Movement habits linked to flourishing in children with asthma

Children and adolescents with asthma who met more evidence-based guidelines for physical activity, screen use and sleep were substantially more likely to be described by caregivers as flourishing, according to a nationally representative analysis of United States children. Researchers combined data from the 2023 and 2024 National Survey of Children’s Health, focusing on young people aged 6 to 17 who had current asthma. The findings suggest that supporting healthy movement patterns could be an important part of pediatric asthma care, although the study cannot show that changing any behavior directly causes better well-being.

The team converted survey responses into a three-part, proxy-based version of the 24-hour movement guidelines for children and adolescents. Meeting the physical-activity proxy required activity on all seven days of the preceding week. Meeting the screen-time proxy meant recreational screen use of no more than two hours per day on most weekdays. The sleep proxy required an age-specific minimum duration of sleep. Children received one point for each criterion they met, producing a score from zero to three. This approach allowed the investigators to examine movement behaviors as a combined pattern rather than treating activity, sleep and screen use as entirely separate exposures.

Flourishing was assessed through caregiver reports of whether a child usually or always met three positive-development indicators: expressing curiosity, completing tasks and demonstrating emotional self-control. This definition reflects the broader idea of healthy functioning, extending beyond the control of asthma symptoms or the absence of negative psychological conditions. Among 5,938 children with complete data on the three movement proxies, 5,936 also had flourishing information. Only 6.1% of the group met all three movement criteria, indicating that relatively few children achieved the full recommended combination of activity, limited recreational screen time and adequate sleep.

The weighted analysis found a marked gradient in flourishing. Prevalence was 40.1% among children who met none of the three criteria and rose to 65.9% among those who met all three. After adjustment, each additional component was associated with 19% higher prevalence of flourishing, yielding an adjusted prevalence ratio of 1.19 with a 95% confidence interval of 1.12 to 1.26. A secondary logistic model produced a similar pattern, with an adjusted odds ratio of 1.44 and a 95% confidence interval of 1.27 to 1.64. The association was statistically significant at P less than .001 in both analyses.

Standardized predictions translated the score into a more intuitive comparison. The model estimated flourishing prevalence at 39.8% for a child with no qualifying movement components and 65.8% for a child meeting all three. The corresponding risk difference was 26.0 percentage points. These are population-level model estimates, not predictions for a particular child, and they do not imply that a 26-point personal improvement is guaranteed if one behavior changes. Nevertheless, the size of the gradient shows that the combined movement pattern was closely connected with positive development in this population.

To place the asthma-specific findings in context, the researchers compared the per-component association among children with and without current asthma. The ratio of adjusted prevalence ratios was 1.02, with a 95% confidence interval of 0.96 to 1.08 and P equal to .474. In other words, the analysis did not detect a statistically significant difference in the movement-flourishing relationship according to asthma status. Risk-difference estimates for children meeting all three criteria versus none were 30.6 percentage points among children with current asthma and 29.6 points among those without it; the estimated difference between the two groups was −1.0 percentage point, with a 95% confidence interval of −10.7 to 8.8 and P equal to .844.

The authors described the absence of detected differences as reassuring because the holistic association appeared broadly similar in children with and without asthma. They also emphasized an important statistical limitation: a null interaction test does not prove that the two groups are exactly equivalent, particularly when confidence intervals still allow for clinically relevant differences. In practical terms, the results do not suggest that asthma erases the potential importance of sleep, physical activity and screen habits. Instead, they indicate that the general relationship between healthy movement and flourishing was also visible among children managing a chronic respiratory condition.

The statistical approach accommodated the national survey’s complex design. Survey-weighted quasi-Poisson models were used to estimate adjusted prevalence ratios, while logistic models supplied secondary adjusted odds ratios. The primary adjusted analysis included 5,647 children after 289 participants with incomplete covariate data were excluded from the larger group with flourishing data. Six poverty indicators were combined using Rubin’s rules, a technique that integrates results from multiple imputation and accounts for uncertainty in the combined estimate. These methods help ensure that the results are not simply an artifact of an unweighted sample or incomplete treatment of missing socioeconomic information.

As an early-access research article, the work is already peer reviewed, citable and assigned a permanent digital object identifier, although the published version remains subject to editorial revision. The analysis used deidentified public-use data and involved no direct contact with participants or access to identifiable information. The findings are best understood as cross-sectional associations rather than a clinical trial. Children with healthier movement patterns may also differ in ways that support well-being, including family environment, access to safe spaces, chronic disease severity, stress and other resources. The study cannot determine whether increasing activity, reducing recreational screen time or extending sleep would itself raise flourishing, nor does it establish the amount of change needed to produce a meaningful benefit.

Even with those cautions, the results add weight to the idea that pediatric asthma care should look beyond medication adherence and respiratory symptoms. A simple three-item assessment based on routine survey questions identified a strong association with emotional and developmental functioning: only 6.1% of children with current asthma met all three movement criteria, while those meeting all three had a modeled flourishing prevalence more than 26 percentage points above those meeting none. For families and clinicians, the practical message is not that any one behavior is uniquely responsible, but that sleep, play and screen routines form a potentially actionable package. A national, post-pandemic dataset indicates that making these everyday habits more achievable may be worth testing in prospective interventions designed specifically for children and adolescents with asthma.

Subject of Research: Associations between 24-hour movement behaviors and flourishing in U.S. children and adolescents with current asthma

Article Title: NSCH-derived proxy measures of 24-hour movement guideline components and flourishing among u.s. children and adolescents with current asthma: a cross-sectional analysis of the 2023–2024 national survey of children’s health

Article References: Qin, C., Shi, Y., Chen, Q., Xu, J., Chen, G., Wu, M., Fu, Y., & Yuan, C. (2026). NSCH-derived proxy measures of 24-hour movement guideline components and flourishing among u.s. children and adolescents with current asthma: a cross-sectional analysis of the 2023–2024 national survey of children’s health. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07850-y

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07850-y

Keywords: childhood asthma, flourishing, physical activity, sleep duration, screen time, 24-hour movement, National Survey of Children’s Health, positive youth development, NSCH-derived, proxy, measures, hour