Helping Babies and Toddlers Thrive: A Look at Recent State Legislation

Jennifer Palmer 2/14/2019

Why Babies?

happy babyWith a million new neural connections forming every second, a baby’s brain grows and develops more in the first few years than at any later point in life. Positive and nurturing relationships with caregivers, high-quality early learning environments, and access to nutrition and other resources for healthy development lay the foundation for lifelong success in school, relationships, work and beyond.

The Role of Legislators

State legislators can play an important role in helping infants, toddlers and their families thrive. Legislators inform and respond to state priorities, enact legislation, develop and approve budgets, leverage federal funding, provide independent oversight of state agencies, and establish committees and task forces to bring additional expertise and perspectives to state issues. As leaders in their communities and states, legislators have a vested interest in not only promoting the health and success of their state’s future students and workforce, but also avoiding higher costs to the state down the road. In the long run, failing to support healthy development in infants and toddlers can lead to greater spending on health, crime, remedial education and other supports.

Recent State Legislation Affecting Infants and Toddlers

In recent years, legislators across the country have considered a range of legislation to improve services and supports for infants, toddlers and their families. Strategies include improving access to and quality of child care, ensuring parents have time to bond with young children, and empowering parents to support their child’s healthy emotional and physical development.

Quality, Affordable Child Care

During each session since 2016, over half the states have enacted legislation concerning child care issues. Topics have included health and safety, background checks for employees, licensing, quality, eligibility for child care assistance, and provider reimbursement rates. New federal requirements for CCDBG have spurred an increase in enacted child care legislation (see box above).

Access to child care is a challenge for parents with children of all ages; however, it is in particularly low supply for parents of infants and toddlers. Florida, Minnesota, New York and Washington are among the states that have recently established task forces to examine child care availability in their states and develop recommendations to address the issues they identify. In addition, recent legislation in Maine directs the state Department of Health and Human Services to develop a comprehensive plan to strengthen the quality and supply of child care. It specifically calls for expanding access to care for infants and toddlers.

At least eight states and the District of Columbia have recently enacted legislation to improve child care affordability for low-income families. Legislation in Washington state and Washington, D.C., for example, expanded eligibility for child care assistance to more families. To meet new CCDBG requirements, California, Colorado, Delaware, Florida, Illinois and Maryland extended eligibility for child care assistance to families experiencing temporary changes to parents’ employment status or participating in an education or job-training program. New Hampshire legislation from 2018 casts an even wider net by including parents completing mental health or substance abuse treatment programs among those eligible for the state’s child care scholarships.

Many legislators are also taking steps to improve the quality of child care. Legislation in Maine created incentives for providers to participate in the state’s quality rating and improvement system (QRIS). An Arizona law allows for higher reimbursement rates for providers serving families receiving child care assistance as the providers improve their QRIS rating. In Rhode Island, increased CCDBG funding allowed policymakers to raise reimbursement rates for providers with high QRIS ratings who care for infants, toddlers and preschoolers. By prioritizing the state’s youngest children, the new tiered reimbursement rate structure improves access to high-quality care for infants, toddlers and preschoolers and meets the federal benchmark of reimbursing providers at 75 percent of market rate.

State lawmakers also have prioritized safety in child care settings. In response to new CCDBG requirements, 25 states have enacted legislation related to background requirements for child care providers. Another focal area is safe sleep for infants in child care. Recent legislation ranges from encouraging the use of safe sleep practices among caregivers, as Georgia has done, to setting civil penalties for child care providers who fail to meet safe sleep requirements, as Indiana did in 2018. Kansas, Minnesota, New York and Oklahoma also passed safe sleep legislation.

Time for Parents to Bond with Their Babies

Research shows that paid leave for new parents leads to healthier infants who have better outcomes later in life. Paid leave also enables mothers to stay better connected to the workforce, which leads to higher earnings. At least 19 states proposed legislation to establish paid family leave programs in 2017 and 25 states considered paid family leave bills in 2018. Six states—California, Massachusetts, New Jersey, New York, Rhode Island, Washington­—and the District of Columbia now have paid family leave laws on the books and more than half of them enacted legislation within the last two years. New York’s 2016 law was implemented in early 2018, Washington state and Washington, D.C.’s paid leave policies will take effect in 2020, and Massachusetts’ policy begins in 2021.

Additionally, at least 13 states provide paid family leave for state employees. Arkansas and Illinois allow employees to take up to four weeks of paid parental leave and Delaware allows up to 12 weeks.

Healthy Emotional Development

Home visiting programs, operating in all 50 states, the District of Columbia and five territories, can improve a variety of social and educational outcomes for children, including healthy emotional development. High-quality home visiting programs are voluntary and support pregnant women and parents by linking them with prenatal care, promoting strong parent-child attachment, and coaching on learning activities that foster their child’s development.

Since 2016, legislatures in six states—Iowa, Indiana, New Hampshire, New Jersey, Rhode Island and Utah—have passed home visiting legislation. Legislators in Iowa, Rhode Island and Utah enacted legislation requiring the use of evidence-based home visiting models in their states to improve outcomes for children. Other states focused on extending home visiting services to targeted populations, such as certain high-need communities in New Jersey and pregnant women receiving substance abuse treatment in Indiana.

State legislators also support healthy emotional development in young children by investing in infant and early childhood mental health. Lawmakers in Colorado and Ohio recently added funding to increase the number of mental health consultants to work with young children, parents, and early care providers and educators. Arkansas lawmakers passed legislation to improve the diagnosis and treatment of mental health disorders in young children and allow Medicaid funding to pay for dyadic treatment, which serves both young children and their caregivers.

Physical Health and Nutrition

Since 2016, lawmakers in four states and Washington, D.C., have enacted measures to support greater access to nutritional foods and services. Vermont required the state’s health commissioner to develop and implement an outreach plan to people eligible but not enrolled in the Women, Infants and Children (WIC) program. California authorized schools and child care facilities that participate in the federal School Breakfast Program to provide universal breakfast to all children or to the maximum extent practical. Legislation in Maine and Washington, D.C., simplified access to state food supplement programs. Two bills enacted in New York ensure families with infants with the greatest need can access specialty formula and donor breast milk.

In the last three years, at least 20 states and the District of Columbia have enacted legislation to support and protect the rights of mothers to breastfeed. Connecticut, Maryland, Massachusetts, Nevada, South Carolina and Texas enacted protections and required accommodations for breastfeeding employees. Others, including California, Illinois and Nebraska, enacted legislation directing schools or community colleges to accommodate students who are breastfeeding. Legislation in California and Connecticut requires jails to make accommodations for inmates who are breastfeeding. Lawmakers in New Hampshire and New Jersey are gathering additional information on how to support breastfeeding.

Finally, following new recommendations from the federal Recommended Uniform Screening Panel (RUSP) in 2016, numerous states have passed legislation to add new conditions to their newborn screening programs. Early detection of certain disorders can prevent severe cognitive and physical disabilities, and even death. Screening newborns can also save states and families money by avoiding costly medical treatments later. In 2018, at least six states—Colorado, Illinois, Indiana, Louisiana, New York and Virginia—added conditions to their state’s newborn screenings.

For more information please see NCSL’s Early Care and Education Legislative Database, Maternal and Child Health Legislative Database and resources on paid family leave.

think babies logoThis brief was made possible with funding from ZERO TO THREE as part of Think Babies™, which was developed to make the potential of every baby a national priority. Funding partners for Think Babies™ include the Perigee Fund and the Robert Wood Johnson Foundation, which supports the public education aspects of Think Babies. Learn more at