Digital Interventions Targeting Parents to Improve Early Childhood Movement, Nutrition, and Sleep Behaviors: Systematic Review

Clinical Snapshot

Key Findings

• P Value: Not reported at the synthesis level; individual study significance reported narratively

• Effect Size: No pooled effect size calculated; narrative synthesis reports mixed findings across all domains. Pregnancy-to-infancy studies: mixed findings for breastfeeding and feeding practices. Toddler studies: improvements in sleep, mixed findings for diet and screen time, no differences in physical activity. Preschooler studies: significant improvements in feeding practices and diet, no differences in physical activity, sedentary behaviour, or sleep, mixed findings for screen time.

• Primary Outcome: Effectiveness of autonomously delivered digital interventions on child physical activity, sedentary behaviour, nutrition, and sleep across three age groups (0–1 year, 1–2 years, 3–5 years)

• Nnt Or Sensitivity: Not calculable from available data; no NNT, sensitivity, specificity, or hazard ratio reported due to narrative-only synthesis

• Confidence Interval: Not calculable — no meta-analysis performed; individual study confidence intervals not reported in the abstract

Clinical Application

Digital interventions are inherently scalable and low-cost to deliver at population level. Autonomous delivery (without clinician involvement) reduces implementation burden on healthcare systems. However, the mixed effectiveness findings and incomplete engagement data mean clinicians cannot yet confidently recommend specific digital tools. Feasibility is high in principle; effectiveness evidence remains insufficient to guide specific platform selection. This review is directly relevant to Australian practice. The authorship team is based at the Institute for Physical Activity and Nutrition (IPAN), Deakin University, Victoria — a leading Australian research centre in this field. Australian national guidelines (Australian 24-Hour Movement Guidelines for the Early Years, 0–5 years) align with the outcome domains examined. The RACGP and the Australian Government's 'Healthy Kids' initiatives support parent-focused early childhood health promotion. Digital health delivery is consistent with Australia's expanding telehealth infrastructure post-COVID-19. PBS and TGA considerations are not directly applicable as these are behavioural (non-pharmacological) interventions. Equity considerations are important: digital interventions may not reach Aboriginal and Torres Strait Islander families, rural and remote populations, or families with limited digital literacy — gaps not addressed in this review. The My Health Record and state-based digital health platforms could theoretically integrate such interventions, but no specific Australian platforms were evaluated. Parents of children aged 0–5 years seeking scalable digital support for promoting healthy movement, nutrition, and sleep behaviours. Most applicable to families with smartphone or internet access. Evidence is strongest (though still mixed) for feeding practices and diet in preschool-aged children (3–5 years) and sleep in toddlers (1–2 years). Evidence is weakest for physical activity across all age groups.

Abstract

BACKGROUND: Early childhood (0-5 years) is key for shaping health behaviors, yet optimal behaviors are rarely achieved. Digital health promotion interventions offer scalable support for families; however, most research has focused on childhood more broadly, leaving limited evidence for the early childhood period. OBJECTIVE: The primary aim of this systematic review was to examine whether autonomously delivered digital interventions targeting parents are effective at increasing physical activity, reducing sedentary behavior, improving nutrition (breastfeeding, feeding practices), and/or optimizing sleep among children aged 0-5 years. The secondary aim was to review the reporting of co-design practices, user engagement, and process evaluation, and to assess how engagement influences intervention effectiveness. METHODS: Seven databases were searched for randomized controlled trials (RCTs) evaluating autonomously delivered digital interventions targeting one or more of the following behaviors: physical activity, sedentary behavior, nutrition, or sleep among children (published to January 2026). Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Findings were narratively synthesized by target age-group and behavior, and the direction of effect was summarized in structured tables. RESULTS: Of the 14,352 identified records, 38 interventions (33 RCTs, 4 pilot RCTs, and 1 feasibility RCT) were included. Most studies focused on pregnancy to infancy (n=24; 0-1 y), followed by preschoolers (n=8; 3-5 y) and toddlers (n=6; 1-2 y). Intervention duration ranged from 2 weeks to 1000 days, and various digital formats were used (apps n=11, SMS text messaging n=10, web- or internet-based platforms n=6, WeChat [Tencent] n=3, tablet-based program n=2, a combination of app and SMS text messaging n=1, website and emails n=1, emails and SMS text messaging n=1, automated voice calls n=1, Facebook Messenger Chatbot [Meta] n=1, and online videos n=1). Interventions spanning pregnancy to infancy reported mixed findings for breastfeeding and feeding practices. Studies targeting toddlers showed improvements in sleep, mixed findings for diet and screen time, and no differences in physical activity. Most studies targeting preschoolers reported significant improvements for feeding practices and diet, but no differences in physical activity, sedentary behavior and sleep, and mixed findings for screen time. Most studies reported co-design or engagement (n=24), but few examined the impact of engagement on intervention effectiveness (n=6), and those that did reported mixed findings. Interpretation was limited by heterogeneous designs, inconsistent outcome measures, and mixed risk-of-bias ratings across studies. CONCLUSIONS: This review advances the field by synthesizing evidence on scalable digital interventions that support parents in promoting healthy lifestyle behaviors across the first 2000 days, together with key design and implementation factors that have rarely been reported in previous reviews. Unlike prior work, it focuses exclusively on autonomously delivered digital interventions in early childhood. Findings show heterogeneous designs and mixed effectiveness, and highlight 3 priority evidence gaps: limited studies in toddlers and preschoolers, incomplete reporting of engagement, and limited understanding of how engagement influences outcomes. These findings define priorities for future research to strengthen the evidence for scalable digital interventions in early childhood.

References

1. 1.Sandborg, J., Reese, B. L., Marshall, S., Hesketh, K. D., Laws, R., & Downing, K. L. (2026). Digital interventions targeting parents to improve early childhood movement, nutrition, and sleep behaviors: Systematic review. Journal of Medical Internet Research. https://doi.org/10.2196/85525