Prenatal-to-Three Policies

The type and quality of interactions a child has with his or her parents and other caregivers is one of the most important factors in building the brain’s foundation. Many parents are stretched thin, particularly new or young parents and parents who are economically disadvantaged, lack stable housing or are food insecure.

Zero to Three, a national advocacy organization, conducted a survey that assessed Millennial and Generation X parents’ thinking about raising young children. The survey found that “many parents don’t realize just how young babies and toddlers are when they can begin to feel complex emotions. Nor do they realize how deeply infants can be affected by the way parents interact with them in the first months of life.” Zero to Three warned of a “missing year” of important opportunities for parents to support their child’s development.

Because the bond between parent and child is so critical, some states are considering paid family leave as a policy option to enable parents to spend more time with their babies. Six states—California, Massachusetts, New Jersey, New York, Rhode Island and Washington—and the District of Columbia have paid family leave laws 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. New Jersey's 2019 law expanded its paid family leave program and new provisions will take effect later in 2019 and in 2020.

NCSL Resources:

• State Actions on Paid Family Leave
• Paid Family Leave LegisBrief
• Paid Family Leave Webpage

High-quality child care provides a safe, nurturing and developmentally appropriate environment for infants and toddlers, while also enabling their parents to work outside the home or pursue education and training opportunities. Nearly four million infants and toddlers are in a family child care setting, which includes home-based and friend, neighbor and relative care. This care is often not regulated or licensed and can be lower quality. A literature review by Mathematica outlines the characteristics of home-based care and options to consider to boost the quality of care. In addition, the Center on American Progress’ 2018 report found that child care shortages for infants and toddlers exist across the country but are more prevalent in rural areas and counties with families with lower incomes.

Family child care providers often have limited access to information and training on quality child care or quality improvement opportunities. The use of family child care networks is a research-informed strategy to promote higher quality in family child care settings.  

A 2019 report by Ready Nation, a national advocacy organization, highlights the challenges parents face finding child care for children under two years of age and the impact it has on their employment. The study revealed that for 86 percent of parents, lack of child care hindered their ability to work consistently. The study found that the economic impact of the lack of child care to working parents, employers and taxpayers is $57 billion per year in lost earnings, productivity and revenue. 

States are working on approaches to improve the supply and quality of infant and toddler child care. A 2015 federal report by the Administration for Children and Families addressed infant and toddler teacher workforce compensation. States are looking to their quality rating and improvement systems (QRIS) to measure or assess the quality of early care programs, including the standards for care for infants and toddlers.  

NCSL Resources:

• LegisBrief: More States Leaning Into Child Care
• Building a Qualified and Supported Early Care and Education Workforce

Additional Resources:

• Conducting a Child Care Cost of Quality Study: A Toolkit for States and Communities by Center for American Progress
• Parents and the High Cost of Child Care: 2019 Report by Child Care Aware of America 
• Workforce of Today, Workforce of Tomorrow: The Business Case for High-Quality Child Care (U.S. Chamber of Commerce Foundation)

Developmental and well-being screenings help ensure that infants’ and toddlers’ growth and development are on track. The American Academy of Pediatrics recommends developmental screenings for infants and toddlers at 9, 18 and 30 months and whenever additional attention is needed. These can be conducted by a trained health provider, early childhood teacher or another qualified provider. Bright Futures are guidelines recommended for physicians, child care providers and home visitors to follow as they administer social, behavioral and developmental screenings.

Millions of children receive health care coverage through their state’s Medicaid or Children’s Health Insurance Program (CHIP). Well-child visits and developmental screenings provided through these programs can save states money through early identification and treatment of health and development issues. Additionally, states are required to provide children enrolled in Medicaid with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This includes comprehensive preventive, dental, mental health, developmental and specialty services. From 2016 to 2018, at least 11 states included funding in their appropriations bills to increase reimbursement rates for health care providers administering EPSDT screenings. 

NCSL Resources:

• The Bright Futures Guidelines: Improving Children’s Health 
• Maternal and Infant Health Webpage

Some states have targeted funding for infant and toddler programs. For example, Kansas uses tobacco settlement funds for infant and toddler state initiatives. Illinois provides a 20 percent birth-to-three funding set-aside by statute, and Nebraska’s Six Pence fund was legislatively established in 2006.  

Federal funds also can be used to increase access to high-quality child care for infants and toddlers. In 2014, the federal government reauthorized the Child Care and Development Block Grant (CCDBG), the program through which the federal child care subsidy program is administered. The federal Child Care and Development Fund final rule set forth changes to improve infant and toddler child care, including an increased 3 percent set-aside for quality. Some states have used the funding opportunity to create a system of infant and toddler specialists and to increase reimbursement rates for infant and toddler care providers.

The Preschool Development Birth through Five Grant (PDG B-5) is a federal one-year planning grant opportunity for states to support infants and toddlers. Forty-four states, the District of Columbia and the Virgin Islands received awards to work on a birth-to-five needs assessment and strategic planning with an emphasis on parental choice, expanding access and improving quality and strengthening the workforce.

Early Head Start is a federal program focused on the early education experiences of low-income babies and toddlers. Early Head Start-Child Care Partnerships (EHS-CCP) is a strategy that states are using to enhance services to infants and toddlers in low-income families. EHS-CCP partnerships increase access, enhance services and provide opportunities to raise program quality at both child care centers that serve infants and toddlers and Early Head Start programs.