An investment of more than £10bn has failed to help improve the health of children under the age of five in England, according to a report.
The government has spent £10.9bn on bettering the health of youngsters in this group since 1998.
But while there have been some improvements, including a decline in baby deaths, other results are "disappointing", the Giving Children a Healthy Start report carried out by the Audit Commission said.
And new policies and programmes have not improved the gap between the rich and poor, it added.
Some £7.2bn has been spent on Sure Start, a programme to improve services for young children.
It includes children's centres, maternity grants to cover essentials, and family lessons on areas such as health and nutrition.
The report said such investments have "not produced widespread improvements in health outcomes".
Childhood obesity rose from 10.1% to 13.9% between 1995 and 2008, although the rate of growth may now be slowing, the report goes on.
Infant death rates have fallen from 5.6 to 4.8 deaths per 1,000 live births but the figure is "still relatively high" compared with other European countries.
Following the MMR scare on a possible link with autism, immunisation rates for mumps, measles and rubella among five-year-olds have decreased from 93% to 89% between 1999 and 2009, the report went on.
Summing up, the study said that between 1999 and 2008, "health outcomes for the under-fives, on the whole, have only marginally changed".
Steve Bundred, Chief Executive of the Audit Commission, added: "Overall, the findings are disappointing. Children need a healthier start in life and policies are not delivering commensurate improvement and value for money."
The Audit Commission calls for councils and the NHS to be clear about how much they are spending on the under-fives.
The cash should be targeted at improving the lives of the most vulnerable and progress must be monitored.