In 2005, an estimated 48 million children aged 0-18 years--12 percent of all children in sub-Saharan Africa--were orphans, and that number is expected to rise to 53 million by 2010. One quarter of all orphans are orphaned because of AIDS, and about 2.6 million children are currently infected with HIV. Untreated, most children born with HIV will die before their fourth birthday, most likely in the first two years of life. UNICEF concludes that, although they represent a smaller percentage of all orphans, the youngest orphans are the least resilient and have the greatest need for physical care and emotional nurturing. Although it is recognised that the focus of support must be on all children made vulnerable by HIV/AIDS, including those living with sick parents or in extreme poverty, the youngest are often invisible to programme planners, despite their vulnerability. In response to the general awareness of the increasing number of these children, a global initiative to develop national plans of action (NPAs) for these orphans and vulnerable children (OVCs), or children affected by HIV and AIDS, has been launched. Between 2003 and 2007, a number of countries did a rapid assessment of the living conditions of children affected by HIV/AIDS and developed plans and costing estimates for appropriate interventions. The plans of 17 countries in sub-Saharan Africa were reviewed, comprising all of the high prevalence countries whose NPAs were finalised. The review found that there is a wide range in the developmental appropriateness of the plans within the 17 countries. The evidence suggests that there is a clear and significant trend over time for increased incorporation of developmentally informed perspectives into plans, with the more recent plans having many more components. This change has been influenced by a series of advocacy efforts by the early childhood development (ECD) community and the HIV/AIDS community. However, these plans remain vague and not well defined. More efforts are needed to ensure that they will in fact be implemented, and that there will be sufficient quality in the responses. A number of assumptions were noted in the plans, such as the belief that funds allocated to a family in general will go equally to all members of the family. As a result, the author makes the following recommendations: (1) Evaluate assumptions; (2) Provide adequate funding for the NPAs to include ECD measures; (3) Build the case with evidence; (4) Develop capacity in ECD at the country level; (5) Strengthen the role of the health sector for young children's development and develop new platforms for care; (6) Strengthen structures at local, regional, and national levels for an integrated approach; (7) Support women's rights; and (8) Link the NPAs with other plans in order to effectively implement them. (Contains 4 tables, 5 figures and 6 footnotes.)