Effective policies and strategies to impact this goal include:

Children experience warm, nurturing, stimulating interactions with their parents that promote healthy development.

Stable, responsive relationships with caregivers during the earliest months and years of a child’s life are key to long-term healthy development. Yet those critical early years also can be stressful for parents, who may themselves struggle to cope and to connect with their children. The developing brain depends on secure attachments and serve-and-return interactions, in which adults reliably and appropriately respond to a child’s cries, babbles, and other bids for connection. These interactions shape brain architecture, both providing the positive stimulation children need for typical development and acting as a buffer to stress, protecting the developmental process from disruption.1

Persistent absence of warm, reciprocal interactions increases the likelihood that a child will experience poor outcomes for health and wellbeing.2 Neglect—which accounts for the majority of child maltreatment cases—is associated with a particularly wide range of mental and physical health consequences, including behavioral disorders, interpersonal difficulties, chronic illness, and poor school achievement.3 When families experience adversity related to economic hardship, limited education, or discrimination, the stress can interfere with parent-child interactions and perpetuate socioeconomic, racial, and ethnic disparities in children’s health risks.4 Many of the stresses brought on by COVID-19—including economic uncertainty and job loss, confinement in crowded settings, and lack of access to support networks—can increase the risk, to both women and children, of exposure to violence and can further exacerbate underlying disparities.5

Measuring the quality of children’s interactions with adults is not easy, nor are data in this area abundant. However, some measures from available state-level data do capture this critical component of children’s development so that states can assess how parents and young children are faring. In the next section “How Are States Currently Meeting This Prenatal-to-3 Goal?”, we provide an overview of these measures—parents’ daily reading with a child, daily nurturing behaviors, and self-reports on coping with the demands of parenting. States should use these outcomes to track progress toward improving young children’s opportunities for engaging with parents in the warm, stimulating interactions they need. States also can implement the policies and strategies, reviewed in these sections, that have proven successful in achieving this goal.

Three outcome measures illustrate parents’ nurturing interactions with their infants and toddlers: (1) daily reading, (2) daily nurturing behaviors, and (3) parenting stress. These outcomes vary considerably across states, and daily reading and nurturing vary by race and ethnicity as well.

All three outcome measures were calculated intentionally in the negative direction to demonstrate where states have room for improvement and to help states prioritize the PN-3 policy goals that are lagging. Out of 51 states, the worst state ranks 51st, and the best state ranks first. The median state indicates that half of states have outcomes that measure better than that state, whereas half of states have outcomes that are worse.

 

OUTCOME MEASURE: LACK OF DAILY READING
% of children under age 3 whose family did NOT read to them daily during the prior week
Median state value: 60.4%

Daily reading to a child stimulates brain development and fosters child-parent bonding. In the US, 3 out of 5 children under age 3 are not read to daily. In the five best states, 40% to 50% of children lack daily reading, but in the five worst states, over 70% of infants and toddlers are not read to daily. Black and Hispanic children are 50% more likely than White children not to be read to daily.

See Prenatal-to-3 State Policy Roadmap Appendix for a table of state variation in Nurturing and Responsive Child-Parent Relationships outcomes and corresponding ranks for each state.
Source: 2016-2018 National Survey of Children’s Health (NSCH). For additional information, please refer to Methods and Sources.

 

OUTCOME MEASURE: LACK OF DAILY NURTURING BEHAVIORS
% of children under age 3 whose family did NOT sing songs or tell stories to them every day during the prior week
Median state value: 42.2%

Singing songs, telling stories, and playing games like peekaboo are effective nurturing behaviors that stimulate brain development and promote child-parent attachment. In the US, more than 2 out of 5 children under age 3 do not receive these nurturing interactions on a daily basis. In the five worst states, approximately half of babies do not have these nurturing interactions, but up to one-third of babies in the five best states do not experience this nurturing either. More than half of Black and Hispanic babies do not experience nurturing behaviors daily, compared to slightly over one-third of White babies.

Source: 2016-2018 National Survey of Children’s Health (NSCH). For additional information, please refer to Methods and Sources.

 

OUTCOME MEASURE: PARENTING STRESS
% of children under age 3 whose parent reports they are NOT coping “very well” with the demands of parenting
Median state value: 29.9%

Parenting can be challenging, and parents who are overwhelmed by the challenges are less likely to engage with their children and foster secure attachments and optimal brain development. Nearly 30% of all children under age 3 live with parents who struggle to cope with the demands of parenting, but the numbers are nearly twice as high in the five worst states compared to the five best states. This outcome does not vary substantially by race and ethnicity.

Source: 2016-2018 National Survey of Children’s Health (NSCH). For additional information, please refer to Methods and Sources.

Effective policies have a demonstrated positive impact on at least one prenatal-to-3 goal, and the research provides clear guidance on legislative or regulatory action that states can take to adopt and implement the policy. By contrast, effective strategies have demonstrated positive impacts on prenatal-to-3 outcomes in rigorous studies, but the research does not provide clear guidance to states on how to effectively implement the program or strategy statewide.

 

EXAMPLES OF IMPACT

Effective state policies and strategies to impact Nurturing and Responsive Child-Parent Relationships

Effective PoliciesExamples of Impact on Nurturing and Responsive Child-Parent Relationships
Paid Family Leave

  • Access to paid family leave led to a 10% to 20% increase in parents who reported reading to infants 4+ days per week, depending on the group (C)

  • Mothers who took paid leave reported going on outings with children 9.8 more times per month, and having breakfast with children 3.6 more times per week (A)

Effective StrategiesExamples of Impact on Nurturing and Responsive Child-Parent Relationships
Evidence-Based Home Visiting Programs

  • Home visiting led to small but significant effects for improving parenting behaviors (overall effect sizes on parenting outcomes from meta-analyses range from 0.09 to 0.37) (A,C,D,E)

  • Significant effects emerge within the context of many more null findings (B,E)

Early Head Start

  • EHS participation led to more supportive home environments for language and literacy (effect sizes 0.12) (I, S), particularly for Black families (effect size 0.19) (N) and families with moderate-level risk factors (effect size 0.18) (N)

  • Fewer parents participating in EHS reported spanking their child (effect size -0.13) (J, S)

  • Black EHS parents were more involved in school at grade 5 follow-up (effect size 0.37) (T)

Note: The letters in parentheses in the tables above correspond to the findings from strong causal studies included in the comprehensive evidence reviews of the policies and strategies. Each strong causal study reviewed has been assigned a letter. A complete list of causal studies can be found in the Prenatal-to-3 State Policy Roadmap Appendix. Comprehensive evidence reviews of each policy and strategy, as well as more details about our standards of evidence and review method, can be found at in the Prenatal-to-3 State Policy Clearinghouse.

 

POLICY VARIATION ACROSS STATES

Have states adopted and fully implemented the effective policy to impact Nurturing and Responsive Child-Parent Relationships?

Paid Family Leave

5 states have adopted and fully implemented a paid family leave program of a minimum of 6 weeks following the birth, adoption, or the placement of a child into foster care.

Sources: As of October 1, 2020. State statutes and legislation on paid family leave.

STRATEGY VARIATION ACROSS STATES

Have states made substantial progress toward implementing the effective strategies to increase Nurturing and Responsive Child-Parent Relationships?

Evidence-Based Home Visiting Programs

23 states supplement federal funding, and the estimated percentage of eligible children served by home visiting is at or above the median state value (7.3%).

Sources: As of June 11, 2020. National Home Visiting Resource Center. Home Visiting Evidence of Effectiveness. National Conferences of State Legislatures (NCSL) FY19 state budget survey. State statutes and adopted FY19 budgets. 2018 American Community Survey (ACS) 1-Year Public Use Microdata Sample (PUMS).

Early Head Start

7 states supplement federal funding, and the estimated percentage of income-eligible children with access to EHS is at or above the median state value (8.9%).

Sources: As of 2020. National Head Start Association report, confirmation emails and phone calls from state EHS experts, 2019 Early Head Start (EHS) Program Information Report (PIR), and 2018 American Community Survey (ACS) 1-Year Public-Use Microdata Sample (PUMS).

Note: Some states in the “no” category for Policy Variation Across States have adopted a policy, but they have not fully implemented it, or they do not provide the level of benefit, indicated by the evidence reviews, necessary to impact the PN-3 goal. Many states in the “no” category for Strategy Variation Across States have implemented aspects of the effective strategies, but states are assessed relative to one another on making substantial progress. For additional information, go to the State Data Interactives.

  1. Center on the Developing Child. (n.d.) Serve and return. https://developingchild.harvard.edu/science/key-concepts/serve-and-return/#:~:text=Serve%20and%20return%20interactions%20shape,of%20communication%20and%20social%20skills
  2. Center on the Developing Child. (n.d.) Neglect. https://developingchild.harvard.edu/science/deep-dives/neglect/
  3. Center on the Developing Child. (n.d.) Neglect. https://developingchild.harvard.edu/science/deep-dives/neglect/
  4. Shonkoff, J.P. (2014). A healthy start before and after birth: Applying the biology of adversity to build the capabilities of caregivers. In K. McCartney, H., Yoshikawa, & L. B. Forcier (Eds.), Improving the Odds for America’s Children (pp. 28-39). Harvard Education Press.
  5. Peterman, A., Potts, A., O’Donnell, M., Thompson, K., Shah, N., Oertelt-Prigione, S., & van Gelder, N. (2020). Pandemics and violence against women and children. Center for Global Development working paper, 528. https://www.cgdev.org/publication/pandemics-and-violence-against-women-and-children