Lancet study finds preschoolers clock 18,500 steps a day: Why it matters for your child

Why step counts matter

Early childhood is a crucial period for growth and development. Low levels of physical activity during these years have been linked to excess weight gain and delayed motor development.

Yet measuring how active very young children are can be difficult. Step counts offer a simple, objective way of tracking movement, particularly because much of the physical activity of preschoolers involves walking, running and other forms of movement. Step counts have also been associated with several health measures, including cardiovascular and metabolic health. The researchers say such measures could be particularly useful in settings where more complex methods of monitoring physical activity are difficult to use.

A wide range of activity

The researchers found considerable differences in how much children moved. Across the 44-country SUNRISE (International Study of Movement Behaviours in the Early Years) study, the weighted median was 18,542 steps a day, meaning half the children took fewer steps and half took more.

The median was 17,502 steps a day among three-year-olds and 18,928 among four-year-olds. However, activity levels varied dramatically. Among three-year-olds, daily step counts ranged from just 1,124 steps among the least active children to 29,320 among the most active. Boys were consistently more active than girls. Among three-year-olds, the median was 18,064 steps for boys compared with 16,426 for girls. Among four-year-olds, the corresponding figures were 19,477 and 18,321.

The children wore a step-counting device on their hip continuously for 24 hours a day for at least three days. Data collected between 2018 and 2025 were analysed.

Not a target for every child

Dr del Pozo-Cruz cautioned against treating 18,542 steps as a minimum requirement. “These numbers indicate where the midpoint of the international reference distribution lies; they should not be interpreted as minimum daily requirements,” he said.

He suggested thinking of the findings as being similar to a growth chart for physical activity — a way of seeing where an individual child or population falls within the range observed internationally. The researchers note that children below the third percentile could potentially be considered “low steppers”, but say more research is needed before such percentiles can be used as clinical or public-health thresholds.

Children in developing countries more active

Interestingly, children in low- and middle-income countries recorded higher daily step counts than those in high-income countries. Children living in rural areas also tended to record more steps than those living in urban settings. The researchers say this could reflect differences in children’s everyday environment and routines, including opportunities for outdoor play, walking and active transport. Greater urbanisation, motorisation and screen use may reduce opportunities for incidental movement.

What about India?

The study included 51 Indian children. Dr del Pozo-Cruz said this was a relatively small country-specific sample and should not be considered nationally representative. “Although this is a relatively small country-specific sample, the analysis was specifically designed so that each of the 44 participating countries contributed equally to the pooled international estimates,” he said.

The researchers, therefore, used a method that prevented countries with larger samples from disproportionately influencing the overall results. At the same time, they stressed that the children were recruited through convenience sampling and cannot be taken as representative of all preschoolers in India.

Active play matters

Dr Vijay Natarajan, a cardiac surgeon who was not associated with the study, said prolonged sitting, particularly screen-based sedentary activity, should be minimised in three- and four-year-olds. The World Health Organization recommends no more than one hour of sedentary screen time a day for children in this age group, with less being better.

“What preschoolers need is an environment that encourages frequent active play throughout the day — which is the best form of exercise,” Dr Natarajan said. He added that the rise in childhood obesity seen in developed countries has been linked to sedentary lifestyles and unhealthy food choices, and that developing countries could face a similar challenge.

“The focus should be on active play, building lifelong habits of movement,” he said. Preschool children also need about 10-13 hours of good-quality sleep in a 24-hour period, including naps, he added.

Why the findings need context

The study was observational, and the researchers caution that the relatively small samples from individual countries limit how widely the findings can be generalised. They also emphasise that step counts are only one part of children’s daily movement. Physical activity, sedentary behaviour and sleep are closely connected, and differences in one may coexist with differences in the others. They called for further research before step-count percentiles are translated into specific health thresholds or recommendations.