Purpose: The purpose of the paper is to consider the opportunities and difficulties in developing health-promotion work in early years settings in the UK. Design/methodology/approach: As the first study of its kind conducted in the UK, a multi-method approach was adopted involving: an overview of health-related guidance and of effective interventions in early years settings to promote health among young children; 26 interviews with key informants in the early years and health fields, regional coordinators for the National Healthy Schools Programme (NHSP) and Foundation Stage regional advisers; a survey of 145 local Healthy Schools Programme coordinators with a response rate of 75 percent; and six case studies of early years settings representing promising practice in the promotion of health and wellbeing. Findings: There is considerable enthusiasm for health promotion work within early years organisations, and interest in developing such work in early years settings. The study suggests that building on existing early years curriculum frameworks, developing partnerships between health and early years professionals, engaging both parents and practitioners, and adequate national and local resourcing will facilitate development of health promoting work in the early years sector. Practical implications: This paper and the outputs from the study offer useful evidence for health and early years professionals who are developing health-promoting work in early years settings. Originality/value: The paper reports on the first study of its kind in which the perceptions of both early years and health professionals are brought together to consider the issues involved in developing healthy early years practice. (Contains 6 notes.)