We followed a structured approach to selecting, collating and presenting available data on child health outcomes within this report. Also, our engagement approach allowed us to gather meaningful views and experiences from children and young people.

How this report was put together

When it was first published in 2017, our groundbreaking State of Child Health was the first report of its kind to highlight the health and wellbeing of children and young people across the United Kingdom, covering physical and mental health. It also made policy recommendations for how these could be improved in each of the four nations. These recommendations were ambitious, and while not all of them have been taken up, we have seen Governments and influential stakeholders sit up and take notice.

In this current State of Child Health 2020 report, data have been updated for existing measures of child health, and new indicators have been added to reflect changing child health priorities and evolving challenges that children and young people face. The focus on the integral role that social determinants of health play in the health and wellbeing of our children and young people remains and is augmented by new indicators dedicated to examining how we as a society create the optimal environment ensure that children have the best start to life.

Selection of measures

Given the multitude of possible measures of children and young people’s health, a pragmatic approach was taken to select indicators that were felt to best present an overall picture of the health of infants, children and young people in the UK today. Indicators from the 2017 report have all been retained and updated where new data are available, and existing indicators have only been removed if there have been no updated data sources since the last report.

For new indicators, we have stayed true to the ethos of the original report, and the following criteria were once again used to guide the selection of new indicators:

The indicator is relevant to a large number of infants, children and young people and of public importance.

Robust published data sources were available, including contemporary data and trend data from the recent past.

Data were available for at least two of the four nations of the UK.

The perspective on child health across all the four nations of the UK remains a vital element of the State of Child report and we have retained the principle of including indicators where data are available from two or more countries.

As before, on the few occasions when we have only included indicators where data are only available UK-wide or only for one country, it is because they have been identified by children and young people themselves to be of exceptional importance. Even then, we have sought to maintain a four-nation focus in the discussion and policy recommendations.

Voice of children and young people – how the data was collected

Children and young people’s voice is at the heart of everything we do at RCPCH. Guided by the United Nations Convention on the Rights of the Child, we support children and young people to have their voices heard in decisions that affect them (Article 12) and work with them to help shape services so they have the best healthcare possible (Article 24).

The RCPCH &Us network brings together children, young people up to the age of 25, their parents/carers and families to work with clinicians, decision makers and each other to educate, collaborate, engage and change to improve health services and child health outcomes.

To support voice across State of Child Health, a mixed methods approach was developed, working with a diverse group of children, young people and parents/carers/advocates across the UK. RCPCH &Us has an established diversity model underpinning its work, ensuring children and young people from a variety of experiences are engaged.

This includes different groups:

  • ‘Universal’ groups such as open access provision – schools, youth centres, play groups
  • ‘Targeted’ groups (condition focused forums, special schools, vulnerable groups)
  • ‘Specialist’ voices (paediatric services experienced children and young people)

Children and young people from 3 to 25 years old were involved across the four nations, taking into account rural and urban locations, primary, secondary and tertiary care settings, schools, charities, local authority programmes, national and regional forums and more.

A multi layered engagement plan was developed which worked across three phases...

Phase one included a series of consultations with all three diversity cohorts asking the question “what keeps children and young people, healthy, happy and well”. These sessions were delivered to groups of all ages, as well in 1:1 conversations with hospital patients with over 3700 ideas shared . Following these sessions, staff did a quick fire thematic analysis and created a “#voicematters vote ” summarising six key topics for children and young people identify the ‘one area that should be prioritised for action in the coming years’.

More than 1,700 young people aged 11 upwards took part across the UK, through sessions, projects and online, sharing their priority area. A full thematic analysis was also undertaken by a research assistant, who reviewed all 3700+ responses, coding, theming and refining with the health policy lead and children and young people’s engagement manager. This process resulted in 12 recurring themes being identified, providing a summary for the UK on what keeps children, healthy, happy and well, also extrapolating data to each nation.

Phase two involved delivering a number of sessions with nearly 300 children and young people on three indicator areas to extend and unpack our understanding of their needs, wishes and views. Topics covered family and social environments, mental health and healthy behaviours, with children and young people defining areas of development, using solution focused thinking to develop recommendations and identify actions for different stakeholder groups.

Phase three brought 23 young people aged 11–22 together from a number of different areas in England to sessions in Newcastle and London. At these sessions, young people formed ‘youth author’ teams, where they looked at the data generated across the nations as part of the phase one collection. The youth authors discussed what elements are needed for children and young people to be healthy, happy and well, then identified from the data areas of most concern for their peer group. As part of their approach, they curated the children and young people data, priorities and their suggestions to develop the Voice matters section of this report, as well as creating games to support groups to be able to “play the story”, embedding knowledge through experiential learning.

A rights based approach, supporting children and young people in their personal journey to work collectively through solution focused thinking, drives our engagement and participation methodologies.

The RCPCH Children and Young People’s Engagement team holds the professional qualification in youth and community development work. The values of this method of working include free choice for children and young people to engage, respect, developing children and young people’s skills and attitudes, working within their view of the world, supporting development of stronger relationships and collective identities, valuing difference and promoting their voices.

We are incredibly proud of the involvement and engagement of children, young people and their families across the last 2 years, supporting the development of their data set and #voicematters section, as well as informing other indicators and thinking.

If you would like to find out more about the work of RCPCH &Us, contact

Who has been involved?

Clinical Lead:

  • Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead

Clinical Advisor:

  • Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor

Project board members:

  • Emily Arkell, RCPCH Director of Research & Quality Improvement
  • Melissa Ashe, RCPCH Head of Health Policy
  • Mark Byrne, RCPCH Head of Media & External Affairs
  • Dr Simon Clark, RCPCH VP Health Policy
  • Alison Firth, RCPCH Paediatrics 2040 Project Manager
  • Olivia Hill, RCPCH Head of Content & Brand
  • Gethin Matthews-Jones, RCPCH Head of Devolved Nations
  • Rachael McKeown, RCPCH State of Child Health Project Manager
  • Dr Ray Nethercott, RCPCH Officer for Ireland
  • Robert Okunnu, RCPCH Director of Policy & External Affairs
  • Dr Anuja Pandey, Research Assistant, University College London
  • Caitlin Plunkett-Reilly, RCPCH Public Affairs and Campaigns Lead
  • Emma Sparrow, Children and Young People’s Engagement Manager
  • Dr Steve Turner, RCPCH Officer for Scotland
  • Dr David Tuthill, RCPCH Officer for Wales
  • Professor Russell Viner, RCPCH President
  • Dr Joe Ward, MRC Clinical Research Training Fellow, UCL Institute of Child Health
  • Dr Ingrid Wolfe OBE, British Association of Child and Adolescent Public Health
  • Jacob Avis, RCPCH Research & Quality Improvement Division
  • Safya Benniche, RCPCH Policy & External Affairs Division
  • Grace Brown, RCPCH Policy & External Affairs Division
  • Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
  • Jonathan Cushing, RCPCH Education & Training Division
  • Melanie David-Feveck, RCPCH Research & Quality Improvement Division
  • Calvin Down, RCPCH Research & Quality Improvement Division
  • Alison Firth, RCPCH Policy & External Affairs Division
  • Karina Green, RCPCH Research & Quality Improvement Division
  • Allison Guiton, RCPCH Chief Executive Division
  • Emma Hosking, RCPCH Chief Executive Division
  • Charlotte Jackson, RCPCH Research & Quality Improvement Division
  • Gethin Matthews-Jones, RCPCH Policy & External Affairs Division
  • Rachael McKeown, RCPCH State of Child Health Project Manager
  • Kirsten Olson, RCPCH Policy & External Affairs Division
  • Vicki Osmond, RCPCH Policy & External Affairs Division
  • Holly Robinson, RCPCH Research & Quality Improvement Division
  • Anna Rossiter, RCPCH Research & Quality Improvement Division
  • Zara Schneider, RCPCH Research & Quality Improvement Division
  • Dr Rakhee Shah, RCPCH State of Child Health Clinical Lead
  • Emma Sparrow, RCPCH Chief Executive Division
  • Nish Talawila, RCPCH Research & Quality Improvement Division

We would like to extend our thanks to all 2,000 children, young people and parents / carers who have participated in our engagement process. The following organisations (including a range of hospitals, schools and nurseries) from across the UK have been involved:

  • Addenbrooks Hospital, England
  • Alder Hey Children’s NHS Foundation Trust, England
  • Barts Youth Empowerment Squad, England
  • BAYouth, Wales
  • Bedford College, England
  • Birmingham Children’s Hospital, England
  • Bishop Burton College, England
  • Bristol Royal Hospital for Children, England
  • Broomfield Hospital, England
  • Central Bedfordshire College, England
  • Central Bedfordshire Youth Voice, England
  • Chatterboxes (YMCA), England
  • Christopher Hatton Primary School, England
  • Darent Valley Hospital, England
  • Debating Mental Health, England
  • Epilepsy Action, England
  • Enniskillen Integrated Primary School, Northern Ireland
  • Fitzalan High School, Wales
  • Fitzrovia Youth in Action, England
  • Frimley Park Hospital, England
  • Girvan Academy, Scotland
  • Glan Clwyd Hospital, Wales
  • Great North Childrens Hospital, England
  • Kings College Hospital, England
  • Kings Mill Hospital, England
  • Knowsley Borough Council – Children in Care Council, England
  • Looked After Services Western Trust Board, Northern Ireland
  • Luton & Dunstable University Hospital, England
  • Milton Keynes College, England
  • Milton Keynes Youth Cabinet, England
  • MK Play Day, England
  • Mrs Doubtfires, England
  • Neath Port Talbot youth support, Wales
  • NICCY, Northern Ireland
  • Ninewells Hospital, Scotland
  • North Harringay Primary School, England
  • North Lindsey College, England
  • Northampton General Hospital, England
  • Northampton University, England
  • Northern Ireland Youth Forum, Northern Ireland
  • Our Lady and St. Patrick’s High School, Scotland
  • Oxford University Hospitals NHS Foundation Trust, Young People’s Executive (YiPpEe) , England
  • RCPCH &Us, UK wide
  • Right Here Brighton (YMCA) , England
  • Riseholm College, England
  • Royal Alexandra Hospital, Wales
  • Royal Hospital for Sick Children, Scotland
  • Sciennes Primary School, Scotland
  • Sheffield Children’s NHS Foundation Trust, England
  • Shuttleworth College, England
  • South West Acute Hospital, Northern Ireland
  • Southampton General Hospital, England
  • St George’s Hosptial, England
  • St John Ambulance Cadets, St Albans Unit, England
  • St Marys College, Northern Ireland
  • Start 360, Northern Ireland
  • Suffolk Children in Care Council, England
  • Tameside General Hospital, England
  • Teenage Cancer Clinical Reference Group, England
  • The Hub, Northern Ireland
  • The Oak Tree Centre, Wales
  • The Priory Witham Academy, England
  • University College London Hospital, England
  • VOYPIC, Northern Ireland
  • Wandsworth Youth Council (The Participation People) , England
  • Warrington Borough Council – Children in Care Council, England
  • YPAGNe, England
  • Ysbyty Gwynedd, Wales

We would like to extend our thanks to all stakeholders who supplied data in relation to this report and to all those who responded to the external consultation process. We would like to acknowledge:

  • Action on Smoking and Health (ASH)
  • Association for Young People’s Health (AYPH)
  • Asthma UK
  • Betsi Cadwaladr University Health Board
  • British Association for Child and Adolescent Public Health (BACAPH)
  • British Association of General Paediatrics (BAGP)
  • British Association of Perinatal Medicine (BAPM)
  • British Dental Association Scotland
  • British Dental Association Wales
  • British Medical Association (BMA)
  • British Society of Paediatric Dentistry (BSPD)
  • Carers Trust
  • Child Poverty Action Group (CPAG)
  • Child Protection Special Interest Group (CPSIG)
  • Department for the Economy Northern Ireland – Skills Division, Economic Social Inclusion Branch
  • Department of Education Northern Ireland
  • Department of Health Northern Ireland
  • Faculty of Public Health
  • Institute of Health Visiting (IHV)
  • National Society for the Prevention of Cruelty to Children (NSPCC)
  • NHS England & NHS Improvement – CYPMH & AMH Policy, Specialised Commissioning and CYP Transformation Team
  • NHS Health Scotland
  • NHS Scotland – National Hub for Reviewing and Learning from the Deaths of Children and Young People
  • Nuffield Trust
  • Obesity Health Alliance
  • Paediatric Mental Health Association (PMHA)
  • Professor Helen Bedford, RCPCH PCHR & Health Improvement Committee
  • Public Health England
  • Public Health Wales
  • Royal College of Obstetricians and Gynaecologists (RCOG)
  • Royal Society for the Prevention of Accidents (RoSPA)
  • Scottish Obesity Alliance
  • The Children’s Society
  • Young Epilepsy
  • Young Minds
  • Dr Sarah Brown, RCPCH Health Improvement Committee
  • Dr Max Davies, RCPCH Officer for Health Improvement
  • Dr Mary Fewtrell, RCPCH Assistant Officer for Health Improvement (Nutrition and Wellbeing)
  • Dr Karen Horridge, RCPCH Informatics for Quality Committee Chair
  • Dr Hannah Lambie-Mumford
  • Dr Elizabeth Marder, RCPCH Treasurer and Paediatricians in Medical Management Committee Chair
  • Dr Karen Street, RCPCH Assistant Officer for Health Improvement (Mental Health)
  • Dr Vicki Walker, RCPCH Looked After Children representative, Child Protection Standing Committee

Published March 2020