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State of Child Health 2026: Early childhood development

Health Policy team
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This indicator assesses whether children have met the expected developmental outcomes as they enter primary school. It provides an indication of their overall health and wellbeing at a key milestone, and whether children have received access to the support they needed to ensure the best start in life.
Last updated
Post date
14 July 2026
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This is one of 12 indicators in our State of Child Health resource.

In the UK, early childhood development is measured using various indicators: proportion of children achieving Good Level of Development (GLD) in England and Early Child Development measures in Scotland. There are no equivalent data in Wales and Northern Ireland. There are significant limitations to this indicator, as there is no shared, standardised measure of early childhood outcomes across the nations.

  • Good Level of Development, England: Assess whether children have achieved the expected level across communication and language; personal, social and emotional development, physical development, mathematics and literacy at the end of the early years foundation stage at age 5.1
  • Early Child Development, Scotland: The child health programme includes screening for specific medical conditions, provision of routine childhood immunisations, and a series of child health reviews. Updates on children’s development are assessed during the 13-15-month, 27-30-month, and 4-5-year child reviews.2
  • In Wales, early childhood development was previously assessed through the Foundation Phase Profile, which was discontinued in 2022. A Welsh Government-commissioned scoping review has highlighted the need for a single definition and agreed indicators to be able to measure whether children in Wales are achieving early childhood developmental outcomes, but these have not yet been established.3
  • Northern Ireland bases its early childhood development work on the Executive Early Learning and Childcare (ELC) Strategy. The Strategic aims are to improve children’s early years development and outcomes; reduce financial pressures on families by subsidising childcare costs; and ensure a sustainable, high‑quality early years sector and workforce.4

What is the problem?

The early years are a critical period for shaping a child’s physical, language, cognitive, social and emotional development. Unfortunately, however, there are significant inequalities in the levels of development among children starting school.

In England, the UK Government has set an ambition that 75% of 5-year-olds will achieve a GLD by 2028. In 2024, around two-thirds (68.3%) of children achieved a GLD. Rates have recovered from a decline from 71.8% in 2018 to 65.2% in 2021.

In Scotland, the Scottish Government’s Early Child Development Transformational Change Programme aims to reduce the proportion of children with developmental concerns at 27-30 months by a quarter, from 18% to 13.5% by 2030. In 2024-25, 14% of children who received a 13–15-month review, 17% of those at 27–30-month review, and 19% of those at 4–5-year review had at least one developmental concern recorded. This represents an increase since 2017-18 at each review stage.

There is a clear link between achieving the expected development milestones and deprivation. In England, this is evidenced by comparing children eligible for free school meals to those who are not. For those eligible for free school meals (FSM) in 2024, only around half (51.3%) achieved a GLD compared with nearly three-quarters (72.5%) of other children. In Scotland, there are also inequalities in the percentage of children recorded as having a developmental concern at each of the reviews. In 2024-25, the proportion of children living in the most deprived areas recorded as having a concern at the 27-30-month review (24%) is more than twice that of children living in the least deprived areas (9%).

See chart in full

See chart in full

There is also evidence of inequalities between ethnic groups. In England, 69.9% of Mixed and 69.7% of White children achieved GLD at age 5 in 2024-25, compared to 62.9% of Black children.

A persistent gender gap is evident too. In England, for example, 75.3% of girls achieved GLD versus 61.6% of boys in 2024.

See chart in full

Why does it matter?

Health and educational outcomes are interconnected: ill health can hinder children’s educational performance and vice versa, as low educational attainment can contribute to poorer health.5

When a child misses key developmental health and learning milestones, this can impact their ability to be ready to start school by lacking the basic skills and capacities needed to learn. For example, children may struggle to communicate effectively, understand instructions, manage emotions, or build relationships and play with peers on entering primary school.6

Drivers of poor outcomes

Multiple barriers have been identified that contribute to children failing to meet the expected early developmental outcomes. Evidence shows that these are interlinked and cumulative, with inequalities widening as children move through the education system.

Poverty is a key driver to poor early childhood development as children living in the most deprived areas are less likely to reach the expected outcomes compared to those in the least deprived.7

A family’s access to high quality early years services, which includes childcare, early years education and parental information and support, also have an impact on meeting these outcomes.8 For example, health visitors have a vital role in health promotion for families and are the often frontline for identifying issues in young children to provide early intervention and prevent ill health escalating. However, the health visiting workforce is currently unable to meet the demand in their services due to their reduced capacity, coupled with the current long waiting lists for children’s community health services, such as in speech and language therapy.9 This can result in delays in diagnosing and mitigating any developmental delays.

Why we need to act now

Meeting the expected standards of early childhood development is central to a child’s physical and emotional wellbeing and sets them up to fulfil their potential. Inequalities in early childhood development influence later inequalities: when children do meet the expected outcomes at this stage, it increases the likelihood of low academic attainment. The attainment gap measured in 11-16-year-olds can be linked back to attainment in the early years.10 As adults, they are also less likely to receive higher education, have lower earnings and have poorer physical health and wellbeing.11

Children who do not have the expected cognitive, social and emotional skills and health outcomes highlight missed opportunities for early identification and support. These children may have required additional support or early intervention to prevent challenges from compounding, which would in turn contribute to widening developmental gaps over time.

A paediatrician's insight

From Dr Saraswati Hosdurga, Consultant Community Paediatrician and RCPCH Clinical Lead for Early Years 

Your experience of supporting and/or treating children and young people in the early years/ to achieve ‘Good Level of Development’ - has anything changed over time?

"As a consultant community paediatrician, my strategic work involves supporting the health needs of vulnerable children as a designated doctor for children in care and care leavers. Over the years, I have seen increased demand for early years paediatric services, with more referrals for speech and language delays, sleep difficulties, developmental, behavioural, and complex health needs, nutritional deficiencies, alongside increased safeguarding and care cases.

"However, since COVID-19, there have been some positive improvements to support families, including the introduction of ambulatory services, hospital at home, virtual wards, digitalisation of some services, palliative care services, and health education at family hubs."

What have been challenges to supporting children and young people in the early years/ to achieve ‘Good Level of Development’- what contributes to this or keeps them returning to the NHS for support?

"Children need strong early foundations to reach a good level of development and start school confidently. This means feeling safe and having access to enriching environments where they can play and grow, alongside timely, accessible healthcare and professional support for parents and carers. However, access to early years services differs across the UK, with variation in availability of services, clinical pathways and referral criteria creating a postcode lottery where early intervention and support can be missed or delayed. These challenges are compounded by poverty and families’ wider circumstances, with early support remaining crucial for children’s health and to reach a good level of development.

"Many families are missing out on vital support they need for a child to reach a good level of development, due to long waiting times, gaps in services and high referral thresholds for speech and language support, autism assessments and developmental assessments. There is also limited access to specialist infant mental health support for emotional and behavioural difficulties, and parent workshops are often hard to attend due to restricted hours. Structured support for parents and carers is also limited, despite clear evidence that family wellbeing is crucial in shaping a child’s early neurodevelopment.

"Service provision in the early years is also often fragmented, with reliance on the charity and voluntary sector to fill gaps and limited coordination across healthcare settings. Many children need joined-up support across health, education, and social care, but separate commissioning makes services hard for families to navigate. For example, a child with developmental delay often sees multiple professionals (such as a physiotherapist, speech and language therapist, paediatrician, portage, health visitor) and attends many appointments, requiring families to navigate complex systems and repeat their story, whereas coordinated, child-centred assessments would streamline care, reduce duplication, and improve outcomes.

"I have also seen that increasing poverty and limited access to green space in urban areas can restrict children’s opportunities to engage in healthy environments. Inequalities in access to safe, free outdoor spaces reduces opportunities for play, which is key to building confidence, supporting physical development, and promoting healthy brain development."

Any examples of good practice to tackle the growing number of children and young people with poor health outcomes in the early years/ to achieve ‘Good Level of Development’?

"At North Somerset community health services, there was a system where a referral for early years was triaged jointly by a paediatrician, physiotherapist, speech and language therapist, child development practitioner and a co-curricular activities (CCA) coordinator. Based on the need, joint appointments were booked as child centred assessments inviting health visitors, portage, and any others a parent want to bring in. One consolidated report was produced and shared with SEND departments so that the education planning and support started at an early stage. Clinicians had the opportunity to advocate for complex health needs. Booking and planning was straightforward as it was clinically led, with bottom-up admin support, thus supporting children’s needs and contributing to their good level of development."

Advice for paediatricians

"Five tips for paediatricians working with children in the early years:

  1. Explore and understand the family environment, including possible adverse childhood experiences, and see if any impact of this on children’s presentation.
  2. Triage the referrals with consideration towards educational levels and digital literacy of the family.
  3. Empower families to seek help on their child’s needs rather than focusing on diagnosis.
  4. Focus on prevention and health education. Explore more about their lifestyle to include mainly diet, nutrition, physical activity and sleep, and screen time.
  5. Gain knowledge about the available local resources to signpost families through paper copies or QR codes for easy access to address issues with digital literacy."

Recommendations

England
  • Ensure equitable and integrated early years support, including the national roll‑out of Family Hubs, the Best Start in Life programme, and community health services, so all families can access high‑quality support.
  • Provide investment to increase the capacity of the health visitor workforce to facilitate an increase in the number of mandatory health visitor contacts for children from five to six.
  • Ensure equitable funding for community health services and workforce capacity and capability through a children and young people’s workforce plan to deliver timely assessments, diagnosis, and support.
Scotland
  • Provide Health Boards and local authorities with dedicated funding to deliver community‑based, inclusive family support programmes. These programmes should offer parents and carers structured guidance on behaviour management, sleep, toileting, diet and the development of healthy routines.
  • Increase investment in primary and community health services, alongside comprehensive enhancements to paediatric training for all healthcare professionals, to enable timely, appropriate care and prevent children and young people from reaching crisis point due to prolonged waits.
Wales
  • Address the significant gap in standardised, population-level data for children aged 2-11 by agreeing a single shared definition of child development across Welsh Government departments, health services and education.
  • Invest in early years play and development to promote movement, language and social development.
  • Invest in the health visiting workforce to support the delivery of the Healthy Child Wales Programme.
  • Embed the Best Start in Life: An Early Years Framework for Action in order to deliver a responsive and joined-up system across local, regional, and national levels.
Northern Ireland
  • Implement and fund the refreshed Healthy Child, Healthy Future framework. This must include focus on the first 1,000 days; stronger support during pregnancy, improved pathways for early identification of health and wellbeing concerns, targeted support and family centred interventions for those with additional needs, and consistent pathways between maternity, health visiting, school nursing and early intervention services.
  • Ensure all Health and Social Care Trusts use unified systems, with the collection of high-quality, consistent data enabled through Encompass, to monitor outcomes and inequalities.
  • Expand targeted support for families, including peer support, targeted local support in areas of high deprivation and public facing breastfeeding promotion that aligns with the early years focus on nutrition and equity.

This is one of 12 indicators in our State of Child Health resource.