Objectives The current understanding of child morbidity in Roman England is dominated by studies of single sites/regions. Much of the data are derived from third to fifth century AD Poundbury Camp, Dorchester, Dorset, considered an unusual site due to high levels of non‐adult morbidity. There is little understanding of children in rural areas, and whether Poundbury Camp was representative of Romano‐British childhood. Materials and methods The study provides the first large scale analysis of child health in urban and rural Roman England, adding to the previously published intra‐site analysis of non‐adult paleopathology at Poundbury Camp. Age‐at‐death and pathology prevalence rates were reassessed for 953 non‐adults (0–17 years) from five major urban, six minor urban, and four rural sites (first to fifth century AD). The data were compared to the results from 364 non‐adults from Poundbury Camp. Results Rural sites demonstrated higher levels of infant burials, and greater prevalence of cribra orbitalia in the 1.1–2.5 year (TPR 64.3%), and 6.6–10.5 year cohorts (TPR 66.7%). Endocranial lesions were more frequent in the minor urban sample (TPR 15.9%). Three new cases of tuberculosis were identified in urban contexts. Vitamin D deficiency was most prevalent at Poundbury Camp (CPR 18.8%), vitamin C deficiency was identified more frequently in rural settlements (CPR 5.9%). Discussion The Poundbury Camp data on morbidity and mortality are not representative of patterns in Roman England and other major urban sites. Rural children suffered from a distinct set of pathologies described as diseases of deprivation, prompting reconsideration of how Romano‐British land management affected those at the bottom of the social hierarchy.