National policies are essential for countries to adapt to the negative health impacts of climate change. Children are disproportionately affected by these impacts and must be at the heart of adaptation policies to address their vulnerabilities. Adaptation commitments worldwide are integrated into national adaptation plans, nationally determined contributions, national communications, and other multisectoral policies. We aimed to evaluate how effectively national climate change policies worldwide plan to protect child health, considering a range of determinants for successful child-health adaptation. We collated each country’s most recent national climate change adaptation plan published up to 12 July 2024. We created a checklist to assess how effectively policies were designed to protect child health, considering five determinant areas: policy background, goals, resources, monitoring & evaluation, and implementation. We assigned each policy quality categories (weak, needs improvement, or strong) for each determinant area, and an overall score (0–23) based on how many items were achieved from the checklist. National adaptation policies worldwide had poor planning to adapt to the harms climate change will cause child health, with 43% not mentioning child health at all. Around half acknowledged the disproportionate impacts of climate change on children, but most did not specify these impacts. Twenty-seven per cent of countries described goals and/or actions to promote child health but lacked clear targets for success. Seven per cent outlined monitoring and evaluation mechanisms, but none measured child health outcomes directly. Twelve per cent involved multiple stakeholders in policy implementation but rarely described their obligations. The design of national policies must be strengthened to protect child health from the harms of climate change. Policies should explicitly acknowledge children and their unique health risks. Goals should be both time- and age-sensitive with clear health targets, accompanied by actions that holistically address child health risks in the region concerned. A clear strategy for resource allocation and mobilisation will improve the success of policy actions. These interventions should be monitored and reviewed regularly to facilitate continuous adaptation to the changing climate. Multi-level stakeholders must be involved in policy design, and their responsibilities defined to improve implementation success. Not applicable.

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