Public Policy and Early Childhood

Danette Glassy, MD, FAAP
WCAAP Early Childhood Committee
BestStart Washington

We all know early experiences are the most powerful in shaping the life-course trajectory of children.  Safe, stable, nurturing relationships have been shown to improve life outcomes, including mitigating the harm done by adverse childhood experiences (ACES).  While many of our efforts as pediatricians have been to identify and address these ACES, we should also understand how we can improve safe, stable, nurturing environments for all children as a preventive strategy.

So what are the efforts that are working to improve safe, stable, nurturing environments for infants and young children?

1. Quality Early Education and Child Care (EECC): Good quality EECC has been proven to improve life outcomes AND poor quality has been shown to be harmful. The most succinct publication outlining what features lead to quality is 13 Indicators of Quality Child Care –

Another resource outlining standards of care, evidence-based best practice in EECC is Caring For Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 4th Edition – This is a fully searchable list of best practices that includes references for why the practice is promoted and how EECC programs might implement them.  Our state uses this to create child care regulations and National Head Start uses this to create their Performance Standards.  The AAP is the publisher, and you can also buy the book at the AAP website.  This is also very helpful in helping your patients answer questions about what should be happening in their childcare.

Access to this care is difficult.  Pediatricians should talk with their families about finding quality care.

The Federal Government provides billions of dollars to states to support child care access and somewhat to funding quality.  This program is the Child Care Development Block-Grant Fund, and the recent Federal COVID-19 Relief bill added billions.

2. Infant Home Visiting: Evidence-based Infant Home Visiting programs, dollar-for-dollar provide the most cost-effective strategy for improving safe, stable, nurturing environments for infants and have been shown to save $14 in society costs for every $1 invested. It is best implemented universally, but limitations in funding have our state supporting only programs that target particular at-risk populations. Washington State uses state dollars in addition to Federal Dollars, and the recent Covid Relief bill provides an extra $150 million to this program nationally. Pediatric clinicians should explore ways they can refer at-risk families, and can join a coalition (Start Early) that advocates for this program:

3. Paid Family Leave: What better way to give infants a safe, stable, nurturing environment than their own parents. Washington State is one of only a handful that has Paid Family Leave.  Employees and Employers each contribute a small amount into a state fund that parents can tap when they have a child or welcome a child into their family.  There are plans at the Federal Level to create a national plan as well.  If you want more information for your families (or yourself 😊):

4. Early Literacy: Most pediatric clinicians know about Reach Out and Read ( and many participate.  This evidence-based intervention delivered through well child visits is important to continue to support. In addition, other early literacy programs in Washington state include Public Library programs. Check your local library, and see these resources for families:

5. Systems: There are several programs that improve access to some of these programs. Many families do not participate for a variety of personal, racial, cultural, life-circumstance barriers.  These programs work to tear down these barriers and are just as important as the programs mentioned above:

  • Within Reach– A beloved state non profit connecting families to early childhood development milestone screening, application assistance for health insurance, help finding a food bank, and parenting class or low-cost medical clinics. Parents can access their resources with one phone call at 1-800-322-2588 or online at
  • Help Me Grow – Help Me Grow is a nationally recognized resource and referral linkage system that guides families through a complex web of services to connect them to appropriate community supports. It helps communities maximize existing resources to make sure everyone feels supported. Through Help Me Grow, parents and caregivers can easily access the resources they need, when they need them. There is advocacy about making this available in all corners of Washington State and implement all parts of this connection, including partnering with our Medical Homes.

6. Every other program that helps families be healthy: A “short” list includes nearly everything else we advocate for children and their families:

    • Adequate Medicaid funding and access to health care for all children and their families
    • Access to appropriate mental health resources for children and families
    • Ending hunger and food insecurity
    • Access to nature

Please join the WCAAP Early Childhood group for quarterly Zoom meetings exploring these issues. Contact Edna Maddalena to learn more.