Objectives The aim of the study was to calculate the impact that the duration of attendance and the location of the kindergarten (rural versus urban) has on the prevalence of multiple delays in preschool children. Methods We analyzed data from 14,068 preschool children, over a period of 14 consecutive years (1997-2010) from the Bavarian Pre-School Morbidity Survey using software package SPSS 21.0. We assessed the incidence of multiple developmental impairments (twofold or above) in various developmental domains. Results The highest prevalence for multiple delays in development existed for twofold impairments in the area of motor (7.9 %) and lowest in fivefold delays in cognition (0.4 %). A shorter duration of visiting a kindergarten (OR: 4.43) and an urban location (OR: 2.53) was associated with an increased risk of multiple delays in development. Conclusions A shorter duration and an urban location of kindergarten attendance are associated with an increased risk for children having multiple developmental impairments. From a public health perspective, the setting and duration of kindergarten attendance may be an important focus in preventive efforts to optimize health outcomes in children. (author abstract)