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Healthy and Ready to Learn: National and State Data on 3-, 4-, and 5-Year-Olds - FAQ

July 9, 2026

Healthy and Ready to Learn (HRTL) is a population-level measure of children’s developmental well-being. The measure captures five domains of development and describes children’s development as either “on track” or not “on track”—both by domain and in an overall summary score.

The HRTL measure is composed of 28 parent-reported items developed for use in the National Survey of Children’s Health (NSCH). HRTL is used by multiple federally funded programs and initiatives, including as a National Outcome Measure of School Readiness for Title V Maternal and Child Health Grantees, the indicator of Developmentally Ready for School for Healthy People 2030, and in the Federal Interagency Forum on Child and Family Statistics annual report, America’s Children. The HRTL items, a scoring overview, NSCH survey data, and estimates for 3-5-year-olds are all publicly available.

The HRTL measure captures five core domains of early development:

  • Early Learning Skills: Language, early literacy, early math
  • Social–Emotional Development: Understanding emotions, sharing, taking turns
  • Self-Regulation Skills: Attention, calming strategies, managing transitions
  • Motor Skills: Drawing, grasping, bouncing a ball
  • Physical Health: Overall health status, presence of health conditions

Together, these domains provide a holistic picture of whether young children are on track for developmental milestones. For an overview of items (i.e., survey questions) for each domain, please see this data brief.

HRTL Data from the NSCH are available annually, providing a population-level measure of developmental well-being for children ages 3 to 5 at both the national and state levels. HRTL shows the percentage of children “on track” for developmental milestones, both overall and by domain. These data were not previously available and fill an important gap for those who monitor and seek to improve children’s developmental well-being. Annual HRTL data are available starting with 2022, and additional data will become available each year.

The HRTL measure was designed to assess the developmental well-being of children ages 3, 4, and 5. Because these ages represent distinct developmental stages, examining them separately provides a more nuanced understanding of young children’s development at both the state and national levels. These data can help health practitioners, educators, policymakers, and program providers better understand how children are developing and where additional support may be needed.

Assessing development at age 3 provides insight into the outcomes of experiences and investments made during infancy and toddlerhood. For 4-year-olds, the data can help inform understanding of children's development during the preschool years and the effectiveness of preschool programs and supports. Assessing development at age 5 offers important information about children's readiness for kindergarten and their transition into formal schooling.

Together, these age-specific data provide a more complete picture of children's developmental well-being during the critical years before kindergarten.

Population-level measures are used to monitor indicators of health and well-being across populations, allowing for examinations across geographic, programmatic, or demographic subgroups. These data are not designed to be informative about an individual person, but rather to generate trends and group estimates that inform programming and policy making at a population level.

HRTL data can help early childhood researchers, policymakers, and state and community leaders:

  • Monitor children’s well-being over time
  • Set benchmarks for measuring progress toward improved child well-being
  • Assess the impact of policies or changing conditions
  • Provide insight into specific and general areas of strength, as well as challenges
  • Design programs and strategies that support children before they reach kindergarten
  • Identify differences in developmental well-being across a variety of subgroups—including by child, family, and community factors—and identify state differences

HRTL data can also be used as an outcome measure. The NSCH contains rich information on family and community conditions, allowing for deeper exploration of the factors and conditions associated with children’s HRTL scores, and can explain differences across populations.

NSCH data are free and publicly available. You can access all NSCH data on the Census Bureau website. Several datapoints from the NSCH, including 3-5-year-olds’ data on HRTL, are also available in the interactive data query. Technical information and statistical analysis code, for use in Stata and SAS, is available in the most recent year’s Federally Available Data (FAD) Resource Document for Title V MCH National Outcome Measures.

Child Trends will continue to update this dashboard with the latest data and insights on 3-year-olds. Our updates will include state-level factsheets and findings from research on the child, family, community, and policy factors associated with HRTL.

The HRTL measure was developed in response to state Maternal and Child Health Title V grantees’ need for a National Outcome Measure focused on young children’s school readiness. Following the 2012 redesign of the Title V Block Grant Performance Measurement System, items from the National School Readiness Indicators Initiative were included in the 2016 National Survey of Children’s Health (NSCH). Child Trends, under a contract with the Human Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB), analyzed these items and created a pilot measure in 2017. From 2018 to 2021, Child Trends partnered again with MCHB to refine and validate the measure. The final version was included in the 2022 NSCH.

Throughout the development and validation process, we gathered input from Title V grantees, national advisory groups, early childhood measurement and data experts, and state education administrators. The HRTL measure was piloted in diverse communities across the country to ensure cross-cultural validity, and the Census Bureau cognitively tested new items added to the NSCH.

To support use of the HRTL measure, the Imaginable Futures Foundation funded additional analyses of the 2017-2018 NSCH datasets to examine how child, family, community, and policy factors were associated with the pilot version of the HRTL measure. Child Trends continues this work today—with support from the Overdeck Family Foundation, Pritzker Children’s Initiative, and Valhalla Foundation—to ensure that everyone working to improve child well-being can access and use HRTL data.

The short answer is: “maybe”. HRTL was designed as a population-level monitoring tool and was not tested to be sensitive enough to detect change over a short amount of time (e.g., from fall to spring of a pre-K year). Researchers have not yet evaluated whether the measure can reliably track an individual program’s outcomes, particularly over a short period of time.

The measure is available and validated in English and Spanish because the NSCH is available in those languages and Child Trends researchers conducted additional validation work with Spanish-speaking populations. While the measure can be translated into other languages, it has not been validated beyond English and Spanish. The Spanish version of the NSCH survey is available here.

There are many possible combinations of scores in determining whether a child is healthy and ready to learn. There are three categories of scores for Healthy and Ready to Learn: “on track,” “emerging,” and “needs support.” To be considered “on track” on the overall measure, a child must be “on track” in 4 or 5 domains and cannot score as “needs support” in any domain. As a result, it is possible for many children to score “on track” in 1-4 domains and still not be considered “on track” on the overall measure.

To illustrate this with the national data: 39.4 percent of 3-year-olds are “on track” in 5 domains, and 22.6 percent are “on track” in 4 domains with no domains scored as “needs support.” These two scoring categories together make up the total percentage of children who are “on track” overall. In addition, 3.1 percent are “on track” in 4 domains and scored as “needs support” in 1 domain, and 17.3 percent are “on track” in 3 domains, which helps explain why the percentage “on track” by domain is higher than the percent “on track” on the overall HRTL measure.

Because the NSCH is based on a representative sample of children rather than on every child in the country, each percentage shown in this dashboard is an estimate of the true value for all 3-, 4-, or 5-year-olds. A confidence interval shows the range within which the true value most likely falls, given the sample used to calculate it.

For example, if 63.6 percent of 3-year-olds are "on track" overall, with a 95% confidence interval of 61.5–65.8 percent, that means we can be 95 percent confident the true national percentage falls somewhere from 61.5 to 65.8 percent.

Confidence intervals tend to be wider for smaller samples, which is why state-level estimates often have wider intervals than national ones. It’s also why this dashboard uses three-year combined estimates (2022–2024) rather than a single year: Pooling years increases the sample size and narrows the intervals, making the state-level estimates more reliable.

Note that whether or not confidence intervals overlap is not necessarily an indication of a statistically significant difference. To determine significant differences, we used a two-sided, nested Z-test (significance level p < .05) to test for significant differences between state estimates and the national averages.

Please feel free to reach out to the project lead, Katie Paschall, at kpaschall@childtrends.org.