The novel coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on everyday life worldwide. Since the declaration of the global pandemic and the first national cases, Australia has had a total of just over 200,000 confirmed cases and 1,968 deaths (from March 2000 through to November 2021) (1). Australia has been faring relatively well compared to the rest of the world, with one of the lowest death rates (7.78 per 100 000 population) (2).

In response to this pandemic, in March 2020, each state in Australia implemented several approaches to reduce the health and economic impact of COVID-19. In New South Wales (NSW), schools and childcare services only remained open for the children of essential workers (hospital staff, teachers, police staff etc), workplaces implemented work-from-home strategies and several restrictions were imposed on the community as cases increased, such as number of visitors permitted in households and outdoor areas, the closure of restaurants, cafes, amusement parks, play centers, gyms, playgrounds, cinemas, and the cancellation of team sports/children's group activities. The height of these restrictions in NSW in 2020 occurred between March-May for a period of 62 days. However, unlike other countries and states within Australia, during this period of restrictions in NSW, there were no restrictions on the amount of time people were permitted outside for exercise. Studies conducted during the COVID-19 pandemic world-wide have shown that children had decreased physical activity, increased screen time and increased unhealthy eating and snacks (3–8). It is anticipated that COVID-19 restrictions in Australia during 2020 likely had a lesser impact on child health behaviors than what has been observed globally given the restrictions at this time for most Australian states except Victoria, was for a short period compared to the rest of the world. However, to date, there are limited data on the impact of the Australian restrictions on the health behaviors of children and families.

During the height of the 2020 COVID-19 restrictions, more than three quarters of Australian households with children kept their children home from school or childcare. While there are currently limited data available on child health behaviors in Australia during this time, over 20% of adults reported eating more discretionary foods and almost 60% indicated that they were spending more time in front of screens (9). As many children were at home during this period, it is likely that there were similar changes in these behaviors among children. There were however some positive changes seen over this time regarding fruit and vegetable consumption and more cooking at home (9). However, with an increasing number of adults losing work, many households were likely under greater financial pressure and struggling to provide healthy foods for their families.

Understanding the association between COVID-19 restrictions and the health behaviors of children and families is important in guiding decision-making among policymakers, and in educating parents and health professionals. Even in short periods of heightened restrictions, deterioration in healthy lifestyle behaviors has the potential to be embedded into usual family routines and have a long-term impact on dietary intake, movement behaviors and weight status (3). The aim of this study was to identify changes in child and family eating and movement behaviors (including physical activity, sedentary behavior and sleep) in families from western Sydney with children 0–12-years of age during the height of the COVID-19 restrictions in 2020.

The aim of this study was to determine changes in eating and movement behaviors in children and families from western Sydney in households with children 0-12-years-of-age during the height of the COVID-19 restrictions in 2020. To our knowledge, this study is the first to examine the early effects of the COVID-19 pandemic on both eating and movement behaviors among Australian children and families. Data were collected during the month of June 2020, subsequent to the first Sydney lockdown to prevent the spread of the SARS COV2 virus. The study will assist in determining the extent of health behavior changes on families resulting from COVID-19 restrictions and guide decision making in regard to initiatives required to address detrimental changes to reduce the risk of long-term health consequences.

Overall, despite the short-term (62 day) period of the first lockdown in Sydney, Australia, the impact of these restrictions appears similar to many of the global changes seen in child and family health behaviors due to lockdowns. The largest impact in this study was noted in relation to family sedentary behaviors, child screen time and social media use. Changes were also seen in relation to eating behaviors, with an increase in meals, snacks and unhealthy foods eaten. There were also some positive food-related changes in that there were more home cooked meals and families were eating more meals together. There was also an increase in consumption of healthy foods. There were changes seen in activity, with small increases overall, but less outdoor activity (with the exception of backyard activity) and more indoor activity.

The increases seen in sedentary behavior, and screen time are not surprising with many parents working from home and children learning remotely. A Canadian study of 1,472 families by Moore et al. (3), which we based our movement questions on, found similar increases in family sedentary time in families with children 5–11-years-of-age (3.78/5.00 compared to 3.91/5.00 in the current study) and child sedentary screen use (4.10/5.00 compared to 4.18/5.00 in the current study). A study by Carroll et al. (4) who investigated changes in child behaviors in 254 Canadian families with children aged 18 months to 5-years-of-age also found changes in screen time, which were related to an increase in online learning. Dunton et al. (5) study for 211 parents of 5–13-year-old children in the US also found increases in sedentary behavior, however most sedentary time was found spent watching television videos or movies. With the increase in screen use for work and learning purposes, this possibly spilled over into more recreational screen time and social media use. It should be noted that not necessarily all this screen time use would be negative, some was essential for educational purposes, and some may have helped in maintaining contact with loved ones. Although there are negative consequences of screen time and social media use (13), for children at this time, it may have assisted in staying connected with friends and family and made a positive contribution to mental wellbeing. However, potential negative consequences should be carefully considered, particularly in the context of long lockdown periods, where prolonged increased screen usage could have a detrimental impact on general health as well as mental wellbeing (14).

Like previous similar studies (4, 6), this study noted a reported increase in eating meals and snacks during the COVID-19 restriction period. Increased food intake during this time could be due to several factors. Spending considerably more time at home indoors and out of regular routines may result in boredom which can lead to increased eating (15). Stress can also be a factor in increased food consumption (16). This may be a result of direct stress of the lockdown on children, not being able to see friends or family, attend school, and difficulty managing remote learning. Anxiety and stress for parents caused by financial pressure, job instability, increased work hours and juggling competing demands could also result in parents overeating and have an indirect on children's food consumption through role modeling. It has been reported that the mental health of 48% of adults and 36% of children in Australia has been affected by COVID-19 (7), so the potential for related overeating is considerable. Increased time on screens and social media may also be a factor in increased food consumption. There is an established relationship between screen time and obesity in children, which is thought to be primarily mediated by food consumption while watching screens and exposure to unhealthy food advertising (17). An Australian study reviewed social media posts of 42 leading food and beverage brands (including fast food, discretionary foods and food delivery services) over 4 months, coinciding with the lockdown period of the current study. It found that almost 80% of these brands capitalized on COVID-19 in their marketing messages, and often these messages related to corporate social responsibility, a strategy which has been demonstrated to increase sales (18). Increases in screen use during this time could therefore have a detrimental impact not only on food intake in the immediate term but also an effect on child weight trajectories.

There appeared to be positive changes in regard to more home cooked meals which was also found by Carroll et al. (4), and in a New Zealand study of adults by Gerritsen et al. (19), half of whom had children under 18 years. Carroll et al. (4) reported that parents expressed interest in involving children in food preparation, and that they would like resources to assist them with this, a strategy which may be useful in future interventions, particularly considering involvement of children in meal planning and preparation has been shown to be predictive of healthier eating (20). While home cooking is generally healthier than takeaway alternatives (21), it should be noted that we did not explore the type of foods being prepared at home. In Gerritsen et al. (19) study, increases in home cooking during lockdown did not necessarily translate to healthier food intake, particularly for households with children. Like Carroll et al. (4), the current study found an increase in the family meals eaten together, possibly due to many parents and children being home together at lunchtime, and many parents being home at dinnertime who may otherwise have long commuting times.

While there was less of an impact on physical activity overall, outdoor activity (other than backyard activity) remained similar, while indoor activity increased. There was a slight increase in walking and bike riding, but less activity in the street and at parks and fields. These findings were similar to Moore et al. (3), though there seemed to be a little more participation in overall child activity in the current study (3.25/5.00) compared to Moore et al. (3) (3.00/5.00), child walking and bike riding (3.18/5.00) compared to Moore et al. (3.00/5.00), and family physical activity (3.20/5.00) compared to Moore et al. (3) (2.72/5.00). These slight differences may be due to differences in the built environments, weather conditions and other differing factors between Australia and Canada. Other studies have reported reductions in child physical activity during lockdowns (4, 5). During the lockdown period in Sydney, there was a reduced variety of opportunities to be active with playgrounds and skateparks closed, and reduction in incidental activities, such as active commuting to school. With the closure of schools (and therefore access to physical education classes and school sport), community sport and other activities, the activity that children undertook during this period was less structured in nature, and it is likely that it was less intensive than activities they participated in prior to lockdown (22). So, although in the current study activity may not have declined overall, it is likely that the activities being undertaken were of lower intensity, which may impact on children's ability to meet the energetic play and moderate to vigorous intensity aspects of the 24-h movement guidelines (23, 24). Parents in the current study reported that their children slept a little more than before, consistent with some studies (3, 8), while other studies have reported sleep was unchanged (4). With children learning from home, it is probable that this increased sleep resulted from children not having to get up as early to leave for school or other activities.

The changes in health behaviors reported in this study have the potential to have a detrimental effect on child weight status. A study in the USA has predicted that based on the impact of school closures for 6 months, child BMI could increase by 0.198 and childhood obesity could increase by 2.373 percentage points. This is solely based on reduction in activity from children not being able to attend school physical education classes and does not factor in any dietary intake changes (25). At the time of writing in 2021, NSW has experienced a recent outbreak resulting in a further lockdown period. Schools closed from June until October 2021. In addition to the initial 4-week closure in 2020, this would amount to a total period of 5 months. While predictions made by An et al. (25) are based on USA data, it is possible that these changes would be similar for children in NSW, and potentially much worse in the state of Victoria, where schools have been closed intermittently for a total of over 8 months during 2020 and 2021.

This study found that children from lower socioeconomic areas reported less physical activity and ate less healthily than those from higher socioeconomic areas during the COVID-19 restrictions. Further, children from lower socioeconomic areas reported an increase in sedentary behavior compared to those from higher socioeconomic areas. It is well-recognized that health inequity is impacted by social determinants such as access to health care, education, employment opportunities, adequate income and affordable housing (26). Overweight and obesity rates in NSW are higher in children from lower socioeconomic backgrounds than children from higher socioeconomic backgrounds. Cardiorespiratory fitness rates have also been reported to be lower in children from lower socioeconomic backgrounds (27). Furthermore, in lower socioeconomic areas, there are generally less safe places to exercise, and less access to greenspaces, making it more challenging for people to be active (22). Cost associated with sporting activities may also contribute to this lower level of fitness. Targeted policies and programmatic strategies are therefore required to ensure the gap between lower and higher socioeconomic families is not exacerbated and widened as a consequence of the pandemic.

Children living in a house increased their overall outdoor activity significantly more than children living in other types of housing. This was also the case in regard to walking and bike riding specifically. Likewise, Moore et al. (3) also found that children that lived in detached houses did more outdoor physical activity and spent more time walking and bike riding. Similarly, Mitra et al. (6) found that residing in a house was correlated with increased outdoor activities. Previous research has demonstrated that children are more active when they are outside than inside (28). Access to more outdoor space for those that live in houses compared to other housing types may account for some of the differences seen in the current study. This finding reinforces the need for judicious urban planning in areas with high-density housing to ensure that there is nearby access to facilities such as greenspaces and walking and cycling tracks to enable families that do not have access to ample outdoor spaces on their property to be active (29). This disparity in outdoor activity may also have been exacerbated by the closure of playgrounds and skateparks at the height of restrictions.

While most parents reported that their children's sedentary behavior increased, older children (5–12-years-of-age) were significantly more affected. Although sedentary behavior increases as children get older (30), the COVID-19 pandemic may be accelerating these changes. Greater increases in sedentary behavior during lockdown in children aged 9–13-years compared to younger children were also noted by Dunton et al. (5) in the USA. Patterns observed in parents' perceptions of changes in children's sedentary behavior further underscore the heightened risk of the pandemic on older children. It is concerning that older children may adopt new behavioral habits of physical inactivity during the pandemic that are extremely difficult to change. The development of healthy habits in childhood needs to be a high priority with particular attention paid to screen time. Previous and current health promotion programs to date focus on educating parents on screen time guidelines, but perhaps like similar public health behaviors (physical activity and healthy eating) broader environmental strategies need to be considered to help regulate screens outside the home, such as in early childhood settings and primary schools and a higher priority in general is given to movement behaviors in schools and childcare settings.

A report by an Australian food charity in 2021 reported that 28% of Australians were food insecure over the past 12 months, and 38% of those who are food insecure had not experienced food insecurity prior to the COVID-19 pandemic (31). While this proportion is much higher than the 7% that reported that they had run out of food in the last 12 months in the current study, 18.5% reported that they were less able to afford food during the height of the restrictions. It should also be noted that the sample was a higher socioeconomic demographic compared to the general western Sydney population, with 75% of the study sample living in the most advantaged postcodes (6–10 top deciles). It is therefore possible that the actual percentage could be larger across the western Sydney population. With the continued lockdown periods that have occurred since our study was conducted, it is also likely that the situation has further deteriorated since.

Prior to COVID-19, in New South Wales, many children were not meeting guidelines for healthy eating and physical activity (32). The negative impact of COVID-19 restrictions is of public health concern as there is the potential for exacerbation of existing unhealthy behaviors in children and families and danger that these habits could become permanently entrenched, increasing the risk of obesity, diabetes and cardiovascular disease in later life. While there has been a plateauing of childhood overweight and obesity rates in NSW in recent years (albeit at high rates of around 23% of 5–16-year-olds in 2019) (33), behavior changes seen during the COVID-19 lockdown could threaten this progress and childhood obesity rates could again begin to increase. Currently, there are no Australian data available on child post-COVID weight status. It is important that overweight and obesity rates are monitored closely during COVID recovery to determine if rates begin to increase. During lockdown, public health messaging has concentrated on infection control and social distancing, with little focus on healthy eating and physical activity and sedentary behavior. It is critical that COVID-19 communications are balanced with health promotion messaging. Programmatic and policy strategies geared toward reducing sedentary behavior, increasing moderate-vigorous intensity physical activity and improving eating behaviors are essential as Australia navigates its way through and beyond the pandemic. Upstream approaches are also essential to ensure that environmental factors influencing such behaviors are addressed. The World Health Organization recommended in their Report of the Commission on Ending Childhood Obesity in 2016 that several initiatives be implemented, including regulating unhealthy food marketing, improving food labeling, taxation of sugar sweetened beverages and creating supportive environments in settings where children gather (34). These recommendations have become even more pertinent in the post-COVID recovery period.

This study provides insights into child and family lifestyle changes during the COVID-19 pandemic in western Sydney, NSW, Australia. Even with the lower level and shorter time-period of restrictions in NSW, Australia in 2020 compared to the rest of the world, there appeared to be notable parent-reported impacts on child and sedentary behaviors and eating behaviors, and child outdoor physical activity. Some of these impacts were more substantial in older children and families residing in areas of higher socioeconomic disadvantage. These disparities highlight the need to enact policies and programs to support families in developing healthy lifestyle habits during COVID recovery.

The datasets presented in this article are not readily available because the datasets presented in this article are not readily available because participants have not provided consent for future use of data. Requests to access the datasets should be directed to JM, Janelle.McNicholas@health.nsw.gov.au.

This study involving human participants was reviewed and approved by Western Sydney Local Health District Human Research Ethics Committee. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

JM: research concept and design, preparing research proposal, conducting qualitative data analysis, and writing the manuscript. MH: research concept and design, preparing research proposal, conducting quantitative and qualitative data analysis, and writing the manuscript. SH and SM: preparing research proposal, dissemination of survey, data cleaning, some data analysis, and reviewing and editing of manuscript. JP: preparing research proposal, dissemination of survey, and reviewing and editing of manuscript. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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