Beyond the pandemic: tracing the evolution of activity, screen time, and sleep in European children over 3 years.

During COVID-19, several studies documented a decrease in physical activity time, an increase in screen use and a worsening of sleep duration. The aim of this study was to compare the proportion of children with unhealthy amounts of time dedicated to these three habits across three different moments: before the pandemic (T1), 2 weeks after its outbreak (T2), and three and a half years later (T3), when the situation was fully restored. A total of 1248 caregivers of children and adolescents aged 3 to 18 years old (46.9% female) from Italy, Spain and Portugal reported the amount of time devoted to physical activity, screen use and sleep at each moment. At T2, an increase in the percentage of children and adolescents with unhealthy time dedicated to physical activity and screen use was recorded. Proportions decreased at T3 but remained higher than at T1. At T3, the proportion of participants with inadequate sleep hours significantly decreased in children aged 3 to 5 compared to T1-T2, showed no differences in children aged 6 to 12, and increased in adolescents compared to T2, with no significant differences compared to T1.Conclusion: Results highlight that, although unhealthy patterns in physical activity and screen use have decreased compared to the confinement in March 2020, three and a half years later they remain higher than before the COVID-19 pandemic. These findings underscore the need for continued efforts to promote healthy lifestyles and prevent potential adverse consequences. What is known? • The COVID-19 pandemic disrupted children's and adolescents' routines, leading to impairments in physical activity, screen use, and sleep. • Some of these difficulties persisted throughout the pandemic, even without confinement measures, while others gradually improved. What is new? • Three and a half years after the start of the pandemic, the proportion of children and adolescents with unhealthy durations in physical activity and screen use had decreased compared to during the confinement, but remained significantly higher than before the pandemic. • Sleep duration does not significantly differ -or even improves, depending on the age group- relative to before the pandemic.