 6 months to 24 months, then tended to plateau at 36 months of age. Of the several variables measured, higher PA levels were associated with children who were breastfed and who had higher levels of daytime sleep, while lower PA levels were found in those with greater "enjoyment of food." The study also identified a positive association between PA and maternal smoking history; however, this counterintuitive finding lacks a clear mechanistic explanation and likely reflects residual confounding. It should be interpreted with caution and does not carry clinical implications. Interestingly, screen time was associated with higher PA levels at 6 months but with a slower rate of PA growth by 24 months, suggesting that the negative impact of screen exposure on physical activity accumulates over time rather than appearing immediately. Higher PA levels were also found in children with older siblings in the home.
This study underscores PA as an important aspect of life at all ages, stages, and developmental abilities. Further evidence regarding PA in this young age group, as it relates to health benefits and recommendations for developmentally appropriate activities, is needed for future inclusion in national guidelines for both patients and health care practitioners. For clinicians in obesity medicine, this paper is a practical reminder that the window for shaping activity behavior opens in the first year of life. Anticipatory guidance on screen time limits and sibling-inclusive active play represents a low-cost, evidence-informed entry point for obesity prevention beginning in infancy.
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Pate RR, Dowda M, McLain AC, Frongillo EA, Saunders RP, Inak N, McIver KL. Longitudinal Change in Physical Activity in Children 6 to 36 Months of Age. J Pediatr. 2025 Jan;276:114358. doi:10.1016/j.jpeds.2024.114358. Epub 2024 Oct 16. PMID: 39423909; PMCID: PMC11645185.
Article reviewed by:
Tahniat Syed, MD, MPH, DABOM, FAAP
Tahniat Sultana Syed, MD, MPH, DABOM, FAAP is a Clinical Associate Professor of Pediatrics at the University of Pittsburgh School of Medicine and Clinical Director for the Center for Adolescent and Young Adult Health at UPMC Children's Hospital of Pittsburgh, where she has practiced as an attending physician for 18 years. She completed her medical training at the Medical College of Pennsylvania, her pediatrics residency at St. Christopher's Hospital for Children, and fellowship training in general academic and adolescent medicine at UPMC Children's Hospital of Pittsburgh, followed by an MPH from the University of Pittsburgh. Her clinical expertise spans adolescent medicine, reproductive health, and obesity medicine, with a particular interest in the role of lifestyle behaviors — including physical activity — in the long-term health of children and adolescents.
V. Sushma Chamarthi, MD, FAAP, DABOM
V. Sushma Chamarthi, MD, FAAP, DABOM is a board-certified pediatrician and diplomate of the American Board of Obesity Medicine. She practices primary care pediatrics at Valley Children’s Healthcare in Fresno, California. Dr. Chamarthi serves as Chair of the Childhood Nutrition and Obesity Prevention Committee for AAP California Chapter 1 and also Editor-in-Chief for Pediatrics and Obesity Medicine at StatPearls Publishing. Her clinical and academic work focuses on pediatric obesity management, ultra-processed food exposure, early intervention strategies, and translating evolving obesity guidelines into practical primary care implementation.
Pediatric Research Update: Physical Activity Patterns and Associations in Infants and Toddlers
The most increase in physical activity (PA) was found to be from infancy to 24 months and then tended to plateau. Greater screen time exposure was associated with a slower rate of PA increase between 6 and 24 months of age. Based on these findings, clinicians should consider integrating PA anticipatory guidance into well-child visits beginning in early infancy, with attention to screen time limits and opportunities for active play. In their original article, Longitudinal Change in Physical Activity in Children 6 to 36 Months of Age , Pate and colleagues not only present the developmental pattern for PA in this age group but also highlight factors that may hinder or promote PA development. Interestingly, screen time was associated with higher PA levels at 6 months but with a slower rate of PA growth by 24 months, suggesting that the negative impact of screen exposure on physical activity accumulates over time rather than appearing immediately. Longitudinal Change in Physical Activity in Children 6 to 36 Months of Age.
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