Adherence to the Singapore Integrated 24 h Activity Guidelines for Pre-Primary School Children Before, During and After the COVID-19 Lockdown in Singapore.

The COVID-19 pandemic has significantly disrupted the lives of pre-primary school children in Singapore where increased infection rates prompted lockdown measures that altered children's daily routines. This study aimed to evaluate the impact of the pandemic on the lifestyle behaviours and health quality of 3134 children aged 5 to 6 years across three periods: pre-COVID, COVID-19 lockdown, and COVID-19 endemicity. Data were collected using the Surveillance of Digital Media Habits in Early Childhood Questionnaire (SMALLQ^®) to measure on- and off-screen media habits of children and the Pediatric Quality of Life Inventory (PaedQL) to assess children's health quality. Adherence to physical activity (PA) guidelines dropped from 32.7% pre-COVID to 27.4% during lockdown but improved to 34.4% in endemicity (p < 0.05). Sleep (SL) adherence followed a similar pattern, decreasing from 33.4% to 27.9% before rising to 40.6% (p < 0.05). Screen time (ST) adherence significantly declined during lockdown (16.7% to 10.8%, p < 0.001). Weak positive correlations with all PaedQL metrics were observed across periods, except during endemicity (p < 0.05). Concerted efforts involving key stakeholders must be made to mitigate the negative effects of the pandemic on children's lifestyle behaviours and QoL, ensuring they are better prepared for the transition to primary school.