What is the state of children's health in England?

Introduction

Children’s health is a foundation for future society. Healthy children are more likely to thrive in school and enjoy better health in adulthood. Conversely, poor health in childhood has lasting impacts on individual life chances and creates avoidable pressure on public services, including the NHS.

The health and wellbeing of children in England presents a complex and evolving picture. Although there have been marked improvements in some health outcomes, momentum has stalled or reversed in others. Today’s generation of children are experiencing some of the worst health outcomes in Europe. Added to that, too many children are facing gaps or lengthy delays in accessing support. Overall, the system that supports the health and wellbeing of children is under pressure. Demand is rising, waiting times are growing, and access to services is uneven.

This explainer – the first in a series – offers a snapshot of the current state of children’s health in England, drawing on the latest available evidence. It focuses on outcomes across physical and mental health, the inequalities and wider determinants that shape those outcomes, and how well the health and care system is responding. It closes with The King’s Fund’s view on priorities for action and a look ahead to the second explainer, which will map the system for children and young people in England – setting out who is responsible for what, how services are delivered, and the levers available to improve outcomes and reduce inequalities.

A clear theme emerges throughout: children’s health is distinct from adults’ health. Children’s needs change quickly as they develop physically, cognitively and emotionally, and patterns of service use and experience of services differ. Services designed around adult models can miss crucial windows for prevention and intervention, and do not always consider the experience of children and young people. Improving children’s health therefore requires a deliberate, system-wide approach that puts children at the centre of service design and delivery.

1. The big picture: trends in children’s health outcomes

Over the past few decades, there have been significant improvements in health outcomes for children, including a decline in infant mortality. However, the UK still lags internationally on several indicators, and some concerning trends are emerging, including an increase in preventable infectious diseases, chronic conditions and mental illness among children.

Life expectancy and mortality

Over the past century, infant mortality has fallen dramatically, contributing to rising life expectancy. Avoidable childhood mortality (commonly caused by congenital abnormalities, injuries and complications during pregnancy and birth) has also fallen by more than a fifth in the past two decades. Children’s survival of cancers has doubled since the 1970s, reflecting advances in diagnosis and treatment.

Yet progress has stalled. Since 2015, infant, child and adolescent mortality rates in England have flatlined, and between 2020 and 2023 mortality increased.

Internationally, the UK ranks below nearly all Western European and other high-income countries for infant mortality, and life expectancy at birth similarly lags peers.

Birth and early development

Birth and early development are crucial to shaping health trajectories. Childhood mortality is highest in the first year of life, when children are most vulnerable. The proportion of babies born with a low birth weight, associated with poor health outcomes throughout life, has remained under 3% for two decades, and the UK sits around the OECD average on this measure.

Breastfeeding supports immunity, nutrition and maternal bonding, and the NHS recommends giving only breast milk for the first six months of a baby’s life. Breastfeeding at six to eight weeks has increased in the past decade (from 43% in 2015/16 to 56% in 2024/25), yet only a third of babies receive breast milk at six months (34% in 2010, the latest available data) – among the lowest rates in Europe.

A further warning sign is the average height of a 5-year-old, which has slipped 30 places in the world rankings between 1985 and 2019. Although height is a blunt indicator, shifts over time can signal the cumulative impacts of declining diet and living standards.

Additionally, developmental assessments consistently show that nearly 1 in 5 children are not meeting expected levels across communication, motor, problem‑solving and social skills at age 2 to 2.5 years. These early gaps often map onto deprivation and can widen during school years if not addressed.

Physical health

The UK has high rates of common chronic conditions in childhood, compared with other European countries, with significant implications for future health.

• Allergies are common, with 40% of children having a diagnosed allergy such as food, eczema, asthma, or hay fever. Food allergies more than doubled between 2008 and 2018. Asthma affects around 1 in 11 children, among the highest rates in Europe, and is a leading cause of emergency hospital admissions and school absence.

• Around 99,000 children across the UK are living with life-limiting conditions such as cancer, cystic fibrosis, and brain or spinal injuries – a figure that has tripled in the past 20 years. This reflects a marked increase in survival rates as well as an increase in recording of diagnoses. Although cancer remains the leading cause of death for children and adolescents aged 1–19, survival has dramatically increased to 85% of children surviving five years, up from 40% in the early 1970s.

There are also high rates of preventable morbidity in England, despite historic improvement in some areas.

• Vaccine-preventable diseases have resurged in children. Confirmed measles cases in 2024 were the highest since 2012, with outbreaks concentrated in areas of lower vaccine coverage. Whooping cough also surged, with the highest rates of infection in babies under three months.

• Unintentional injuries are a major factor in causing harm among children and disproportionately affect those who are socio-economically disadvantaged. Accidents such as falls, poisoning and drowning cause nearly 1 in 6 deaths among children and adolescents aged 1–19, yet most are preventable through safer home environments and child safety measures. Road traffic collisions, although falling, are the second leading cause of death among those aged 15–19.

• Poor oral health can negatively impact a child’s overall health and wellbeing, yet is preventable. In 2023/24, 22% of 5-year-olds had signs of tooth decay. In the poorest communities, 5-year-olds are three times more likely to have had teeth removed due to decay.

• Sexual and reproductive health has improved substantially, with prevalence of sexually transmitted infections among adolescents lower than a decade ago. Conceptions under 18 years have fallen by more than two-thirds since 2002 as a result of concerted national prevention efforts. However, the adolescent birth rate remains high relative to other Western European countries, and outcomes for young parents and their children remain disproportionately poor.

  

Mental health, wellbeing and neurodevelopment

Children’s mental health has deteriorated over the past decade, with rising prevalence and increasing complexity of need. In 2023, about 1 in 5 children and young people aged 8–25 had a probable mental disorder (such as anxiety, depression, conduct disorder or hyperactivity), up from 1 in 8 in 2017.

Among 17–19-year-olds, rates of eating disorders rose sharply between 2017 and 2023, from 1.6% to 20.8% in young women, and from less than 1% to 5.1% in young men. Hospital admissions as a result of self-harm among adolescents aged 10–19 have increased steadily over the past decade, from 298 per 100,000 in 2011/12 to a peak of 474 per 100,000 in 2021/22, although indications suggest that rates are falling post-pandemic. Suicide and self-injury is consistently the leading cause of death for adolescents aged 15–19.

Compared internationally, there is a continuing pattern of lower happiness and wellbeing reported by children in England, with overall life satisfaction among 15-year-olds the lowest across 27 European countries. The proportion of children and young people reporting low happiness with their health has also increased in recent years, from 3.5% in 2016 to 8.9% in 2022.

Evidence suggests a rise in the identification of neurodevelopmental conditions in children and young people in England. It is estimated that more than 600,000 children and young people aged 5–17 have attention deficit hyperactivity disorder (ADHD), including those without a formal diagnosis. Boys are more likely to be diagnosed than girls, pointing to a gap in understanding of how these conditions present across the sexes.

Neurodivergent children often require additional support in education. Among pupils with an education, health and care (EHC) plan, autistic spectrum disorder (ASD) is the most common primary need, while for those receiving special educational needs (SEN) support, the most frequent need relates to speech, language and communication.

2. What shapes children’s health? Interacting inequalities and wider determinants

Children’s health is shaped by a complex web of factors that interact and are reinforced by the conditions in which children are born, grow and learn, and by the resources and opportunities available to their families. Health inequalities based on deprivation, geography, ethnicity, gender and sexuality affect exposure to risk, access to protective factors, help-seeking behaviour, and the likelihood of receiving timely, appropriate care. Children with disabilities face unique challenges and are disproportionately disadvantaged in their access to care and their health outcomes.

These dimensions often intersect – for example, deprivation and geography frequently go hand in hand, and structural discrimination can amplify the effects of poverty. Health inequalities overlap with wider determinants of health such as diet, physical activity, housing, clean air, and parental health behaviours to influence outcomes across the life course. Overall, child poverty is one of the most powerful predictors of poor health.

Deprivation and poverty

Around 3 in 10 children (4.3 million) in the UK are living in poverty, and relative child poverty (living in a household whose income is less than 60% of the current median) is growing at the highest rate of any advanced nation. The impact of childhood poverty is felt throughout the life course, with early disadvantage associated with chronic health conditions and poorer outcomes in adulthood. Children from lower-income families are less likely to eat nutritious food, access medical care, or live in safe housing.

The gap caused by deprivation is stark across a broad range of indicators:

• Infant mortality is over twice as high in the most deprived areas than in the least deprived.

• Children in the most deprived areas are 1.7 times more likely to attend A&E.

• Hospital admissions for asthma are over twice the rate in the most deprived areas.

  

Risk behaviours among children and adolescents have generally declined, which is a public health success. However, inequalities remain. Among 15-year-olds, for example:

• regular smoking (in the past week) has fallen from a high of 30% in 1996 to 2% in 2023, although regular vaping among this age group is now at 11%

• regular drinking (in the past week) has declined sharply from a high of 53% in 1996 to 16% in 2023

• regular drug use (in the past month) has decreased from 24% in 2001 to 11% in 2023.

Children whose parents smoke are up to three times more likely to take up smoking themselves. With prevalence of smoking across all ages three times higher in the most deprived areas, this risk behaviour will continue to be a dominant driver of health inequalities among children.

Ethnicity

Children from minority ethnic backgrounds experience different patterns of need, and some groups are more likely to report being in poorer health. It is difficult to unpick the causes of ethnic inequalities in health. Available evidence suggests a complex interplay of many factors, including deprivation, environment and health-related behaviours. Most ethnic minority groups are disproportionately affected by deprivation.

Notable disparities exist across many of the indicators mentioned:

• Infant mortality is consistently highest among Black children.

• South Asian children have significantly higher rates of obesity.

• Special educational needs and disabilities (SEND) provision is highest among children in the Traveller of Irish heritage community, with more than a third (34%) receiving SEN support or an EHC plan.

• Uptake of routine childhood vaccinations is lower in some ethnic minority groups.

  

Gender and sexuality

Gender norms shape behaviours and experiences from an early age, and sexuality and gender identity intersect with mental health and service access. For example, girls are less likely to meet recommended physical activity levels than boys. At the same time, young women are twice as likely to experience a mental health condition as young men. In particular, eating disorders are four times more common in young women (21%) than young men (5%). These patterns may be linked to societal pressures, body image concerns, and the impact of social media.

Boys, meanwhile, are twice as likely to die by suicide in adolescence, despite being less likely to be diagnosed with a mental health condition, pointing to barriers when it comes to seeking help, and potential gaps in diagnosis and support.

Children who identify as LGBTQ+ are more likely to experience poor mental health, stigma and discrimination, and may struggle to access inclusive and affirming care. Children who identify as non-binary are more likely to be referred to mental health services ‘in crisis’, and trans-identifying children referred for mental health support face the highest proportions of long waits, highlighting gaps in timely and appropriate care. LGBTQ+ young people are also more likely to undertake risk behaviours, such as smoking and recreational drug use.

Diet and physical activity

Nutrition and physical activity underpin healthy growth but are shaped by affordability, availability and the environments in which children live. Standards of childhood nutrition in the UK have fallen over the past two decades, contributing to declining health. In 2022/23, more than 730 children were admitted to hospital with malnutrition, rickets or scurvy – all conditions that are entirely preventable.

Food insecurity affects more than 1 in 4 children, increasing household reliance on cheaper, unhealthy food options. Ultra-processed foods (UPFs) now account for more than half (59%) of the daily calorific intake of 7-year-olds. Children are particularly vulnerable to marketing pressures and less able to make informed choices.

At the same time, obesity rates among children have risen to the highest level since records began, excluding the first year of the pandemic. Almost 1 in 4 children (24%) are now overweight or obese by the time they start primary school, and more than 1 in 3 (36%) are overweight or obese by the time they leave it. Prevalence of obesity is more than twice the rate among children in the most deprived areas. Obesity in childhood tracks into adulthood, increasing the risk of chronic conditions such as type 2 diabetes, cardiovascular disease, and some cancers. Obesity-related complications already affect 1.2 million children.

Added to this, levels of physical activity are falling, with fewer than half (48%) of children meeting recommended activity levels. Sedentary behaviours such as screen time are up, while opportunities for active play are down.

Housing and environment

Homelessness and insecure housing also impact health. More than 1 in 10 children in England live in non-decent housing (one with a hazard or immediate threat to a person’s health, not in a reasonable state of repair, lacking modern facilities, or not effectively insulated or heated). Poor housing conditions, such as damp and cold, are linked to respiratory illness, asthma, mental health problems, and developmental delays. Children in temporary accommodation face heightened risk. Inadequate temporary accommodation contributed to the deaths of at least 74 children between 2020 and 2025. Housing instability can disrupt education, relationships and access to services.

Exposure to air pollution also significantly increases the risk of childhood asthma, respiratory illness, and chronic disease in adulthood. In 2023/24, asthma accounted for almost 19,000 hospital admissions among under-19s, and spikes in air pollution concentration have been shown to correlate with increased hospital admissions. Deprived neighbourhoods and ethnic minority communities tend to experience higher levels of air pollution.

Parental health and family context

Children’s health is tightly linked to the health of parents and the family environment. The family environment can be a powerful protective factor: consistent, responsive caregiving relationships support healthy brain development, laying the foundation for optimal cognitive, emotional and social development. Outcomes for children with chronic genetic conditions can also be positively influenced by early intervention in childhood.

Conversely, when families face adversity, the risks to children’s health increase. Adverse childhood experiences (ACEs) – including abuse, neglect, domestic violence and household instability – can trigger a strong and lasting stress response, altering brain development and affecting cognitive, social and emotional functioning. This can increase the likelihood of adopting risk behaviours in adolescence, such as substance misuse or unsafe sex, and raises the risk of serious health problems in adulthood.

Maternal health during pregnancy is also critical for foetal development. Perinatal diet, environmental exposures, and health behaviours can impact the development of diseases across a child’s life course, including cardiovascular and lung disease, diabetes, and some cancers. Prenatal alcohol exposure, for example, is linked to learning difficulties, behavioural problems, and increased risk of mental ill health.

Persistent poor parental mental health and poverty multiply the risk of emotional and behavioural disorders six-fold and more than double the risk of mental health problems at age 17. Children growing up in poverty are also much more likely to be exposed to ACEs, compounding disadvantage. Overall, all personal development builds on early development; getting the early years right offers a crucial opportunity to protect the future health of children.

3. How well is the NHS working for children?

The health system for children in England is under strain in many specialties, with waiting times for some services at an all-time high. Across community and mental health care, access is worsening, but elective secondary care is showing signs of improvement. Overall access remains uneven, with persistent inequalities between groups and places. Long waits for care can mean prolonged periods of uncertainty and discomfort for children and their families.

Mental health services

Demand for mental health services has outpaced capacity in recent years. In the 12 months to August 2025, nearly 850,000 children and young people accessed NHS mental health services, equivalent to around 60% of the estimated 1.4 million with a mental health condition. Anxiety is the most common reason for referral, with more than 500 referrals each day in 2023/24 – twice as many as in 2019/20.

Waiting times are highly variable. In 2023/24, fewer than half (45%) of children starting treatment did so within a month of referral, and 14% faced waits of over two years. Median waits are longest for the youngest children (under-5s), who wait on average six times longer than 16–17-year-olds.

There are evident inequalities between groups of different ethnicities. Children and young people of white ethnicity made up 81% of those who accessed care in 2023/24, compared with constituting 73% of the national population. Children from Black and Asian backgrounds experienced shorter average waits, yet this reflects higher rates of ‘crisis’ referrals triaged more urgently, pointing to missed opportunities for earlier support.

Eating disorder services are the only children’s mental health service with a national waiting time standard (95% to be seen within one week for urgent cases; four weeks for non-urgent), but this standard has never been met nationally.

Inpatient admissions to mental health wards have declined to the lowest rate for several years, reaching 80 per 100,000 in 2023/24. However, concerns remain around out-of-area placements and the use of adult mental health wards for children and young people.

Community health services

Community services (which include speech and language therapy, occupational therapy, physiotherapy, health visiting, and diagnosis and support for physical and learning disabilities and neurodevelopmental conditions) are crucial to children’s development and educational inclusion. Almost 1 in 5 children and young people in school have special educational needs and disabilities (SEND), and they make up a considerable proportion of children supported by NHS community services.

Overall, waiting times for children’s community services are long, with over half (54%) waiting more than 18 weeks in August 2025 – a much higher proportion than the 14% of adults waiting more than 18 weeks. Children’s waiting lists are also growing rapidly. Much of this growth is due to the increase in the number waiting for ‘community paediatric services’ (which provide assessments for physical and learning disabilities and neurodivergence), which has more than doubled in just two years. Delayed diagnosis and support can prolong distressing symptoms and worsen outcomes.

There is wide variation in waiting times between services. Whereas only 11% of patients waiting for physiotherapy services have been waiting longer than 18 weeks, community paediatric services routinely report much longer waits, with 4 in 10 (39%) waiting over a year. Demand for autism and ADHD assessments has experienced exponential growth, with average waits for diagnosis now exceeding two years, and large geographic variation. Delays also occur after diagnosis, where families may struggle to access post-diagnostic support, reasonable adjustments in education, and therapies.

Childhood vaccination services

Routine childhood immunisation coverage has declined over the past decade from a high initial level. England has failed to meet the World Health Organization (WHO) target of 95% coverage for any routine vaccine since 2017/18. Coverage varies significantly geographically and is consistently lowest in London.

As discussed earlier, falling vaccination coverage is already resulting in a marked increase in preventable diseases, causing avoidable harm to babies and children. MMR (measles, mumps and rubella) vaccine coverage is at 84%, its lowest since 2009/10, with uptake lower in more deprived areas. This has led to measles outbreaks, with almost 3,000 cases in 2024 – a virus that had previously gained elimination status in the UK.

The HPV (human papillomavirus) vaccination programme, delivered in schools since 2008, has dramatically reduced HPV infections and cervical cancer risk, but uptake among girls has decreased from 85% in 2015/16 to 63% in 2022/23, leaving a large proportion of eligible pupils unprotected.

The reasons for falling uptake of routine vaccines are varied and complex, including barriers in accessibility and availability of health appointments.

Secondary care

Elective paediatric care waiting times have improved since the beginning of 2024, though long waits remain for some children and specialties. As of August 2025, more than 320,000 children were waiting for elective secondary care; 39% had waited more than 18 weeks, and 2.5% had waited more than a year. Overall, waiting list size and duration of waits for paediatric services have grown more rapidly for children than for adults.

Emergency care remains a key access point for children. Unplanned A&E attendances by children have been stable as a share of total attendances over the past 15 years, ranging from 25% to 28% (excluding a dip during the pandemic). However, up to 40% of A&E attendances for all children and adolescents (0–19) are ‘non-urgent’ and potentially avoidable. Unintentional injuries are consistently a major cause of emergency admissions, and among under-5s are 38% higher in the most deprived areas than the least deprived.

Of the 2.2 million children admitted to hospital in 2024/25, 41% were babies under one who were primarily admitted for reasons relating to birth. Among children aged 5–9, dental decay was the most common cause for admission – a condition that disproportionately affects deprived communities.

Alongside routine and emergency care, the NHS provides specialist services for children with complex conditions such as cancers, congenital anomalies, and rare genetic disorders. These conditions are often not caused by preventable factors, and come with unique and specific needs that are different from those of adults. They often require multidisciplinary teams, specialist diagnostics, and long-term follow-up. Around 75% of rare diseases affect children and more than 30% of children with a rare disease die before their fifth birthday, underscoring the importance of early diagnosis and rapid treatment.

4. Children’s experiences of care: why voice and participation matter

Improving outcomes for children is not only about access to and outcomes from treatment; it is also about how care feels to children. The previous sections highlight long waits and uneven access; these delays and gaps shape children’s experiences as much as the care itself. Feeling listened to, having information explained in age-appropriate ways, and being involved in decisions are central to safe, effective care.

Historically, the health care experience of babies, children and young people has received less attention than that of adults, despite their right to participate in decisions that affect them. This is changing; children’s experiences are increasingly recognised as a core component of care quality, and national guidance now sets out what ‘good’ looks like. Engagement with children and young people consistently shows that they want to feel listened to and participate – more than 80% say they want to give their opinions about their care. As one child put it: ‘I like to talk to the doctor because it is my body.’

Concerns about not being listened to or being dismissed by health care staff can be a barrier to children seeking help, and lower trust, engagement and adherence to treatment. Understanding children’s and parents’ experiences is vital to identifying how to improve care services, and by extension, health outcomes.

Many providers gather feedback from children, parents and carers, but practice is variable, and findings are not consistently published. The Care Quality Commission (CQC) regularly surveys children’s experiences of attending hospital, and NHS England runs an annual Under 16 Cancer Patient Experience Survey. But there is no equivalent national survey of the experience of children under 16 in general practice, community mental health or cancer services, despite such surveys existing for adults.

What the existing data does tell us is that children and young people’s experiences of hospital care are mixed. In the most recent CQC survey (2024), the majority of children reported being well looked after, and feeling listened to and involved in decision-making about their care. Yet a significant minority did not: more than 1 in 5 (22% of 8–11-year-olds; 23% of 12–15-year-olds) said they were not listened to; and 21% of 8–11-year-olds and 13% of 12–15-year-olds said they were not involved in decisions about their care as much as they wanted to be.

For cancer care specifically, there is a similar pattern where the majority (78%) of children say they are well looked after. Most parents and children (69%) felt they were ‘definitely’ involved in decisions about care and treatment, but again, an important minority (4%) say they were not involved.

Experience also varies between groups. In hospital, children with a mental health or neurodevelopmental condition more often report poorer experiences, while parents of disabled children are less likely to say staff took their child’s needs into account. Involving the voices of children and their families in the design of services can help ensure that services reflect the lived experiences of a range of children and young people.

The King’s Fund view

Children’s health is a driver of the future wellbeing of the population. The evidence in this explainer shows that although some progress has been made, too many children in England are growing up with preventable health challenges, shaped by poverty, inequality, and a system that struggles to meet their needs. The current state of children’s health is the result of policy choices, service design, and investment decisions made by successive governments over many years.

Improving children’s health requires a shift in approach: one that recognises the distinct needs of babies, children and young people while also ensuring that they are not treated as an add-on or afterthought, but instead are placed at the heart of efforts to improve population health and wellbeing. This means embedding children’s voices in care, designing services around developmental stages, and ensuring that no child is left behind.

Crucially, this is not just about health policy. Tackling health inequalities and the wider determinants of health demands co-ordinated action across government – from housing and education to welfare and environmental policy. Aligning strategies across sectors, supported by clear accountability and shared goals, is essential to delivering lasting change.

Looking ahead to part two of this series, we will explore how the health and care system is structured for children, where accountability lies, and what levers exist to drive change. A healthier future for children is possible, but it will require bold, co-ordinated action across the system and beyond.