A new national indicator is transforming how researchers, policymakers, and families understand young children’s well-being in the United States. Introduced in the 2022 National Survey of Children's Health (NSCH), the Healthy and Ready to Learn (HRTL) measure provides the first standardized, nationally representative way to examine young children’s holistic development across multiple domains: physical health, motor development, social-emotional functioning, self-regulation, and early learning skills.
The new indicator opens the door to important questions about children’s developmental well-being. How are children faring in each domain and overall? How does developmental well-being vary across states and among different groups of children? How is well-being changing over time and what conditions support or hinder healthy development? Understanding these patterns can guide policies and investments that support children before they enter school.
Three-year-olds develop within an ecology of support, and multiple aspects of their everyday lives are associated with developmental well-being. This blog highlights findings from our series of research briefs examining how children's daily experiences, family characteristics, neighborhood environments, and health care access relate to HRTL outcomes. Together, these analyses illustrate how a national, parent-reported population-level measure can help identify the conditions that support children's well-being.
Daily experiences
Three-year-olds who spend more time outdoors; have limited screen time; participate in language-rich activities such as reading, singing, and storytelling; or attend preschool are more likely to demonstrate stronger developmental well-being.
While these findings reinforce the importance of enriching children’s everyday experiences, many of these experiences are not universal. More than half of 3-year-olds (53%) experience too much screen time, defined as two or more hours daily, and fewer than half (44%) are enrolled in preschool or read to every day (44%). Only half (50%) are sung to or told stories daily and just 61 percent spend two or more hours outdoors each day. Because these experiences are malleable and far from universal, their study represents important opportunities for research, practice, and policy to strengthen children's developmental contexts.
Family characteristics
Lower parental aggravation, stronger family resilience, and positive parent mental health are each associated with stronger developmental well-being among 3-year-olds.
These findings reinforce decades of research linking children's development to caregiver well-being. Encouragingly, most families in the United States report protective levels of these characteristics: 71 percent of parents report low parenting aggravation, 85 percent report high family resilience, and 78 percent report very good or excellent mental health. Targeted supports for families experiencing greater stress or lower resilience may have meaningful benefits for children at greatest risk.
Neighborhood conditions
Three-year-olds living in neighborhoods with stronger social supports, greater access to community amenities, and fewer physical challenges are more likely to be developmentally on track.
Most 3-year-olds in the United States live in neighborhoods without major physical disorder, such as vandalism and litter (75%). However, fewer than 4 in 10 live in neighborhoods with high social support (38%) and only about one third have access to all the neighborhood amenities measured, such as parks and libraries (35%). These findings highlight opportunities to improve neighborhood amenities and identify children in less supportive neighborhoods who may benefit from additional resources.
Health care access
Three-year-olds with a medical home[1] and adequate, continuous insurance coverage have stronger developmental well-being. Importantly, these associations differ for children with and without special health care needs, such that receiving care in a medical home (and specifically, receiving family-centered care) is particularly salient for 3-year-olds with special health care needs.
Among children with special health care needs, nearly two thirds do not receive care through a medical home (64%) and nearly half need care coordination and do not receive it (42%). Among children without special health care needs, one in four lacks adequate insurance coverage (29%), highlighting opportunities to improve access to affordable, high-quality care. These findings underscore the role of pediatric and public health systems in supporting child well-being.
Across all four briefs, we found that developmental well-being among 3-year-olds reflects multiple, interconnected influences. Development cannot be understood through a single behavior, family characteristic, neighborhood feature, or health care experience. Instead, it reflects the combination of experiences and supports available in children’s everyday environments. Many of these factors are malleable. Supporting caregiver well-being, expanding access to enriching early experiences, creating supportive and well-resourced neighborhoods, and ensuring access to high-quality health care all represent areas where policies, programs, and community investments can strengthen the environments in which young children develop.
These findings on the HRTL indicator generalize to all 3-year-olds in the United States because the data come from a very large, representative survey. Because the same outcome measure is used to assess different influences across developmental contexts, our findings provide a more complete picture of the conditions associated with child well-being. Their consistency with decades of developmental science substantiates that literature and provides confidence that the HRTL measure captures important aspects of children's holistic development.
At the same time, these analyses identify associations, not cause and effect. A growing body of evidence from evaluations of early childhood education, home visiting and parenting support programs, neighborhood and housing initiatives, and health care interventions aligns with these findings and suggests that targeted investments can improve many factors that affect early development. As additional years of data become available, future analyses can examine whether these investments lead to measurable improvements in children's developmental well-being at the population level.
Perhaps most importantly, including the HRTL measure in a rich national survey expands what we can learn about how our youngest Americans are faring—both nationally and in each state. Beyond showing whether children are doing well, HRTL helps us understand the conditions associated with developmental well-being across the population, monitor how those conditions change over time, and assess whether policies and programs are moving the needle for young children. This creates new opportunities for researchers, practitioners, advocates, and policymakers to identify where support is needed most and where investments may have the greatest impact.
Looking ahead for HRTL
These four briefs represent just the beginning of what is possible with HRTL. Upcoming work will extend these analyses through policy analyses, an examination of how HRTL aligns with state kindergarten readiness assessments, and new analyses made possible by larger samples as additional years of NSCH data become available. Together, these products will translate this new national indicator into actionable evidence for researchers, advocates, practitioners, and policymakers working to improve the lives of young children.
By making developmental well-being measurable at the population level, HRTL gives us a powerful new tool—not only for understanding children's experiences today, but also for assessing whether collective investments are creating healthier, more supportive environments for young children.
Suggested citation: Bredeson, M., Paschall, K., Moore, K., Reddington, E. (2026). Highlighting findings on a new national indicator for understanding development among 3-year-olds. Child Trends. DOI: 10.56417/6089v6083t
[1] Medical home is defined as having a personal doctor or nurse, a usual source of sick care, access to needed referrals, coordinated care, and family-centered care.