School-Aged Children’s Movement, Screen, and Diet Patterns Cluster

This cross-sectional study, published in the Bulletin of Faculty of Physical Therapy, examined how physical activity, screen exposure, and dietary habits co-occurred in 66 children aged 5 to 9 years. The findings suggest that under constrained home-based conditions, these behaviors do not operate as independent domains but rather organize into coherent, interpretable patterns that differ across both movement-related and dietary components.

The study was conducted between June and September 2021, a period characterized by mandated citywide lockdowns in Santiago, Chile. These restrictions compressed children’s daily lives into the home environment, concentrating physical activity, screen exposure, and dietary behaviors within domestic settings. The research team aimed to use a clustering approach to identify behavioral patterns that might not be observable when these behaviors are analyzed individually. By examining the joint configuration of these domains, the study sought to understand how spatial and temporal constraints shape routine action in young children.

The sample consisted of 66 children, including 30 girls and 36 boys, living in an urban district of Santiago. The mean age of the participants was 6.53 years, with a standard deviation of 1.36. Parent-reported anthropometry indicated a mean body weight of 28.52 kg, a mean height of 1.23 meters, and a mean body mass index of 18.77 kg/m². Regarding housing characteristics, 74.2% of the participants lived in owned dwellings, while 25.8% lived in rented homes. The median household size was 4 persons, and the median number of rooms in the dwelling was 3.

Data collection relied on parent-reported measures obtained through an online questionnaire. The instrument included selected items from national survey instruments routinely applied in population-based research in Chile. Physical activity was assessed using a national instrument from the Instituto de Nutrición y Tecnología de los Alimentos, measuring outdoor play, blocks walked, and structured physical activity. Sedentary behavior comprised daily screen time and sitting at home while playing. Dietary intake for the previous day was recorded using items from the Chilean National Food Consumption Survey, capturing portions of dairy products, fruits, vegetables, bread, and fats or oils. Household characteristics were derived from the CASEN 2017 survey, including dwelling tenure, total area, number of rooms, and household size.

The analytical approach involved a two-level pattern-based analysis. First, the researchers computed a Spearman rank correlation matrix across the behavioral and dietary variables to describe the co-occurrence structure. After controlling for multiple testing using the Benjamini-Hochberg false discovery rate procedure, five associations remained statistically significant. These included a positive association between outdoor play and weekly structured physical activity, with a Spearman rho of 0.35. Additionally, fruits were positively associated with vegetables (rho 0.39), and bread was associated with fats and oils intake (rho 0.41). Notably, associations involving screen exposure did not remain significant after false discovery rate correction, indicating that direct correlational evidence linking screen time with other specific behaviors was weak after multiplicity control.

Building on these quantitative relationships, the team applied hierarchical agglomerative clustering to identify interpretable behavioral configurations. A two-group solution was retained as an exploratory summary of participant configurations, as a three-group solution was not supported by the dendrogram structure. One configuration was characterized by higher screen exposure together with higher bread intake and lower outdoor play. The contrasting configuration showed greater outdoor play and higher intake of dairy products, vegetables, and fruits. The separation between these groups was described as low-to-moderate, with an average silhouette value of approximately 0.30, and bootstrap stability was modest, suggesting that group assignment was somewhat sensitive to resampling.

Between-profile differences that remained significant after correction included outdoor play, screen time, bread intake, and dairy intake. The screen-centric group had lower outdoor play, with a median of 0.00 on the normalized scale compared to 0.50 in the more active group. Screen time was higher in the screen-centric group, with a median of 0.60 versus 0.20 in the more active group. Bread intake was also higher in the screen-centric group, while dairy intake was higher in the more active configuration. Vegetables showed a nominal difference that did not survive false discovery rate correction, and other variables such as fruits, fats and oils, blocks walked, and weekly structured physical activity were not significant after adjustment.

To examine the alignment between these exploratory configurations and individual or household characteristics, the researchers fitted a binomial logistic regression model. In the adjusted analyses, boys had higher odds of belonging to the screen-centric configuration, with an odds ratio of 3.46 and a 95 percent confidence interval ranging from 1.16 to 10.30. This suggests that sex was a more informative predictor of behavioral configuration membership than aggregate household indicators. In contrast, age, body mass index, household size, and the number of rooms in the dwelling were not associated with configuration membership in the multivariable model. The overall model fit was summarized by Tjur’s R² of 0.299, indicating that the included predictors explained a portion of the variance in configuration membership.

The study highlights that under constrained home-based conditions, daily behaviors tend to co-organize in restricted environments. The findings suggest that individual characteristics, particularly sex, may be more informative than aggregate household indicators when examining behavioral configurations in children. This implies that public health surveillance relying on single-behavior indicators may obscure how routines are actually structured in everyday life. Integrated behavioral profiles could provide a more accurate capture of the co-occurrence and alignment of movement, screen, and dietary habits, reducing the misclassification of children’s routines during periods of mobility restriction.

However, the study has several limitations that frame the findings as context-specific and exploratory. The design was cross-sectional and relied exclusively on parent-reported information, which precludes causal inference. The findings should be interpreted as descriptive associations rather than directional effects. Parent-report measures are subject to recall and social desirability bias, which may affect the accuracy of behavioral and dietary estimates. The sample size was small and drawn from a single urban district, limiting statistical power and restricting generalizability to other populations, geographic contexts, or seasonal conditions. Data were collected during the Southern winter, further constraining extrapolation to other periods of the year.

Additionally, the configurations derived from unsupervised clustering represent exploratory patterns of co-occurrence rather than stable or generalizable behavioral types. Given the limited sample size, the clustering results were interpreted as descriptive summaries, with internal stability and separation metrics used solely as diagnostic tools. The use of false discovery rate correction to address multiple testing prioritized control of type I error over sensitivity to smaller associations, increasing the likelihood that modest effects may not have been detected. The household indicators used, such as number of rooms and household size, may not fully capture the micro-spatial or functional characteristics of the home environment that are relevant to children’s movement opportunities.

Future research should move beyond cross-sectional descriptions of behavioral co-occurrence and examine how these configurations organize and persist over time. Longitudinal designs would allow for the assessment of the temporal stability of the identified patterns and their relationship with changes in household and environmental conditions. The integration of device-based measures of movement, sedentary time, and sleep, together with repeated assessments of dietary routines, would help determine whether the observed configurations reflect stable modes of daily organization or context-dependent behavioral arrangements. More detailed characterization of the inhabited environment may clarify how lived environments structure children’s behavioral configurations, progressing from descriptive patterning toward evaluating directional relationships between environmental context, behavioral organization, and child-related outcomes.

Subject of Research: Behavioral configurations of movement, screen exposure, and diet in school-aged children during mobility restriction

Article Title: Behavioral configurations of movement, screen exposure, and diet in school-aged children: a cross-sectional study

Article References: Gutiérrez-Pérez, P., Lisboa-Zamorano, C., Paredes-Suazo, R., & Márquez, J. L. (2026). Behavioral configurations of movement, screen exposure, and diet in school-aged children: a cross-sectional study. Bulletin of Faculty of Physical Therapy, 31(1), Article 8. https://doi.org/10.1186/s43161-026-00340-3

Image Credits: AI Generated

DOI: 10.1186/s43161-026-00340-3

Keywords: pediatric health, screen time, physical activity, dietary habits, cross-sectional study, behavioral clustering, mobility restriction, child development, Santiago Chile, public health surveillance, Behavioral, configurations