Will scrapping the two-child limit have an impact on the health of children?

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

Welfare reforms –  including the scrapping of the two-child limit announced by the Chancellor in the recent Autumn Budget – have been widely debated over the last year. Yet the implications for health, which could be central to the impact on children and public finances, have received much less attention.

We know that the number of children living in poverty in the UK – defined as living in a household receiving less than 60% of what an average family earns (after paying for housing and adjusted for family size) – increased from 3.6 million in 2010/11 to 4.5 million in 2024/25. Welfare policies such as the two-child limit (whereby child benefit is not paid for third and subsequent children), and the household benefit cap (which limits total household payments), have contributed to the striking concentrations of poverty in larger families.

There has been growing evidence directly linking the two-child limit to worse health outcomes, as it can lead to increased financial insecurity, anxiety, living in cold/damp homes, or not being able to afford a well-balanced, nutritious diet.

Families also report indirect effects on their health through reduced participation in educational and social activities, embarrassment and shame by not being able to afford necessities, and stress on family relationships. These are often exacerbated by the wider challenges facing both families (including the rising cost of living, cuts to local services and lack of good jobs and affordable housing) and disproportionately affected, already marginalised groups, such as single-parent families.

So we might expect an increasing concentration of poor health among children living in large, low-income households. However, recent evidence from a study in north-west London suggests a more complex picture, with inconsistent findings across different health outcomes.

Dental caries linked to deprivation and larger families

Tooth decay (or dental caries) is a public health priority, as it’s the most common reason for hospital admission in primary school-age children. It’s entirely preventable and a major driver of health and educational inequalities.

In this study, dental caries showed a clear link with both deprivation and family size. One in 30 children (3.3%) who were living in more deprived postcodes and in households with three or more children had needed tooth extraction in hospital before the age of 12, which is effectively double the proportion of children from smaller households in more affluent areas (1.7%) who had needed the same procedure (see chart below). 

In contrast, children’s A&E visits showed a very different pattern. Rates were highest in two-child households, and then decreased with increasing household size.

So what might explain these contrary findings? For dental health, it’s important to note these findings don’t support a simple ‘parent-blaming’ narrative: differing rates of dental problems can’t just be explained by different levels of parental supervision. Similar increases in dental extractions are seen between larger and smaller households in more affluent areas, and parents in north-west London described the cumulative impact of a variety of factors, including financial barriers to giving their children a healthy, balanced diet, as well as the widespread advertising and accessibility of sugary drinks, alongside difficulties in accessing NHS dental services.

For A&E visits, other factors seem to be at play. Parents of second or subsequent babies described feeling more confident managing minor illnesses, and also mentioned that younger siblings are often exposed to more infections in the first year or two of life than first-born children. 

Scrapping the two-child limit is a step in the right direction

The two-child limit and household benefit cap largely affect children in larger, more deprived households. Emerging evidence suggests that these children also experience disproportionately poor health on some but not all outcome measures. So scrapping the two-child limit is an important step, which may help reduce child health inequalities. It’s also possible that the costs could be partially offset by reduced NHS spending, as well as bringing wider benefits, such as reducing behavioural problems and poor attainment in schools caused by toothache.

But life on universal credit will still be hard for many families with children, particularly those with long-term conditions and disabilities. Formal, ongoing assessment of the impact of welfare policies on health inequalities is needed, which should combine household-linkage techniques and robust community engagement with parents, carers, children and young people, to understand the impact on families with different types of need.

Dougal Hargreaves is Professor of Paediatrics & Population Health at the Mohn Centre for Children's Health & Wellbeing, Imperial College London; Hannah Fairbrother is a Senior Lecturer in Public Health at the University of Sheffield; Steven Hope is a Research Fellow at the Mohn Centre for Children's Health & Wellbeing, Imperial College London; Nick Woodrow is a Research Associate at the University of Sheffield; George Melrose is a Research Assistant at the Mohn Centre for Children's Health & Wellbeing, Imperial College London; Mandy Cheetham is Assistant Professor at Northumbria University.

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust. 

Acknowledgements

The authors would like to thank the members of Families in Action Together (Wealdstone Baby Bank) and the Young People’s Advisory Network in the NIHR Applied Research Collaboration North East and North Cumbria, who have been public partners in this project. The research was supported by the NIHR through the School of Public Health Research. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.