Are Preschoolers in the US Meeting Healthy Behavior Goals?

TOPLINE:

Only about 20% of preschoolers in the US followed five to six healthy habits, with clear differences by socioeconomic factors and geographic location. Children who lived in homes with enough food, had safe neighborhoods, had parents with excellent or very good mental health, and often ate meals with their families were more likely to have healthy behaviors.

METHODOLOGY:

• Researchers analyzed data from the 2021 and 2022 National Survey of Children’s Health to assess factors related to healthy behavior among children aged 3-5 years in the US.
• A total of 23,123 children were included in the analysis, with data collected through parent or caregiver reports.
• Six healthy behaviors were examined: daily consumption of fruits, daily consumption of vegetables, no sugary drinks, frequent outdoor play, limited screen time, and adequate sleep.
• Logistic regression modeling was used to assess relationships between healthy behaviors and various characteristics of the child, family, and community.

TAKEAWAY:

• The prevalence of healthy behaviors among preschoolers varied, with 32.4% not consuming sugary drinks and 65.3% consuming fruit daily. Only 20.3% of preschoolers engaged in five to six healthy behaviors.
• Black non-Hispanic, Hispanic, and Asian non-Hispanic children were less likely to engage in five to six healthy behaviors than White non-Hispanic children (adjusted prevalence rate ratio [aPRR], 0.38, 0.57, and 0.64, respectively; P < .05 for all). Children aged 3 years were more likely to engage in five to six healthy behaviors than those aged 5 years.
• Engagement in five to six healthy behaviors was more likely among children with parents with excellent or very good mental health (aPRR, 1.30), those living in safe neighborhoods (aPRR, 1.17), those living in homes with enough food (aPRR, 1.35), and those who ate meals with their families 4 or more days a week (aPRR, 1.70; P < .05 for all).
• State-level variations were substantial, with Vermont having the highest adjusted prevalence of preschoolers engaging in five to six healthy behaviors (36.2%) and Mississippi, the lowest (8.3%).

IN PRACTICE:

“Study findings underscore the importance of the family context and the challenges families experience in supporting children’s engagement in HBs [healthy behaviors], with fewer than half of preschoolers having no sugary beverages, limited screen time, or eating vegetables daily,” wrote the authors of the study. “There are opportunities to promote healthy living among children across multiple domains of influence, including direct counseling, screening, and referral to community resources to meet basic needs, and supporting family-focused policies and programs,” they added.

SOURCE:

The study was led by Julie F. Donney, PhD, of the Office of Epidemiology and Research at the Maternal and Child Health Bureau, Health Resources and Services Administration in Rockville, Maryland. It was published online on July 14, 2025, in the American Journal of Preventive Medicine.

LIMITATIONS:

The design of the study made it difficult to determine if healthy behaviors were caused by certain factors. The link between family or community factors and healthy behaviors may be affected by unmeasured variables such as parenting styles or seasonal changes. Different definitions of healthy behaviors were not examined.

DISCLOSURES:

This study did not receive any specific funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.