More must be done more quickly to make the world fit for children by 2015, the UN children's agency, Unicef, has said.
Children go hungry most often in South Asia
In a report it noted considerable strides had been made to meet pledges in education and areas of health care.
But it stressed that "much more must be done" in order to meet the 2015 Millennium Development Goals deadline.
The report identified areas for urgent action as maternal mortality, HIV prevention and pneumonia, which kills more children than any other illness.
The UN agreed a set of Millennium Development Goals in 2000 to improve standards in key areas such as education, employment and health care by 2015.
'Making a difference'
Unicef said its sixth Progress for Children report since 2004 was the most comprehensive to date.
It noted "some remarkable progress" in the under-five child mortality rate, which had fallen by 60% since 1960 to 9.7 million.
And there were "major improvements" in measles immunisation, breastfeeding rates, malaria prevention and supplements of vitamin A, which can help prevent common illnesses.
"Overall, [the report's] findings reinforce Unicef's conviction that the combined efforts of governments, international organisations, civil society, local communities and the private sector are making a difference and delivering results for children," Ann M Veneman, Unicef's executive director, said.
"Yet it also reveals that much more must be done. The 2015 deadline for the Millennium Development Goals is fast approaching.
"We need to accelerate progress towards these goals and approach them with a common sense of urgency."
'No cause for celebration'
The Unicef report said more than 1.2 billion people had gained access to safe drinking water between 1990 and 2004.
Sub-Saharan Africa still has many of the worst indicators for children
It said that between 1996 and 2004 rates of early and exclusive breastfeeding had increased in many countries. There had been a jump of 20% in seven countries in sub-Saharan Africa.
Unicef estimates that breastfeeding could stop 13% of all under-five deaths in developing countries.
The report said many malaria-affected countries had seen use of insecticide-treated nets triple, saving many children's lives.
And access to antiretroviral drugs to reduce HIV/Aids infection rates in mothers and children had risen significantly.
There had also been progress in education, gender equality and child protection, the report said.
But it said some statistics gave "no cause for celebration".
"An alarming number of children under five - 143 million - still suffer under-nutrition, with more than half of them in South Asia."
Treatment for major childhood diseases such as pneumonia and malaria had also "been slow to expand".
More than 500,000 women still die every year during pregnancy and childbirth, about half of them in sub-Saharan Africa, the report said.
And much more needed to be done to improve basic sanitation and prevent HIV/Aids.