Before children reach the age of five, they have already lived through one of the most critical periods of their lives. Early childhood is when the foundations are laid for future health, well-being and educational attainment. Every child deserves the best start in life, but some are missing out: a significant number of children in Scotland are not reaching their developmental milestones at the rate we would expect to see. 

17% of children in Scotland are identified as having a developmental concern as part of their health review at the age of 27-30 months. Many of these children will be struggling with fundamental things like communication, self-regulation and the ability to interact and play with their peers. These challenges affect their ability to learn and thrive at nursery, school and at home, impacting their long-term outcomes.  

It is vital that early support is provided to help families as their babies and young children develop. A key aspect to delivering the right support at the right time is having a clear understanding of which children and families in our communities are most at need. A closer look at the data relating to early childhood reveals an unequal picture, where certain groups of children are far more likely to experience these challenges.

These challenges, or “developmental concerns” - concerns around aspects of a child’s physical, cognitive, social and emotional development - are identified in the pre-school child health reviews that children in Scotland are entitled to.

From early infancy through to school entry, children living in the most deprived areas in the country consistently experience the highest rates of developmental concerns. For example, at 27-30 months children in the most deprived areas are two and a half times more likely to be identified with a developmental concern compared to those in the most affluent areas.

When we look at local authorities across Scotland, we see the same trend - developmental concerns are disproportionately prevalent for children living in more deprived areas.

It is not just that children growing up in deprived areas are more likely to experience these challenges: they also tend to face multiple concerns. In the areas of highest deprivation, children are now four times more likely than children in our least deprived communities to be identified with three or more concerns. And the gap between these areas and less deprived areas has widened significantly since Covid-19.

The data reflects something that we are hearing in our conversations with those working on the ground: families are experiencing increasingly complex challenges. The growing scale and complexity of challenges faced by families in the most deprived areas needs close attention.

Boys are consistently more likely to be identified with a developmental concern than girls across all levels of deprivation. But this differential becomes particularly stark for boys growing up in the most deprived areas.

32.2% of boys living in the most deprived areas in Scotland were identified as having at least one developmental concern in the most recent data of the 27-30 months assessments. This compares to 13.2% of boys in the least deprived areas. 

When we compare boys and girls living in the same areas the figures are even more striking: in the 20% most deprived areas in Scotland, 32.2% of boys are identified with a concern compared to 18.3% of girls. In more affluent areas, while the figures for both boys and girls are lower, the trend holds: 13.2% of boys are identified as having a developmental concern at 27-30 months compared to 6.6% of girls.

This disparity between boys and girls is most pronounced in areas like speech, language, and communication. 

In fact, boys in the most deprived areas account for 22.1% of all speech, language and communication concerns identified at 27-30 months, despite accounting for only 11.5% of all assessments carried out. This disproportionate burden continues into later childhood; at four to five years, boys in the most deprived areas account for 23.8% of all emotional and behavioural development concerns, while making up only 11.9% of all completed assessments.

Similar disparities between early outcomes for boys and girls exist in data from other nations too. Many theories have been put forward for why these large gaps exist between boys and girls (for example, inherent bias within the testing, different developmental rates for boys and girls) but there is still not conclusive evidence as to why these gaps exist or what this means for longer term outcomes. Further research within Scotland could be useful to understand what is behind this disparity.

Another group of children with significantly higher levels of identified developmental concerns are care-experienced children. 40% of care-experienced children have an identified developmental concern at their 27-30 month assessment compared to 17% of children who are not care-experienced.

For children who are not care-experienced, the rise in developmental concerns seen after Covid-19 has now started to flatten out. However, developmental concerns for care-experienced children continue to rise for all domains of development.

This worrying trend, and the impact that we know early development challenges can have on children’s later life experiences, highlights the importance of being able to engage early with families at risk to provide them with the support that they need.

Every child in Scotland deserves to have the same chance of developing to their full potential in the early years. But, as the data illustrates, children growing up in deprived areas are often facing more significant and complex challenges than their peers living in more affluent areas.

Scottish Government already has an ambitious target to reduce the percentage of children identified with a developmental concern at their 27-30 month assessment to 13% by 2030. Achieving this will require a tailored approach to ensure support is targeted at babies, young children and families who need it most. Fortunately, in Scotland, there is relatively rich data to inform work around early-years development. Understanding these patterns of developmental concern is the first step towards building targeted and effective support in the early years aimed at removing early developmental inequalities. 

There is more evidence than ever before showing the importance of the early years to later development and about the protective factors that support children to have the best start in life. But a key question is whether the sector is able to access and use data and knowledge as effectively as possible to support babies and young children.  

Our analysis here scratches the surface, but we know the data holds more insights to guide policy and practice. In the coming months we’ll continue to unpack these learnings. Our new project to improve early-learning help for babies and families will also investigate the core support needed to best support families.