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Id Subject Object Predicate Lexical cue
T1 0-153 Sentence denotes Sociodemographic Predictors of Changes in Physical Activity, Screen Time, and Sleep among Toddlers and Preschoolers in Chile during the COVID-19 Pandemic
T2 155-163 Sentence denotes Abstract
T3 164-415 Sentence denotes The aim was to examine the sociodemographic predictors associated with changes in movement behaviors (physical activity, screen time, and sleep) among toddlers and preschoolers during the early stages of the coronavirus disease 2019 pandemic in Chile.
T4 416-518 Sentence denotes Caregivers of 1- to 5-year-old children completed an online survey between 30 March and 27 April 2020.
T5 519-666 Sentence denotes Information about the child’s movement behaviors before (retrospectively) and during the pandemic, as well as family characteristics were reported.
T6 667-737 Sentence denotes In total, 3157 participants provided complete data (mean children age:
T7 738-756 Sentence denotes 3.1 ± 1.38 years).
T8 757-919 Sentence denotes During early stages of the pandemic, time spent in physical activity decreased, recreational screen time and sleep duration increased, and sleep quality declined.
T9 920-1127 Sentence denotes Toddlers and preschoolers with space to play at home and living in rural areas experienced an attenuated impact of the pandemic restrictions on their physical activity levels, screen time, and sleep quality.
T10 1128-1352 Sentence denotes Older children, those whose caregivers were aged ≥35–<45 years and had a higher educational level, and those living in apartments had greater changes, mainly a decrease in total physical activity and increase in screen time.
T11 1353-1486 Sentence denotes This study has shown the significant impact of the pandemic restrictions on movement behaviors in toddlers and preschoolers in Chile.
T12 1488-1490 Sentence denotes 1.
T13 1491-1503 Sentence denotes Introduction
T14 1504-1609 Sentence denotes The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on everyday life worldwide.
T15 1610-1794 Sentence denotes Since the declaration of the global pandemic and the first national cases, Chile has had a total of 462,991 infected and suffered 12,741 deaths (from March through September 2020) [1].
T16 1795-1966 Sentence denotes During the pandemic, Chile has been in the top 10 countries with the highest ratio of deaths per 100 k population (67.9 deaths/100 k inhabitants by 30 September 2020) [2].
T17 1967-2104 Sentence denotes In response to this pandemic, the Chilean government implemented several approaches to reduce the health and economic impact of COVID-19.
T18 2105-2220 Sentence denotes On 16 March 2020, all schools were closed, and, in the same week, workplaces implemented work-from-home strategies.
T19 2221-2332 Sentence denotes On 17 March, all national parks were closed, and on 26 March some districts enforced lockdowns and curfews [3].
T20 2333-2500 Sentence denotes These restrictions likely had a negative impact on young children’s movement behaviors, (physical activity, sedentary behavior—including screen time, and sleep) [4,5].
T21 2501-2800 Sentence denotes Global guidelines recommend that children aged 1 to 5 should accumulate at least 180 min of physical activity, engage in no more than 1 h sedentary screen time (none for 1-year-olds), and have between 11–14 h (1- to 2-year-olds) and 10 to 13 h (3- to 5-year-olds) good-quality sleep per night [6,7].
T22 2801-3088 Sentence denotes Complying with these movement behavior guidelines, in one or more of several possible combinations of these recommendations (e.g., physical activity and sleeping) has been favorably associated with motor development, cognition, fitness, emotional regulation, adiposity, among others [6].
T23 3089-3198 Sentence denotes Limiting young children’s ability to meet these recommendations may have long-term health consequences [4,8].
T24 3199-3386 Sentence denotes Studies conducted during the COVID-19 pandemic have shown that children and adolescents have decreased physical activity, increased screen time, and slightly increased sleep duration [5].
T25 3387-3542 Sentence denotes However, there is a lack of data regarding the impact of COVID-19 on movement behaviors in children under 5 years of age and from Latin-American countries.
T26 3543-3748 Sentence denotes Understanding the association between COVID-19 factors and young children’s movement behaviors is important in guiding decision-making among policymakers, and in educating parents and health professionals.
T27 3749-3855 Sentence denotes This information would be relevant not only during the pandemic but also when returning to a “new normal”.
T28 3856-4047 Sentence denotes The purpose of this study was to examine the early impact of COVID-19 restrictions implemented in Chile on levels of physical activity, screen time, and sleep among toddlers and preschoolers.
T29 4048-4189 Sentence denotes In particular, we aimed to explore the sociodemographic factors associated with changes in these movement behaviors in this population group.
T30 4191-4193 Sentence denotes 2.
T31 4194-4215 Sentence denotes Materials and Methods
T32 4216-4356 Sentence denotes Main caregivers of 1- to 5-year-old children living in Chile were invited to participate in an online survey from 30 March to 27 April 2020.
T33 4357-4477 Sentence denotes The study was promoted through social media (Facebook, Twitter, and Instagram) and emails from educational institutions.
T34 4478-4647 Sentence denotes Potential participants accessed a personalized link to read more detailed information about the study and gave their online informed consent to participate in the study.
T35 4648-4843 Sentence denotes The inclusion criteria were: (1) living in Chile, (2) being the main caregiver of a 1- to 5-year-old child, and (3) living with the child most of the time before and during the COVID-19 pandemic.
T36 4844-4945 Sentence denotes The study was approved by the Scientific Ethics Committee at Universidad de La Frontera, Chile (ORD.:
T37 4946-4956 Sentence denotes 009-2020).
T38 4957-5078 Sentence denotes Data were collected and managed using REDCap (Research Electronic Data Capture) [9] hosted at Universidad de La Frontera.
T39 5079-5213 Sentence denotes Data collection started two weeks after the government enforced educational centers to close in Chile (16 March 2020) due to COVID-19.
T40 5214-5325 Sentence denotes At the end of the data collection, the education centers were still closed at a national level (27 April 2020).
T41 5327-5331 Sentence denotes 2.1.
T42 5332-5358 Sentence denotes Sociodemographic Variables
T43 5359-5466 Sentence denotes The online survey included questions about the caregiver, family, and the child participating in the study.
T44 5467-5737 Sentence denotes The sociodemographic and home characteristics section of the survey included questions about educational level, family income, occupational situation, dwelling type and size, space to play at home, inhabitants per home, area of residence (urban/rural), city, and region.
T45 5738-5887 Sentence denotes If there was more than one child at home between 1 to 5 years of age, the caregiver was asked to answer for only one of the children (freely chosen).
T46 5888-6036 Sentence denotes Also, caregivers were asked about child sex, age, disability (yes/no and type), and enrolment in an early childhood education center (ECEC; yes/no).
T47 6037-6167 Sentence denotes Caregivers were also asked if they were in lockdown at home at the moment of the survey, and the number of days spent in lockdown.
T48 6169-6173 Sentence denotes 2.2.
T49 6174-6192 Sentence denotes Movement Behaviors
T50 6193-6328 Sentence denotes A proxy-report from the main caregiver was used to assess children’s movement behaviors (physical activity, screen time, and sleeping).
T51 6329-6487 Sentence denotes Caregivers were asked to provide the time (in hours and minutes) spent by the child on each of the movement behaviors before and during the COVID-19 pandemic.
T52 6488-6585 Sentence denotes Sleep quality was assessed with a Likert scale (1 to 7; a higher score indicated better quality).
T53 6586-6719 Sentence denotes The survey was piloted in a small sample before the official launch to optimize readability, length, and pertinence of the questions.
T54 6720-6803 Sentence denotes The questions regarding movement behaviors are included as a Supplementary File S1.
T55 6804-7067 Sentence denotes The questions included in the study were based on those included in the International Study of Movement Behaviors in the Early Years (SUNRISE, www.sunrise-study.com) [10,11], but adaptations were made to capture the potential changes during the COVID-19 pandemic.
T56 7068-7544 Sentence denotes Unpublished data from pilot studies in several countries assessed the concurrent validity of the questions for measuring time spent in total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) compared with ActiGraph GT3x accelerometers (ActiGraph, Pensacola, FL, USA) have shown significant but low correlations with both TPA (r = 0.14; p = 0.003) and MVPA (r = 0.16; p = 0.002), which is comparable with other proxy-report tools in this age group [12].
T57 7546-7550 Sentence denotes 2.3.
T58 7551-7571 Sentence denotes Statistical Analysis
T59 7572-7656 Sentence denotes Only participants with complete data for all sections were included in the analysis.
T60 7657-7837 Sentence denotes Mean (standard deviation, SD), median (interquartile range, IQR), and proportions were used to describe participants on key characteristics and outcomes based on data distribution.
T61 7838-7996 Sentence denotes Comparisons between sociodemographic characteristics were performed using parametric and non-parametric tests to compare behaviors before and during COVID-19.
T62 7997-8066 Sentence denotes Multicollinearity was assessed with variable inflation factors (VIF).
T63 8067-8388 Sentence denotes We used multiple linear regressions with a residualized change score approach [13,14] to investigate the sociodemographic predictors (independent variables) of changes in physical activity, recreational screen time, sleep duration, and sleep quality (dependent variables) during the early stages of the pandemic in Chile.
T64 8389-8573 Sentence denotes This approach provides robust estimates by eliminating auto-correlated errors and regression towards the mean, which often makes it preferable to the simple change score approach [13].
T65 8574-8751 Sentence denotes First, we regressed the standardized score during the COVID-19 pandemic on the standardized scores before the COVID-19 pandemic for each of the behaviors assessed in this study.
T66 8752-8959 Sentence denotes The residualized change score (i.e., trend) for each behavior was then estimated as the average of each participant’s residual score (i.e., the difference between the estimated value and the observed value).
T67 8960-9116 Sentence denotes A positive residualized change score indicates an increase in the specific behavior from the time before COVID-19 and a negative score indicates a decrease.
T68 9117-9349 Sentence denotes For each residualized change score, we explored the predictive role of a series of sociodemographic factors a priori thought to have influenced changes in the behaviors herein assessed after ECEC and school closures due to COVID-19.
T69 9350-9451 Sentence denotes We adjusted all models for age and sex of the child, family income, presence of lockdown, and region.
T70 9452-9540 Sentence denotes Data preparation and validation was conducted with Stata 15.0 (College Station, TX, USA:
T71 9541-9666 Sentence denotes StataCorp LLC), while analyses were conducted in R (version 3.5.2) (R Foundation for Statistical Computing, Vienna, Austria).
T72 9667-9731 Sentence denotes The level of significance was set at usual p < 0.05, two-tailed.
T73 9733-9735 Sentence denotes 3.
T74 9736-9743 Sentence denotes Results
T75 9744-9851 Sentence denotes In total, 5505 individuals accessed the survey and 5266 accepted participation and signed the consent form.
T76 9852-9909 Sentence denotes We had participants from each of the 16 regions in Chile.
T77 9910-10106 Sentence denotes A total of 2109 (40.0%) participants were excluded from the analysis because they provided incomplete data (726 in demographics and COVID-19 related questions and 1383 for the movement behaviors).
T78 10107-10174 Sentence denotes The final sample consisted of 3157 participants with complete data.
T79 10175-10397 Sentence denotes Participants that provided complete data were more likely to be older (31.4 [6.06] vs. 30.3 [6.26], p < 0.001) and more educated (52.4% vs. 40.2% with university studies or more, p < 0.001) than those with incomplete data.
T80 10398-10769 Sentence denotes The caregivers’ characteristics from those with complete data were comparable with those observed for the respective age group in the last National Census in terms of dwelling (81.6% vs. 79.7% living in a house) and living area (11.4% vs. 13.5% living in a rural area), but the current sample was more educated (65.7% vs. 39.7% with more than 12 years of education) [15].
T81 10770-10816 Sentence denotes The mean age of children was 3.1 (1.38) years.
T82 10817-10857 Sentence denotes Most main caregivers were women (96.6%).
T83 10858-10958 Sentence denotes Children enrolled in ECEC or schools were 28.1% of 1- to 2-year-olds and 71.9% of 3- to 5-year-olds.
T84 10959-11001 Sentence denotes Most participants lived in houses (81.6%).
T85 11002-11062 Sentence denotes About 9 out of 10 caregivers reported space to play at home.
T86 11063-11223 Sentence denotes A large proportion of participants resided in urban areas (88.6%), and 76.3% s were under lockdown at the moment of the survey (mean duration 23.5 days [7.26]).
T87 11224-11473 Sentence denotes Most sociodemographic characteristics were similar between boys and girls, except for the sex of the main caregiver (95.4% vs. 97.8%, p < 0.001), the number of people (4.2 vs. 4.1, p = 0.013) and children (1.6 vs. 1.7, p = 0.004) per home (Table 1).
T88 11475-11479 Sentence denotes 3.1.
T89 11480-11529 Sentence denotes Movement Behaviors before and during the Pandemic
T90 11530-11637 Sentence denotes Table 2 shows the changes in movement behaviors from before to during the COVID-19 pandemic by sex and age.
T91 11638-11940 Sentence denotes Across all ages, mean time spent in physical activity decreased (−0.75 [CI 95% −0.81, −0.70] h/day), recreational screen time and sleep duration increased (1.4 [CI 95% 1.34, 1.45] h/day and 0.09 [CI 95% 0.04, 0.15] h/night, respectively) and sleep quality declined (−0.75 [CI 95% −0.81, −0.69] points).
T92 11941-12038 Sentence denotes No differences by sex were observed for any of the movement behaviors before and during COVID-19.
T93 12039-12196 Sentence denotes Older children were consistently less physically active, spent more time in screens, slept less, and had better sleep quality before and during the pandemic.
T94 12197-12290 Sentence denotes More details according to other sociodemographic factors are shown in Supplementary Table S1.
T95 12292-12296 Sentence denotes 3.2.
T96 12297-12339 Sentence denotes Predictors of Change in Movement Behaviors
T97 12340-12448 Sentence denotes Table 3 shows the sociodemographic predictors of changes in movement behaviors due to the COVID-19 pandemic.
T98 12449-12585 Sentence denotes Older children had greater reductions in physical activity and sleep duration, while they had more marked increase in their screen time.
T99 12586-12685 Sentence denotes Children whose main caregiver was a man had smaller decline in physical activity and sleep quality.
T100 12686-12885 Sentence denotes Those with caregivers aged ≥35–<45 years had greater reduction in physical activity and increase in screen time, while those with caregivers aged 45 and older had greater reduction in sleep duration.
T101 12886-12964 Sentence denotes Children whose family had higher income had smaller decrease in sleep quality.
T102 12965-13150 Sentence denotes Children whose main caregiver was more educated and those previously enrolled in an ECEC had greater reductions in their physical activity levels, and a greater increase in screen time.
T103 13151-13340 Sentence denotes Toddlers and preschoolers living with five or more people had less marked decline in their physical activity, while those living with four or people had less marked increase in screen time.
T104 13341-13414 Sentence denotes Children living with four people had greater reduction in sleep duration.
T105 13415-13500 Sentence denotes Those living with more children had a less marked decline in their physical activity.
T106 13501-13645 Sentence denotes Children who lived in apartment had greater reductions in physical activity and sleep quality, while they had a greater increase in screen time.
T107 13646-13749 Sentence denotes Those living in a home different to a house or apartment had less marked increase in their screen time.
T108 13750-13852 Sentence denotes Children who lived in homes with more square meters per person had a smaller decline in sleep quality.
T109 13853-14052 Sentence denotes Children who had a space to play at home and those living in rural areas had smaller decline in physical activity and sleep quality, and less marked increase in screen time compared with their peers.
T110 14054-14056 Sentence denotes 4.
T111 14057-14067 Sentence denotes Discussion
T112 14068-14199 Sentence denotes To our knowledge, this is the first study examining the effects of COVID-19 on movement behaviors among children aged 1 to 5 years.
T113 14200-14332 Sentence denotes We found that all movement behaviors changed across all ages, reflecting important secondary detrimental effects from this pandemic.
T114 14333-14614 Sentence denotes The most common sociodemographic predictors of movement behaviors change during the COVID-19 pandemic were age, main caregiver’s sex, age, and education, family income, previous enrolment in an ECEC, dwelling type, available space to play, and type of residence area (urban/rural).
T115 14615-14754 Sentence denotes This is also the first known study in Chile that examined all three components of the 24-h movement behaviors in toddlers and preschoolers.
T116 14755-14907 Sentence denotes A novel finding was that children from poorer families were more physically active than those in more affluent or educated families during the pandemic.
T117 14908-15006 Sentence denotes This finding is different from that commonly observed in Chilean children and adolescents [16,17].
T118 15007-15262 Sentence denotes It is plausible that those caregivers were less likely to work from home under lockdown and kept more “normal” routines with their families, while those children may have had more freedom to play indoors and less demand to stay quiet during working hours.
T119 15263-15405 Sentence denotes Also, having space to play at home was consistently related to healthier levels in all movement behaviors both before and during the pandemic.
T120 15406-15625 Sentence denotes This finding reinforces the need for ensuring spaces for children at home and surrounding areas to play as this is likely to promote these behaviors not only during the pandemic but also in the return to a “new normal”.
T121 15626-16037 Sentence denotes In Chile, specific content was developed for promoting physical activity through social media and national TV (since the 27 April 2020) as a response to the pandemic [18,19], and an expert committee on physical activity was installed by the Ministries of Sports, Health, and Education to inform, adapt and add physical activity content into the curriculum of the classes delivered remotely in this context [20].
T122 16038-16307 Sentence denotes Nevertheless, the lockdown measures did not allow people to participate in physical activity outdoors and most public parks were still closed during the period included in our study [3], with few councils prioritizing pedestrian zones to favor physical distancing [21].
T123 16308-16570 Sentence denotes These opposing strategies where on one hand physical activity is promoted indoors while at the same time it is severely restricted outdoors need to be periodically revised and aligned with the latest evidence, so health impairing over-restrictions are prevented.
T124 16571-16712 Sentence denotes Preschoolers were the most affected by the restrictions during the pandemic, particularly for physical activity and recreational screen time.
T125 16713-16842 Sentence denotes This may be explained by preschoolers needing more space to play and having greater access to screen-based devices than toddlers.
T126 16843-16978 Sentence denotes The reduction in physical activity and the increase in screen time have particularly affected those with previous enrolment in an ECEC.
T127 16979-17253 Sentence denotes Schools would be in a better position to respond with specific actions to prevent physical inactivity during this period than ECECs, as children and adolescents are more likely to be connected to participate in their virtual school activities than toddlers and preschoolers.
T128 17254-17363 Sentence denotes Therefore, governments, policymakers, and professionals should devote particular attention to this age group.
T129 17364-17559 Sentence denotes Our results suggest that more educated parents tend to restrict their children’s physical activity more, while at the same time may provide more opportunities to engage in screen-based behaviors.
T130 17560-17744 Sentence denotes This is an interesting finding as, before the pandemic, children with more educated caregivers tended to engage less with screen-based devices than children with less-educated parents.
T131 17745-17942 Sentence denotes This may be partially explained as more educated caregivers may have to work from home, and this, in turn, may require the caregiver to use screens to entertain their child while working from home.
T132 17943-18148 Sentence denotes This may be even more complicated in families living in apartments, one of the strongest predictors of declines in physical activity and increases of screen time observed in this study during the pandemic.
T133 18149-18198 Sentence denotes This finding has implications for urban planning.
T134 18199-18520 Sentence denotes As the full impact of COVID-19 is uncertain and other pandemics may occur, upgrading substandard areas that are currently plenty of small social apartments with insufficient recreational public spaces should be considered, together with stronger regulation, as part of a plan to build healthier and more resilient cities.
T135 18521-18784 Sentence denotes Undoubtedly, families and caregivers play a key role in facilitating movement behaviors of toddlers and preschoolers, but some political actions such as allowing specific time for those residing in apartments to go outside with their family may boost the process.
T136 18785-19138 Sentence denotes Some caregivers and family characteristics (caregiver’s sex and age, number of people and children per home) were also associated with changes in movement behaviors during the pandemic, so strategies should consider messages and actions for the entire family group, particularly small families and those whose main caregivers are aged 35 and older [22].
T137 19139-19262 Sentence denotes Overall, sleep quality worsened, but children with higher family income and less crowded homes showed less marked declines.
T138 19263-19400 Sentence denotes This aspect may reflect other social issues that are not captured in this study that are related to the economic situation in Chile [23].
T139 19401-19617 Sentence denotes The decrease in sleep quality has also been described in a study conducted in Italy in children aged 3 to 6 during the early stages of the pandemic; however, after two weeks of follow-up, this decline plateaued [24].
T140 19618-19859 Sentence denotes Some key messages to promote healthy sleep duration and quality, such as creating a bedtime routine and avoiding screens before sleep should be regularly disseminated and reinforced; and particularly tailored to low-income families [4,6,25].
T141 19860-19985 Sentence denotes Having space to play at home was the most consistent factor in the home environment predicting changes in movement behaviors.
T142 19986-20141 Sentence denotes A novel finding from our study is that the play space was not only important for physical activity and screen time but also had an impact on sleep quality.
T143 20142-20333 Sentence denotes This is particularly important as this association reinforce the call from the World Health Organization for focusing on the interaction of all three behaviors as they benefit each other [6].
T144 20334-20504 Sentence denotes Therefore, strategies originally thought for promoting active playing at home or surroundings may impact sleep, and this, in turn, may benefit the whole home environment.
T145 20505-20628 Sentence denotes Another relevant factor that resulted in healthier changes in physical activity and screen time was living in a rural area.
T146 20629-20800 Sentence denotes Recent studies conducted during the COVID-19 pandemic in children and adolescents have also reported that rurality is an important correlate of movement behaviors [26,27].
T147 20801-20975 Sentence denotes A study conducted in Croatia reported that the decrease in physical activity was more evident in adolescents living in urban areas than it was in those from rural areas [26].
T148 20976-21130 Sentence denotes For children living in Canada, factors such as living in an apartment and the proximity to major roads were barriers to engage in outdoor activities [27].
T149 21131-21268 Sentence denotes Also, adolescents spent more time outdoor if they lived in a low-density area and had access to parks in high-density neighborhoods [28].
T150 21269-21404 Sentence denotes We acknowledge that one of the primary measures taken by countries to control the pandemic was the imposition of mobility restrictions.
T151 21405-21576 Sentence denotes However, decision-makers should seek options to facilitate outdoor recreational activities for the population while preserving safety and physical distancing instructions.
T152 21577-21744 Sentence denotes Outdoor time is not only relevant for all movement behaviors but also the lack of it may impact other areas such as mental health, vitamin D deficiency and myopia [4].
T153 21745-22032 Sentence denotes In our study, the region of residence and lockdown situation were not predictors of the movement behavior changes suggesting that regardless of location and containment measures, movement behaviors, in both toddlers and preschoolers, were similarly affected during the pandemic in Chile.
T154 22033-22133 Sentence denotes The provision of safe spaces for physical activity is critical when physical distancing is required.
T155 22134-22380 Sentence denotes As parks may be limited in space, availability and accessibility, programs such as open streets (e.g., Ciclovía) or play streets can be adapted and implemented while maintaining the physical distancing and other COVID-19-safe measures [29,30,31].
T156 22381-22576 Sentence denotes Thus, councils could provide additional safe spaces by closing lanes to cars, implementing complete streets schemes, and transforming them into spaces for physical activity, play, and recreation.
T157 22577-22778 Sentence denotes Colombia has been highly innovative during the pandemic as they modified their current programs, usually delivered in parks or closed areas to face the needs of the population during the pandemic [32].
T158 22779-22942 Sentence denotes For example, in Bogotá, one of the first measures taken during the pandemic was the closure of lanes to private cars and the instalment of daily open streets [33].
T159 22943-23125 Sentence denotes Also, professionals from the Ministry of Sports Colombia have delivered their physical activity programs in the neighborhoods while maintaining an appropriate physical distance [32].
T160 23126-23392 Sentence denotes These low-cost initiatives have been positively received by the general public and policymakers [34,35], so once adapted to local needs they could be implemented in other contexts and countries, including Chile, and could help to alleviate the inactivity crisis [3].
T161 23393-23495 Sentence denotes The detrimental effects of the COVID-19 pandemic in toddlers and preschoolers are still uncertain [8].
T162 23496-23746 Sentence denotes If sustained, the COVID-19 lockdown measures may have a serious impact on children, with a greater effect on those from a more deprived background, increasing the gap in other developmental outcomes such as motor development, cognition, and literacy.
T163 23747-23841 Sentence denotes Actions to prevent the adverse effects of the restriction measures due to COVID-19 are needed.
T164 23842-24035 Sentence denotes As younger children are mostly dependent on adults, we should embrace this challenge and offer the best possible opportunities to promote a comprehensive development in the current context [8].
T165 24036-24229 Sentence denotes Messages and strategies should be respectful and appropriate for the families as many are suffering not only from the direct effects of the COVID-19 but also from economic and social hardships.
T166 24230-24386 Sentence denotes These challenges are novel and highly demanding for governments and can only be successfully addressed if coordinated actions across sectors are undertaken.
T167 24387-24561 Sentence denotes Cross-country collaborative efforts are needed to understand further how the pandemic is affecting movement behaviors of people from other ages, locations, and social groups.
T168 24562-24631 Sentence denotes This may guide the allocation of resources where it is more critical.
T169 24632-24896 Sentence denotes This study adds evidence that allows more balanced decision-making processes where not only the need to impose mobility restrictions to prevent contagion is taken into consideration but so is the need to avoid health impairments derived from extended confinements.
T170 24897-25047 Sentence denotes Government departments are encouraged to develop and update their protocols in awareness of the multiple health impacts derived from the confinements.
T171 25049-25074 Sentence denotes Strengths and Limitations
T172 25075-25171 Sentence denotes Strengths of this study include a large sample of participants from each of the Chilean regions.
T173 25172-25433 Sentence denotes As recruitment was conducted online, voluntary response bias may have affected the sample composition with participants being more concerned regarding their children’s health and having therefore higher chances to notice impairments in their movement behaviors.
T174 25434-25679 Sentence denotes Besides this limitation, the respondents’ characteristics were comparable from those observed in the last National Census for the respective age group in terms of dwelling type and living area, but the sample in our study was more educated [15].
T175 25680-25814 Sentence denotes Although our instrument was piloted before it was officially launched, we had a large percentage of incomplete questionnaires (40.0%).
T176 25815-25963 Sentence denotes This could be explained since some people may be more reluctant to provide personal information through online platforms than in face-to-face modes.
T177 25964-26086 Sentence denotes Some of the factors associated with the movement behaviors showed small predictive power (e.g., number of people at home).
T178 26087-26172 Sentence denotes This may be explained as there are some other factors explaining these relationships.
T179 26173-26350 Sentence denotes We recognize that movement behaviors are complex and depend on several dynamic factors that our questions were unable to capture, particularly during early stages of a pandemic.
T180 26351-26566 Sentence denotes However, we measured these factors using the best assessment option possible under the very restricted circumstances imposed at the very early stages of the pandemic, when the data collection was conducted in Chile.
T181 26567-26694 Sentence denotes We acknowledge that self-report measures used in this study may have biased the results (e.g., social desirability and recall).
T182 26695-26934 Sentence denotes The use of accelerometers was not possible as physical distancing was mandated at the national level, including for those studies that were not strictly related to COVID-19 in clinical settings during the early stages of the pandemic [36].
T183 26935-27082 Sentence denotes Considering this, we collected data only for four weeks to minimize the risk of recall bias regarding the retrospective nature of some assessments.
T184 27084-27086 Sentence denotes 5.
T185 27087-27098 Sentence denotes Conclusions
T186 27099-27190 Sentence denotes The COVID-19 lockdown measures have shown to have a serious impact on children’s behaviors.
T187 27191-27335 Sentence denotes This study has shown that all movement behaviors changed during the early stages of the COVID-19 pandemic in toddlers and preschoolers in Chile.
T188 27336-27605 Sentence denotes The most common sociodemographic factors associated with these changes were child’s age, main caregiver’s age, sex, and education, family income, main caregiver’s education, previous enrolment in an ECEC, dwelling type, space to play at home and type of residence area.
T189 27606-27782 Sentence denotes Toddlers and preschoolers with space to play at home and living in rural areas had less marked impacts on physical activity, screen time, and sleep quality due to the pandemic.
T190 27783-27994 Sentence denotes In contrast, older children, those whose caregivers were aged ≥35–<45 years and had higher educational level, and children living in apartments had greater changes, decreasing the TPA and increasing screen time.
T191 27995-28296 Sentence denotes Together, the information provided in this study may help professionals and decision-makers to balance more precisely the health risks and benefits of confinements, inform future strategies and focus resources to reduce the potential adverse effects of the pandemic, immediately, and in the long-term.
T192 28298-28313 Sentence denotes Acknowledgments
T193 28314-28463 Sentence denotes The authors would like to thank all the participants of this study as they gave their time during the difficult period of COVID-19 pandemic in Chile.
T194 28464-28587 Sentence denotes Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
T195 28589-28612 Sentence denotes Supplementary Materials
T196 28613-28703 Sentence denotes The following are available online at https://www.mdpi.com/1660-4601/18/1/176/s1, File S1:
T197 28704-28774 Sentence denotes Movement behaviours related questions included in the study, Table S1:
T198 28775-28947 Sentence denotes Description of movement behaviours before and during the early stages of the COVID-19 pandemic in toddlers and pre-schoolers in Chile according to sociodemographic factors.
T199 28948-28984 Sentence denotes Click here for additional data file.
T200 28986-29006 Sentence denotes Author Contributions
T201 29007-29607 Sentence denotes Conceptualization, N.A.-F. and B.d.P.C.; methodology, N.A.-F., P.M.-F., M.T.-V., S.M.-M., C.C.-M., F.R.-R., and A.C.-O.; software, M.T.-V. and N.A.-F.; validation, N.A.-F. and M.T.-V.; formal analysis, N.A.-F. and B.d.P.C.; investigation, N.A.-F., P.M.-F., M.T.-V., S.M.-M., C.C.-M., F.R.-R., and A.C.-O.; resources, N.A.-F. and P.M.-F.; data curation, N.A.-F.; writing—original draft preparation, N.A.-F.; writing—review and editing, all authors; visualization, N.A.-F.; supervision, N.A.-F., P.M.-F., and A.D.O.; project administration, N.A.-F. and P.M.-F.; funding acquisition, N.A.-F. and P.M.-F.
T202 29608-29684 Sentence denotes All authors have read and agreed to the published version of the manuscript.
T203 29686-29693 Sentence denotes Funding
T204 29694-29974 Sentence denotes The study was partially supported by the Research Office at the Universidad de La Frontera (DIUFRO DFP19-0012, Programa para grupos de alta productividad, apoyo a la inserción de estudiantes pre- y postgrado a la investigación DI20-2009, y apoyo a postulantes FONDECYT DI20-1002).
T205 29975-30022 Sentence denotes ADO is supported by a NHMRC Investigator Grant.
T206 30024-30060 Sentence denotes Institutional Review Board Statement
T207 30061-30236 Sentence denotes The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Scientific Ethics Committee at Universidad de La Frontera, Chile (ORD.:
T208 30237-30262 Sentence denotes 009-2020; 27 March 2020).
T209 30264-30290 Sentence denotes Informed Consent Statement
T210 30291-30376 Sentence denotes Informed consent was obtained electronically from all subjects involved in the study.
T211 30378-30405 Sentence denotes Data Availability Statement
T212 30406-30509 Sentence denotes The data presented in this study can be shared based on specific request from the corresponding author.
T213 30511-30532 Sentence denotes Conflicts of Interest
T214 30533-30577 Sentence denotes The authors declare no conflict of interest.
T215 30578-30762 Sentence denotes The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
T216 30764-30796 Sentence denotes Table 1 Sample characteristics.
T217 30797-30851 Sentence denotes Total(n = 3157) Boys(n = 1597) Girls(n = 1560) p a
T218 30852-30926 Sentence denotes Children’s age, mean years (SD) 3.1 (1.38) 3.1 (1.38) 3.1 (1.38) 0.459
T219 30927-30947 Sentence denotes Children’s age, n(%)
T220 30948-31001 Sentence denotes     1–2 y 1243 (39.4) 635 (39.8) 608 (39.0) 0.833
T221 31002-31048 Sentence denotes     3–4 y 1345 (42.6) 672 (42.1) 673 (43.1)
T222 31049-31092 Sentence denotes     5 y 569 (18.0) 290 (18.1) 279 (17.9)
T223 31093-31174 Sentence denotes Main caregiver’s sex, woman, n (%) 3048 (96.6) 1523 (95.4) 1525 (97.8) <0.001
T224 31175-31258 Sentence denotes Main caregiver’s age, mean years (SD) 31.4 (6.06) 31.2 (6.01) 31.6 (6.10) 0.098
T225 31259-31295 Sentence denotes Main caregiver’s age category, n (%)
T226 31296-31356 Sentence denotes     ≥18–<25 years 440 (13.9) 236 (14.8) 204 (13.1) 0.076
T227 31357-31411 Sentence denotes     ≥25–<35 years 1769 (56.0) 888 (55.6) 881 (56.5)
T228 31412-31465 Sentence denotes     ≥35–<45 years 894 (28.3) 454 (28.4) 440 (28.2)
T229 31466-31509 Sentence denotes     ≥45 years 54 (1.7) 19 (1.2) 35 (2.2)
T230 31510-31540 Sentence denotes Family’s monthly income, n (%)
T231 31541-31597 Sentence denotes     <530 USD 1201 (32.3) 504 (31.6) 517 (33.1) 0.589
T232 31598-31653 Sentence denotes     ≥530–<1830 USD 1546 (49.0) 787 (49.3) 759 (48.7)
T233 31654-31703 Sentence denotes     ≥1830 USD 590 (18.7) 300 (19.1) 284 (18.2)
T234 31704-31746 Sentence denotes Main caregiver’s level of education, n (%)
T235 31747-31811 Sentence denotes     Incomplete high school 102 (3.2) 49 (3.1) 53 (3.4) 0.716
T236 31812-31872 Sentence denotes     Complete high school 982 (31.1) 499 (31.2) 483 (31.0)
T237 31873-31929 Sentence denotes     Technical degree 420 (13.3) 222 (13.9) 198 (12.7)
T238 31930-31988 Sentence denotes     University degree 1653 (52.4) 827 (51.8) 826 (52.9)
T239 31989-32026 Sentence denotes Children enrolled in ECEC, yes, n (%)
T240 32027-32090 Sentence denotes     1- to 2-year-old 699 (28.1) 366 (29.1) 333 (27.1) 0.247
T241 32091-32148 Sentence denotes     3- to 5-year-old 1786 (71.9) 891 (70.9) 895 (72.9)
T242 32149-32169 Sentence denotes Dwelling type, n (%)
T243 32170-32225 Sentence denotes     House 2576 (81.6) 1310 (82.0) 1266 (81.1) 0.696
T244 32226-32275 Sentence denotes     Apartment 475 (15.0) 232 (14.5) 243 (15.6)
T245 32276-32316 Sentence denotes     Other 106 (3.4) 55 (3.4) 51 (3.3)
T246 32317-32333 Sentence denotes Home size, n (%)
T247 32334-32387 Sentence denotes     <50 m2 810 (25.7) 424 (26.6) 386 (24.7) 0.458
T248 32388-32442 Sentence denotes     50 to <100 m2 1607 (50.9) 798 (50.0) 809 (51.9)
T249 32443-32490 Sentence denotes     ≥100 m2 740 (23.4) 375 (23.5) 365 (23.4)
T250 32491-32570 Sentence denotes Number of people per home, mean (SD) 4.1 (1.40) 4.2 (1.48) 4.1 (1.31) 0.013
T251 32571-32652 Sentence denotes Number of children per home, mean (SD) 1.7 (0.82) 1.6 (0.76) 1.7 (0.88) 0.004
T252 32653-32677 Sentence denotes Children per home, n (%)
T253 32678-32733 Sentence denotes     1 child 1511 (47.9) 778 (48.7) 733 (47.0) 0.026
T254 32734-32785 Sentence denotes     2 children 1190 (37.7) 615 (38.5) 575 (36.9)
T255 32786-32835 Sentence denotes     3 or more 456 (14.4) 204 (12.8) 252 (16.1)
T256 32836-32876 Sentence denotes Squared meters per person at home, n (%)
T257 32877-32943 Sentence denotes     <11.7 m2 per person 802 (25.4) 393 (24.6) 409 (26.2) 0.530
T258 32944-33012 Sentence denotes     ≥11.7 to <18.3 m2 per person 724 (22.9) 373 (23.4) 351 (22.5)
T259 33013-33079 Sentence denotes     ≥18.3 to <25 m2 per person 721 (22.8) 357 (22.3) 364 (23.3)
T260 33080-33137 Sentence denotes     ≥25 m2 per person 910 (28.8) 474 (29.7) 436 (28.0)
T261 33138-33168 Sentence denotes Available space to play, n (%)
T262 33169-33222 Sentence denotes     Yes 2926 (92.7) 1481 (92.7) 1445 (92.6) 0.907
T263 33223-33241 Sentence denotes Living area, n (%)
T264 33242-33297 Sentence denotes     Urban 2797 (88.6) 1410 (88.3) 1387 (88.9) 0.584
T265 33298-33343 Sentence denotes     Rural 360 (11.4) 187 (11.7) 173 (11.1)
T266 33344-33358 Sentence denotes Lockdown, n(%)
T267 33359-33412 Sentence denotes     Yes 2409 (76.3) 1211 (75.8) 1198 (76.8) 0.524
T268 33413-33486 Sentence denotes Number of days, mean (SD) 23.5 (7.26) 23.267 (7.37) 23.2 (7.15) 0.786
T269 33487-33649 Sentence denotes Abbreviations: ECEC, early childhood care and education centers; USD, United States dollar. a: significance when comparing characteristics between boys and girls.
T270 33650-33816 Sentence denotes Table 2 Description of movement behaviors before and during the early stages of the COVID-19 pandemic in toddlers and preschoolers in Chile according to age and sex.
T271 33817-33949 Sentence denotes Physical ActivityMean (SD), h/Day Screen TimeMean (SD), h/Day Sleep DurationMean (SD), h/Day Sleep QualityMean (SD), Score 1 to 7
T272 33950-34116 Sentence denotes Characteristic Before COVID-19 During COVID-19 p Before COVID-19 During COVID-19 p Before COVID-19 During COVID-19 p Before COVID-19 During COVID-19 p
T273 34117-34250 Sentence denotes Total 3.6(1.97) 2.82(2.15) <0.001 1.66(1.15) 3.05(1.92) <0.001 10.92(1.80) 11.01(1.86) 0.001 5.68(1.54) 4.93(1.77) <0.001
T274 34251-34254 Sentence denotes Sex
T275 34255-34387 Sentence denotes Girls 3.6(2.00) 2.8(2.14) <0.001 1.65(1.17) 3.00(1.86) <0.001 10.86(1.75) 10.99(1.82) 0.001 5.67(1.56) 4.92(1.79) <0.001
T276 34388-34519 Sentence denotes Boys 3.6(1.94) 2.9(2.15) <0.001 1.66(1.13) 3.09(1.98) <0.001 10.97(1.84) 11.02(1.90) 0.214 5.69(1.52) 4.93(1.76) <0.001
T277 34520-34532 Sentence denotes Age in years
T278 34533-34679 Sentence denotes 1 3.94 a(2.17) 3.65 b(2.42) <0.001 1.33 a(1.03) 2.14 b(1.66) <0.001 12.11 a(1.95) 11.96 b(2.03) 0.024 5.26 a(1.58) 4.58 b(1.76) <0.001
T279 34680-34810 Sentence denotes 2 3.92(2.18) 3.14(2.29) <0.001 1.56(1.12) 2.77(1.73) <0.001 11.35(1.72) 11.38(1.92) 0.710 5.54(1.53) 4.83(1.79) <0.001
T280 34811-34941 Sentence denotes 3 3.59(1.96) 2.70(2.01) <0.001 1.77(1.20) 3.29(1.91) <0.001 10.79(1.61) 10.82(1.70) 0.645 5.68(1.57) 5.05(1.69) <0.001
T281 34942-35073 Sentence denotes 4 3.22(1.75) 2.42(1.87) <0.001 1.76(1.13) 3.33(1.98) <0.001 10.33(1.59) 10.57(1.71) <0.001 5.89(1.49) 5.04(1.81) <0.001
T282 35074-35205 Sentence denotes 5 3.23(1.62) 2.25(1.81) <0.001 1.84(1.21) 3.66(1.97) <0.001 10.07(1.33) 10.38(1.47) <0.001 6.01(1.42) 5.12(1.76) <0.001
T283 35206-35422 Sentence denotes Abbreviations: COVID-19, coronavirus disease 2019; a: p-value < 0.05 when comparing each behavior between categories before COVID-19. b: p-value < 0.05 when comparing each behavior between categories during COVID-19.
T284 35423-35555 Sentence denotes Table 3 Sociodemographic predictors of change in movement behaviors in toddlers and preschoolers during COVID-19 pandemic in Chile.
T285 35556-35805 Sentence denotes Characteristic Residualized Change Score in Physical Activity(SD)(n = 3157) Residualized Change Score in Screen Time(SD)(n = 3157) Residualized Change Score in Sleep Duration(SD)(n = 3157) Residualized Change Score in Sleep Quality(SD)(n = 3045)
T286 35806-35892 Sentence denotes Child’s sex (ref: girls) 0.033 (0.035) 0.056 (0.035) −0.032 (0.036) −0.003 (0.036)
T287 35893-35917 Sentence denotes Child’s age, years (ref:
T288 35918-35999 Sentence denotes 1 year) −0.121 *** (0.013) 0.155 *** (0.013) −0.047 *** (0.013) 0.019 (0.013)
T289 36000-36094 Sentence denotes Caregiver’s sex (ref: woman) 0.201 * (0.098) −0.169 (0.098) −0.058 (0.098) 0.252 * (0.099)
T290 36095-36116 Sentence denotes Caregiver’s age (ref:
T291 36117-36130 Sentence denotes 18–<25 years)
T292 36131-36210 Sentence denotes     ≥25–<35 years −0.104 (0.055) 0.096 (0.055) −0.077 (0.055) 0.064 (0.056)
T293 36211-36297 Sentence denotes     ≥35–<45 years −0.244 *** (0.062) 0.216 ***(0.062) −0.113 (0.062) 0.093 (0.063)
T294 36298-36378 Sentence denotes     ≥45 years −0.229 (0.145) −0.127 (0.145) −0.387 *** (0.145) 0.162 (0.146)
T295 36379-36419 Sentence denotes Family income per month (ref: <530 USD)
T296 36420-36503 Sentence denotes     ≥530–<1830 USD −0.058 (0.040) 0.056 (0.039) −0.016 (0.040) 0.109 ** (0.041)
T297 36504-36583 Sentence denotes     ≥1830 USD −0.062 (0.040) 0.051 (0.051) −0.010 (0.052) 0.294 *** (0.053)
T298 36584-36626 Sentence denotes Main caregiver’s level of education (ref:
T299 36627-36650 Sentence denotes Incomplete high school)
T300 36651-36736 Sentence denotes     Complete high school −0.182 (0.102) 0.177 (0.102) 0.013 (0.104) 0.121 (0.107)
T301 36737-36825 Sentence denotes     Technical degree −0.300 ** (0.109) 0.282 ** (0.108) −0.099 (0.111) 0.104 (0.114)
T302 36826-36916 Sentence denotes     University degree −0.371 *** (0.104) 0.271 ** (0.103) −0.093 (0.106) 0.122 (0.109)
T303 36917-36952 Sentence denotes Children enrolled in ECEC (ref: no)
T304 36953-37030 Sentence denotes     Yes −0.195 *** (0.048) 0.391 *** (0.048) 0.078 (0.049) −0.032 (0.050)
T305 37031-37050 Sentence denotes Dwelling type (ref:
T306 37051-37057 Sentence denotes House)
T307 37058-37144 Sentence denotes     Apartment −0.404 *** (0.049) 0.226 *** (0.049) −0.089 (0.051) −0.109 * (0.051)
T308 37145-37217 Sentence denotes     Other 0.114 (0.098) −0.219 * (0.098) 0.030 (0.100) 0.031 (0.101)
T309 37218-37254 Sentence denotes Number of people per home (ref: ≤3)
T310 37255-37327 Sentence denotes     4 0.058 (0.042) −0.088 * (0.042) −0.085 * (0.043) −0.009 (0.044)
T311 37328-37402 Sentence denotes     ≥5 0.115 ** (0.043) −0.112 ** (0.043) 0.004 (0.044) −0.049 (0.045)
T312 37403-37427 Sentence denotes Children per home (ref:
T313 37428-37436 Sentence denotes 1 child)
T314 37437-37517 Sentence denotes     2 children 0.112 ** (0.038) −0.021 (0.038) −0.015 (0.039) −0.023 (0.040)
T315 37518-37594 Sentence denotes     3 or more 0.124 * (0.053) −0.025 (0.053) 0.067 (0.054) 0.006 (0.055)
T316 37595-37656 Sentence denotes Squared meters per person at home (ref: <11.7 m2 per person)
T317 37657-37748 Sentence denotes     ≥11.7–<18.3 m2 per person −0.042 (0.052) 0.049 (0.051) −0.074 (0.052) 0.051 (0.053)
T318 37749-37838 Sentence denotes     ≥18.3–<25 m2 per person −0.038 (0.053) 0.079 (0.053) −0.025 (0.054) 0.087 (0.055)
T319 37839-37924 Sentence denotes     ≥25 m2 per person 0.053 (0.053) −0.007 (0.053) 0.025 (0.054) 0.158 ** (0.055)
T320 37925-37958 Sentence denotes Available space to play (ref: no)
T321 37959-38040 Sentence denotes     Yes 0.546 *** (0.067) −0.398 *** (0.067) −0.057 (0.069) 0.396 *** (0.070)
T322 38041-38065 Sentence denotes Living area (ref: urban)
T323 38066-38146 Sentence denotes     Rural 0.563 *** (0.055) −0.278 *** (0.055) 0.102 (0.056) 0.120 * (0.057)
T324 38147-38228 Sentence denotes Lockdown (ref: no) −0.074 (0.042) 0.050 (0.041) −0.076 (0.042) −0.076 (0.043)
T325 38229-38329 Sentence denotes Abbreviations: COVID-19, coronavirus disease 2019; ECEC, early childhood care and education centers.
T326 38330-38415 Sentence denotes Models adjusted by child’s sex, age, family income, presence of lockdown, and region.
T327 38416-38475 Sentence denotes Significance: *** = p < 0.001; ** = p < 0.01; * = p < 0.05.