We report on a national South African multistage cluster sampling survey of early development in 5,222 children aged 50-59 months enrolled in preschool programmes. Children were assessed on the Early Learning Outcomes Measure (ELOM 4&5), the ELOM Social-Emotional Rating Scale, and linear growth (height-for-age), in the last quarter of 2021. ELOM 4&5 is standardised for South Africa and measures development in five domains: Gross Motor, and Fine Motor Development, Numeracy and Mathematics, Cognition and Executive Functioning, and Literacy and Language skills. Cut scores are used to classify children as On Track, Falling Behind, or Falling Far Behind expected developmental standards. Post-survey weights were computed, permitting us to interpret results as representative of children attending early learning programmes. Only 45.7% of the sample were On Track overall. Apart from Literacy and Language (54.7%), no other domain exceeded 50% On Track. Children who were better off socio-economically achieved higher scores (except for Gross Motor Development). Height-for-age measurements revealed a stunting rate of 5.1%, (>8.8% in one province). A mixed linear model analysis showed that age, sex, quintile, growth status, and socio-emotional score were significant predictors of the total ELOM 4&5 score, with growth status and quintile being stronger predictors. The results indicate concerningly poor preparedness for school. Two further surveys prior to 2030 will be undertaken and used to establish the country’s progress toward meeting Sustainable Development Goal 4.2: “all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education”.