In fiscal year 2025, 1.59% of all federal spending was dedicated to supporting children from birth to age 3, down about 20% from its peak of 1.98% in 2021, when adjusted for inflation. 

That鈥檚 according to , an annual report from First Focus on Children, a nonprofit, bipartisan advocacy organization that seeks to elevate children and families in federal policy and budget decisions. 

For the 2025 edition, the authors tracked nearly 150 federal programs that invest in infants and toddlers, including mandatory programs such as Medicaid and SNAP and discretionary programs such as the Child Care and Development Fund, Head Start and Preschool Development Grants. Their findings, they said, confirm that the U.S. can and should be doing a lot better when it comes to babies.

And with major funding cuts to Medicaid and SNAP looming 鈥� programs which help to meet the basic needs of America鈥檚 youngest population and make up about half of all federal spending on babies 鈥� the next few years are only expected to be worse. 

鈥淎ll the research shows this is the best investment you can possibly make for any age group, and yet we shortchange it,鈥� said Bruce Lesley, president of First Focus and one of the report鈥檚 authors. 鈥淲e make far fewer investments for kids 鈥� but particularly babies and toddlers 鈥� than we actually should be making.鈥�

Is there a magic number of dollars to invest in young children? In an interview, Lesley and his co-authors said no. But they did note that while the world鈥檚 largest economy spends $1.59 out of every $100 on babies, it spends about $13 on defense.

Lesley also pointed out that children from birth to age 3 make up about of the U.S. population, meaning federal spending on them is not even half of their population share. And some would argue that infants and toddlers, being an especially vulnerable, wholly dependent group, warrant more than their fair share of spending. 

鈥淢any things about human infants and toddlers are expensive,鈥� said Elizabeth Gaines, founder and CEO of Children鈥檚 Funding Project, a nonprofit that works with states, communities and Native nations to support and expand funding for children. 鈥淭hey鈥檙e vulnerable creatures. We should be spending more of our resources on the most vulnerable of us.鈥�

Many countries have better infrastructure for supporting children and families than the U.S. does, said Melissa Boteach, chief policy officer at Zero to Three, a national nonprofit advocating for infants and toddlers. Most have paid family and medical leave and universal health care systems, which the United States does not provide. That leaves many populations, including the youngest, to fend for themselves. 

鈥淚t鈥檚 paltry,鈥� Boteach said of federal investment. 鈥淏abies are 100% of the future. They鈥檙e in a period where their brain development is so rapid, the investments have such a long-term impact, and yet we continue to underinvest in babies.鈥�

While overall spending on babies is down about 20% over the past four years, discretionary spending has fared even worse. Since 2021, investment in programs that support child care, early learning, environmental safety and health for babies has declined by more than half 鈥� from 2.05% in 2021 to 0.96% in 2025. 

Many of these programs received historic levels of funding in 2021 as part of the , in response to the pandemic, making it an outlier year, acknowledged Chris Becker, vice president of budget policy and data analysis at First Focus and an author of the report. As a result of all that spending, he said, the child poverty rate in the U.S. was , lifting nearly 3 million children out of poverty and illustrating what could be possible if the nation invested more in its youngest citizens. 

鈥淐hild poverty exists. Food insecurity exists for babies. Homelessness exists for babies,鈥� Becker said. 鈥淚 don鈥檛 know what number solves that, but it is solvable.鈥�

H.R. 1, also referred to as the 鈥淥ne Big Beautiful Bill Act,鈥� which was signed into law by President Donald Trump in July 2025, may only increase the child poverty rate in the country, the authors of the Babies in the Budget report said. The legislation includes an estimated $1 trillion in cuts to Medicaid and SNAP, which will gut the largest sources of federal spending on children from birth to 3. It will then be up to individual states to decide whether to make up the cost difference in those programs or let benefits lapse.

Trump has cast himself as a 鈥溾�� president, promoting rhetoric about boosting birth rates and supporting parents 鈥� a message by Vice President JD Vance and other allies. But the legislation tells a different story: Federal investment in babies and toddlers remains limited, and the largest funding streams for young children face steep cuts.

鈥淚 don鈥檛 even like to think about what is going to come from SNAP and Medicaid cuts,鈥� said Gaines of Children鈥檚 Funding Project. 鈥淜ids in states that step up may end up being OK. Kids from states that largely voted this administration into office may not be OK.鈥�

The president鈥檚 鈥� though not in any way binding and merely used as a blueprint so Congress can see what the administration wants to prioritize 鈥� included program and funding cuts across the board, said Becker of First Focus. But 鈥渂abies are hit especially hard,鈥� he said, with proposed elimination of dozens of programs serving babies and a reduction of more than $2.5 billion in discretionary spending.

There is a dichotomy between the administration鈥檚 words and actions on children and families, added Boteach. 

鈥淏udgets are moral documents,鈥� she said. 鈥淪how me your budget, and I鈥檒l tell you what your priorities are. You can say your priorities are whatever you want, but the words are empty if they鈥檙e not reflected back in a document that actually puts resources into what you say your priorities are.鈥�

Some leaders in the Trump administration have argued these programs for children are too costly, but Gaines doesn鈥檛 accept that as an answer.

鈥淭he resources are there. This is a nation of abundance,鈥� said Gaines. 鈥淲hen people say the money is not there 鈥� it clearly is. Choices are being made about where we invest our dollars publicly.鈥�

To illustrate her point, she noted that the One Big Beautiful Bill Act included a expansion of immigrant detention facilities. In 2021, the federal government spent on child care relief, and it was transformative for the field, she said. 

鈥淚 think if we asked the public whether they want their money on ICE detention centers or child care centers,鈥� Gaines added, 鈥渢hey鈥檇 say child care centers.鈥�

The service is growing in popularity because it has been shown to make a dramatic difference in the birth experience for mothers, babies and families. A U.S. Department of Health and Human Services report published in December found that doula services drastically improved maternal health outcomes.听 鈥淒oula-assisted mothers were four times less likely to give birth to a baby with low birth weight, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding,鈥� the report states. According to the , the one-on-one emotional support provided by doulas has been shown to reduce cesarean births, help shorten the duration of labor and improve the rate of spontaneous vaginal birth.

American mothers need all the help they can get. Though rates of maternal deaths have been declining in most countries, the U.S. has the of any industrialized country in the world, and the Centers for Disease Control and Prevention reports that 鈥渟tark and unacceptable鈥� racial and ethnic disparities persist in this maternity crisis. A large body of research suggests that doula support is a promising strategy to mitigate these disparities.

Medicaid each year 鈥� roughly 1.5 million births 鈥� and among the CDC鈥檚 policy recommendations to address America鈥檚 maternity crisis is to extend Medicaid coverage to make sure that no one in this country dies because of pregnancy. Because states have some discretion in how to use their Medicaid funding, some have begun following the evidence and offering doula services as a benefit to their enrollees.

Michigan has now become the latest state to reimburse doula services for individuals covered by or eligible for Medicaid insurance, joining 15 other states that have done so or are in the process of providing this benefit. In taking this step, the Great Lake State has made it possible for the approximately 45,000 Michigan Medicaid enrollees who give birth each year to access the gift of childbirth assistance that for years has been a luxury enjoyed by those who could pay for the service out of pocket or had great insurance.

Though Michigan has made strides recently in improving maternal and infant health, it still suffers from one of the nation鈥檚 highest infant mortality rates, with infant deaths among its Black and Native American communities more than double those among white infants. Black women in Michigan are three times more likely to die from pregnancy-related causes than white women 鈥� in keeping with similar national disparities.

To address these inequities, Gov. Gretchen Whitmer launched her initiative, allocating millions of dollars to improve birth outcomes and support birth equity. As part of this initiative, Michigan expanded Medicaid coverage for a full 12-month postpartum period, providing access to critical physical and behavioral health services, dental care, treatment for substance abuse, and more throughout the first year after pregnancy.

In January 2023, Gov. Whitmer announced that announced that Michigan would begin supporting expecting mothers by covering doula services for Medicaid enrollees. In making the announcement, Gov. Whitmer stated that a whopping 63 percent of maternal deaths in Michigan are preventable. (Michigan is by no means an outlier in these numbers: The in 2020 that more than 80 percent of pregnancy-related deaths from 2017 to 2019 in the U.S. were preventable.) To powerfully impact that situation, the state has put together a comprehensive program, a sort of one-stop shop that will spread the word about doula services, build the workforce, and provide ongoing resources and support for Michigan鈥檚 doulas.

A Solid Platform for Success

Doulas practiced in Michigan before the launch of the initiative, says Dawn Shanafelt, director of the Michigan Department of Health and Human Services Division of Maternal & Infant Health, who is leading the . 鈥淏ut with the program, Michigan will have a central location where families that have Medicaid insurance can find doulas available in their communities.鈥�

The initiative also provides a registry for doulas that offers webinars, training and continuing education, as well as for enrolling as a Medicaid provider and guidance on billing for doula services through Medicaid. To become a provider, individuals must have completed Michigan Department of Health and Human Services-approved (MDHHS) training, and they can find these approved programs on the website. The initiative provides scholarships for those who want to take the training and become professional doulas 鈥� a strategy that both builds the workforce and offers economic opportunity within local communities.

A key component of the program is the Doula Advisory Council comprising 29 individuals, all doulas from across the state who represent the diversity of Michigan鈥檚 communities, Shanafelt says. The council will work to promote advancement of doula services statewide and advise the MDHHS on policies, applications and resources, as well as providing advice on content for continuing education and reviewing training programs to ensure they meet Medicaid requirements.

The health department is hiring two doula specialists to work with Shanafelt鈥檚 division to serve different geographic areas of the state. She says one of these specialists has been hired 鈥� a doula with 22 years鈥� experience 鈥� and a second is on the way.

Medicaid policy includes a maximum of six doula visits during the prenatal and postpartum period, plus one visit for labor and delivery in a hospital setting. The flat reimbursement rate is $75 for each of the six visits, plus $700 for attendance through labor and delivery.

A stumbling block for states accessing Medicaid funding for doula services has been the requirement by the federal Centers for Medicare and Medicaid Services that doula services must be recommended by a licensed healthcare provider. To address this, Michigan鈥檚 chief medical executive Dr. Natasha Bagdasarian has issued a standing recommendation that doula services are medically necessary and should be offered to families covered by Medicaid insurance.听In her recommendation, Bagdasarian wrote that doula services should be offered 鈥渋mmediately and on an ongoing basis to Medicaid recipients until such time as determined no longer necessary.鈥�

Results Speak Volumes

Since professional doula services were first offered in 1970s, friction has existed with the medical community, with some doctors and nurses viewing doulas as encroaching on their territory, or just one more body to get in the way of their efficiency during labor and delivery.

鈥淭he way to change the mindset regarding who鈥檚 a part of the care team is by seeing excellent outcomes,鈥� Shanafelt says. 鈥淏y seeing that the patient or birthing person鈥檚 well-being improved by having a doula as part of their care team, attitudes change.

鈥淗aving the American College of Obstetrics and Gynecology recommend having an emotional support person such as a doula present because it is associated with better outcomes for women in labor makes a difference,鈥� she says. 鈥淒oulas have been serving birthing persons for decades, even hundreds of years, so this isn鈥檛 a new concept. The difference is the recognition of the value and importance of the doula profession.

鈥淭he shift is partly a result of the research that鈥檚 been published (about the benefit of doulas), but most importantly, it鈥檚 come from listening to families. Families tell us what works best for them. They鈥檙e the experts. So, if you listen to the experts, you鈥檙e going to hear time and time again that doulas make the difference.鈥�

RESOURCES

• , a nonprofit organization connecting Black families to certified Black doulas throughout the U.S. The maternal mortality rate among Black women听, according to the Centers for Disease Control and Prevention (CDC).
• Survey of medical literature demonstrating significant benefit for birthing parents and their infants, notably for Black patients

FACT CHECK

• (Journal of Law, Medicine & Ethics)

Typically, about experience a developmental delay. But children born during the pandemic, a 2022 study has found, have of developmental delays in communication and social development compared to babies born prior to the pandemic.

The reason, some researchers believe, is related to , among other factors.

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Delays in communication can mean a child learns to talk later, talks less or uses gestures like pointing instead of talking. Social developmental delays might be present when a child doesn鈥檛 respond to their name when called, doesn鈥檛 look at what adults are paying attention to in the environment, or doesn鈥檛 play with other children or with trusted adults.

It鈥檚 hard to say if children who suffer from these delays can be caught up or if they will require continued services or special education into elementary school and beyond. The more severe the delay, the more likely the child will need ongoing specialized services.

One way to be more certain is to talk to your child鈥檚 pediatrician about whether your child is meeting certain developmental benchmarks. The Centers for Disease Control and Prevention, part of the U.S. Department of Health and Human Services, also recommends that parents contact their state鈥檚 and say, 鈥淚 have concerns about my child鈥檚 development, and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.鈥�

In the meantime, parents and early childhood teachers can support language development for children who may suffer from delays by providing rich, responsive interactions and conversations.

As a who specializes in language and literacy skills for young children with learning disabilities, here I offer five evidence-based strategies that parents and teachers of children with pandemic-related developmental delays can use to support the growth of their child鈥檚 language skills and later school performance.

1. Get children talking

Language is how we share experiences. However, children with developmental delays may not talk very much. Adults can , which helps children develop the ability to communicate and interact with others.

One way to do this is to create situations in which the child has to talk to get something they want. For example, at home, put a favorite toy or snack in a clear sealed bag or plastic container so the child can see the item but cannot get it themselves without asking for help. At preschool or day care during snack time or free play, provide the student with two choices and have them say which choice they want. For children whose speech is hard to understand, any noise or attempt at talking is a good sign. The important part is that they are trying to talk, not that the words come out perfectly. If the child鈥檚 speech is unintelligible, have them point and talk at the same time to show their choice.

2. Expand on children鈥檚 speech

Providing is critical for supporting the language development of children with developmental delays.

One way to provide rich language is by responding to what the child says and then adding on details or adjectives. For example, if a young child sees a dog and exclaims, 鈥淒oggy!鈥�, an adult could expand on that speech by saying, 鈥淵es! There鈥檚 a big brown dog.鈥� The adult is acknowledging what the child said and providing more language for the child to hear and respond to while sharing the experience of seeing a dog.

3. Be a warm and attentive conversation partner

When adults provide warm, supportive interactions, children go on to have , better vocabulary and reading ability in first grade, and better mathematics performance in third grade.

Being a supportive partner means . For example, play with toys the child chose or enact pretend scenarios the child came up with. During conversation, talk directly to the child about a topic the child chose and take turns talking. Don鈥檛 worry about correcting the child or guiding the interaction. It鈥檚 OK if you鈥檝e talked about the dog across the street a thousand times. Each interaction builds language skills. Stay positive and engaged.

4. Share a book

Shared book reading is a technique where the adult actively involves the child in the storytelling experience. Children who participate in frequent shared book reading have larger vocabularies, use more complex language and have .

Start by asking open-ended questions like, 鈥淲hat do you think will happen next?鈥� Talk to the child about their real-life experiences similar to the book, like, 鈥淩emember when we went to the park? What did we do there?鈥�

Point out words and letters while reading aloud to help children develop their awareness of print. Talk about interesting words in the story and define new words. Children often like to read the same book over and over, so there will be many opportunities to use these strategies during story time. Don鈥檛 worry about using them all at once.

5. Talk about words

Help children develop a better awareness of the connection between words and how they sound. This is an important skill that .

Clap or count syllables in words, such as 鈥渃upcake鈥� or 鈥渂utterfly.鈥� Tell nursery rhymes and have the child say which words rhyme or come up with other words that rhyme. Talk about the sounds you hear at the beginning or end of words, such as the 鈥渢鈥� sound in 鈥渢iger鈥� or the 鈥渕鈥� in 鈥渞oom.鈥� Children are slowly learning that spoken language is made up of words and sounds that can be represented by written letters. This knowledge is the gateway for learning to read and write.

This article is republished from under a Creative Commons license. Read the .

鈥淥nce children start producing humor, they鈥檙e doing so every three hours,鈥� says the survey鈥檚 co-lead author Dr. Elena Hoicka, associate professor at the University of Bristol鈥檚 School of Education. 鈥淎nd that鈥檚 a conservative estimate because the parents may have put their child to bed several hours before filling out the survey, or they might have missed an instance. So, it鈥檚 a pretty conservative measure. But it鈥檚 safe to say that kids are appreciating and producing humor really frequently.鈥�

involved a 20-item questionnaire for parents about their children鈥檚 humor development from 1 to 47 months, such as whether they were playing peekaboo or laughing at their adults making funny faces. The survey pooled data from multiple studies involving families in the U.K., U.S., Canada and Australia to create a global taxonomy of humor development in the first four years. The researchers found that children in all locations were developing humor at the same rates and were responding to and creating the same sorts of humor, suggesting that humor is universal.

鈥淭he caveat is, of course, that these are all English-speaking countries,鈥� Hoicka says. 鈥淥ne of my colleagues is now working on a Turkish version and it will be interesting to see if we鈥檒l get the same results or if things look a bit different when we look at other countries. But across these English-speaking countries, we didn鈥檛 find differences related to income, gender, parents鈥� education level or other such factors.

鈥淚 would have thought that having an older sibling might increase a child鈥檚 humor, but we didn鈥檛 find that. Based on our data, it seems that children are developing humor at the same general rate, regardless of other children in the home.鈥�

Hoicka says the researchers wanted to create this survey to establish when humor emerges and what sorts of humor children appreciate, and as a tool to see how development of humor relates to other stages in children鈥檚 development. Humor affects many other stages of life such as making friends, coping with stress and creativity. The intention is that systematically charting early humor development will be useful for other researchers who will be better able to target their future experiments and observations, as well as for parents and early childhood educators. Media professionals who are developing children鈥檚 programming can use the survey to target what kinds of humor will work at different ages.

The survey starts with babies at one month old, though Hoicka says it isn鈥檛 clear whether babies before three or four months really know what they鈥檙e doing. They do smile at their parents doing silly things like making funny faces or weird noises. In baby psychologist Dr. Caspar Addyman鈥檚 research on infant laughter, parents sent in videos of very young babies laughing, a few as early as one month.

鈥淪o, we decided to start our survey at that earliest age,鈥� Hoicka says, 鈥渁nd though it鈥檚 rare, we do have some parents reporting humor appreciation and laughter at one month. But babies actually appreciating humor starts with, at best, three months and most are smiling and laughing at jokes (like peekaboo) at four months.鈥�

Hoicka offers a word of caution in taking the timeline too much to heart. She doesn鈥檛 want parents thinking their child is a humorless dud just because they aren鈥檛 losing it at Daddy鈥檚 clowning by their fourth month. Children are born with different natures 鈥� some are naturally more somber; some seem to be born light-hearted. They鈥檙e going to respond to the world and the people around them on their own timelines. And sometimes Daddy’s clowning around just isn’t as funny as he thinks.

The development of humor is a complex process, and it understandably tracks with the child鈥檚 other developmental trajectories. For example, the first year is devoted to sensory development, so disruptions to the ordinary in what the baby hears and sees can be great material for eliciting a laugh. The element of surprise is important in humor of all sorts and equally so with babies. A sound they鈥檝e never heard before can be startling but also hilarious. For example, entire YouTube channels are now devoted to babies cracking up over their parents tearing paper.

Humor and laughter are inherently social and, Hoicka says, can be a first step in parent-child communication. Babies at an early age don鈥檛 understand language, so clowning and playing provide some of the earliest opportunities to communicate and bond. Humor is also a place for children to practice creativity, because in making a joke or a funny face, the child is getting experience with the something-from-nothing that is the basis of any creative endeavor. Humans spend a lot of time in life trying to get it right; with a joke, the stakes are low and there鈥檚 no messing up 鈥� it鈥檚 just all part of the goofiness.

The call-and-response of humor is another way in which adults scaffold children鈥檚 development. The adult provides a cue, and the child responds to the cue; then the adult builds on that with another cue and, like conversational turn-taking, their information highway about the world is strengthened. They learn that when Mummy pretends to eat their toes that she鈥檚 really not the toe-eating sort and when Daddy pretends to sneeze a strand of spaghetti out of his nose, why, that鈥檚 just silly.

One-year-olds engage in tickling, chasing and funny bodily actions in tandem with their advances in motor development. As they grow older and begin to wrap their heads around language, the types of humor often shift to word-based jokes and riffs, which can be great practice for understanding fact and fiction and putting them to good advantage for a laugh.

鈥淚f you鈥檙e 4 and you know where the chocolate bar is but mum doesn鈥檛, that can be leverage for a joke,鈥� she says. But for the child to understand and deliver the joke, they must understand that they鈥檙e trying to get their audience to consider what鈥檚 true or not true at the same time to pull one over on mum. Pretty sophisticated thinking for one so young.

Children don鈥檛 really understand types of humor like knock-knock jokes and puns until they鈥檙e somewhat older 鈥� around 7, Hoicka says 鈥� but that doesn鈥檛 necessarily keep them from giving it a shot. 鈥淜苍辞肠办-办苍辞肠办.鈥� Who鈥檚 there?鈥� 鈥�顿辞驳!鈥� isn鈥檛 exactly a knee-slapper, but it鈥檚 good practice as they sort not only what lands, but why.

For humor to be funny, it needs a positive environment, Hoicka says. Among many mammals, playfulness is used as animals are learning fighting or hunting, for instance, signaling that 鈥淵es, we鈥檙e fighting, but let鈥檚 not actually hurt each other, shall we?鈥� When 鈥渇unny鈥� gets too pushy or mean, it ceases to be funny and is read for what it is: aggression.

鈥淎ggressive humor is not linked well to good mental health,鈥� Hoicka says. 鈥淚t鈥檚 linked to bullying and, although a lot of people seem to find it funny, it isn鈥檛 adaptive to human development in the way other types of humor are. Saying nonsense words is going to get you a lot more friends, for instance, than pushing someone even if you find that funny.

鈥淲e haven鈥檛 studied this as much as I鈥檇 like, but with aggressive humor, it looks as though not everyone gets there even by 47 months. Some kids maybe just aren鈥檛 as into it 鈥� that鈥檚 certainly what we see in older kids and adults. Some people just aren鈥檛 into meanness and aggressive humor.鈥�

Beyond a certain age, Hoicka says, there鈥檚 a certain type of humor that rarely fails to land. She has a 3-year-old and a 6-year-old and says the richest vein of jokes for either is anything having to do with bodily functions and toilet humor, which a quick scan of some of the highest-grossing (pun intended) movies in the U.S. tells us never goes out of style.

鈥淢y daughter, the 3-year-old, has just discovered whispering,鈥� Hoicka says. 鈥淪he鈥檒l call me over, 鈥楥ome here, come here!鈥� and I just know what鈥檚 going to happen. I lean down and 鈥︹��

Yep.

鈥淧oo-poo,鈥� she whispers, followed by delighted laughter.

Gets 鈥榚m every time.

In 1990, Issaquah resident Karen Ridlon became aware of the number of babies who were starting life without adequate food, clothing or beds. A certified Pediatric Nurse Practitioner working in well-child and newborn care, and newborn ICU support, for several medical groups, Karen saw the impossibility of trying to teach a parent how to feed their infant when they didn鈥檛 even have access to bottles or the necessities for nursing. She had read about a small 鈥渂aby corner鈥� that was working with Swedish Hospital in Seattle. She convened a gathering of providers including public health nurses to get their feedback on the idea, and then began collecting items in her home.

She reached out to people from area churches and her neighborhood, and to parents of children in local schools 鈥� anyone she could buttonhole to contribute, or to come help her gather and distribute the growing mounds of donated items. Response from the community was overwhelming, says Helen Banks Routon, who has been 鈥檚 director of development and community relations for 13 years.

鈥淭he project almost immediately outgrew Karen鈥檚 home,鈥� Routon says, 鈥渟o she went to real estate property developer Skip Rowley and said, 鈥楥an I have a little storage unit?鈥� Skip eventually said, 鈥極K, here鈥檚 a 10鈥� by 20鈥� unit. Pretty soon she said, 鈥業 need more.鈥� So then it was a bigger unit and then a 4,000 square foot building and now, we鈥檝e expanded to 15 bays in this warehouse facility.鈥�

For 30 years now, Rowley Properties has donated at least 75% of the warehouse rental and have been partners in every way, she says, from serving on the board of directors to participating in fundraising efforts. With Karen Ridlon鈥檚 vision and Skip Rowley鈥檚 generosity, the corner has now grown into an agency that in 2020 alone distributed $3.6 million worth of products, averaging 12,266 orders for essential products each month. EBC provides for children ages birth to 12 and families below the poverty line. It now reaches more than 13,000 children annually and distributes more than 1.6 million diapers each year. Volunteers donate more than 30,000 hours annually.

From stacks of donations in Karen Ridlon鈥檚 house, this little corner has grown into a mature organization with an annual budget of $5,119,045, a fulltime staff of 18, hundreds of volunteers and a community that it both supports and is supported by.

The agency鈥檚 stated purpose, 鈥淭o help kids reach their full potential tomorrow by meeting basic needs today鈥� is both a mission statement and marching orders, Routon says. The model is not to provide direct assistance to individual families, but to 鈥渉elp the helpers,鈥� through a network of agency partners including food banks, social service agencies, schools and others who work with vulnerable people. Families can access EBC through 238 program sites in the central Puget Sound service area.

EBC now has three hubs in the Puget Sound where donations are processed. The Issaquah warehouse often overflows 鈥� literally 鈥� with the community鈥檚 generosity as volunteers sort piles of clothing, toys, furniture and every imaginable accoutrement that could improve the life of a vulnerable child or parent. And some accoutrements that are simply baffling, Routon says, such as the gift of a bunch of child-sized sparkly high heels. The shoes never went in the clothing bundles but did make their way into table d茅cor for fundraisers. Some of the not-so-functional frippery gets routed to the Halloween section where it eventually makes some kid really happy.

The sorting, labeling, storing and distributing of all this generosity runs like a well-oiled machine. Streamlining the process has been an organic progression developed over time by volunteers and staff whose contributions are welcomed and implemented.

鈥淚t used to take way longer to fill orders 鈥� and we did a lot less,鈥� Routon says. 鈥淭he system is constantly growing and changing. Somebody came up with one part of it, another person came up with another part. These people who come in every single week will eventually say, 鈥榊ou know, we could do this better鈥︹��

鈥淎nd we always say, 鈥極K, great. Whatever works.鈥欌��

The pandemic has had a powerful impact on the work of Eastside Baby Corner, both by significantly reducing the number of volunteers and financial contributions, and drastically increasing demand for its services. Large corporate groups such as Windemere Real Estate, Microsoft, Expedia or Liberty Mutual used to bring in 10 to 50 volunteers at a time as part of their give-back to the community. The COVID-related stay-home orders brought those big gatherings to a standstill while at the same time, the need for goods and services skyrocketed.

In 2020:

• The number of product orders increased more than 33% over the previous year and recurring orders increased by 28 percent 鈥� indicating the need for EBC assistance to migrate from supplemental to sustaining, as families in need remained unable to move on from their constrained circumstances.
• EBC assisted 5,014 households, of which 3,306 were 鈥渇irst time ever ordered.鈥� Meanwhile, diaper donations dropped 49% in 2020 as diaper distribution rose by 47%. The Rapid Response program provided 332,485 diapers.

And things don鈥檛 look a lot better so far in 2021, as 27% of EBC鈥檚 households now indicate they are experiencing homelessness.

The agency fulfills orders regularly, offering their partners a catalog of about 250 items, from newborn diapers to a craft kit for a 12-year-old, Routon says. On Thursday afternoons, the orders close and volunteers get busy fulfilling the requests. The labels not only have the child鈥檚 age and size but try to capture as much information as possible so volunteers can personalize the orders for the individual child and also try to be mindful when possible to provide items that are appropriate for their cultural or ethic background. Whenever someone receives items from EBC, they know they are cared about and cared for.

鈥淥rders can be huge, like an entire week鈥檚 wardrobe in what we call a Big Bundle,鈥� Routon says, 鈥渙r it could also just be for a bar of soap. We just see how many labels have come in every single week and we pull those items and fulfill that request.鈥�

Sometimes, life throws families very large curve balls and EBC鈥檚 team is there to meet that need. A woman might be fleeing domestic violence with nothing but the clothes on her and her children鈥檚 backs. A family might find itself evicted and unable to access its personal items.

鈥淭hree weeks ago, a family was burned out in an apartment fire. The woman was pregnant and went into labor,鈥� Routon says. 鈥淥verlake Hospital called us and we immediately turned around a full layette, a pack-and-play bed, nursing equipment and everything else they needed because the fire had left them with nothing.鈥�

EBC is now working with partners who are resettling Afghan refugees. Agencies such as the Afghan Health Initiative and Jewish Family Services can order the families anything they need to help them get started in their new lives. So far, about 150 Afghan families have been processed and settled in King County; Routon said she knows the need will continue over the coming year.

The need that EBC is addressing is by no means limited to Washington鈥檚 Puget Sound region. According to Joanne Samuel Goldblum and Colleen Shaddox, authors of 鈥�Broke in America: Seeing, Understanding, and Ending U.S. Poverty, one in three moms in the U.S.鈥� now struggles to afford diapers for their babies and, though more than five million U.S. babies and toddlers live in poor and low-income families, no government programs provide diapers or funding to purchase them. EBC is part of the that grew out of Goldblum鈥檚 work and is working to address this need throughout the U.S.

Though the need is massive, these organizations鈥� existence demonstrates that the situation doesn鈥檛 have to be hopeless. It will begin to shift when enough of us personally respond to that question Karen Ridlon answered three decades ago: 鈥淗ow much difference can one person make 鈥� really?鈥�

鈥淚鈥檓 a mom and a boss,鈥� proclaims the owner and operator of Rocking Horse Child Care Center in Grafton, North Dakota. She knows all about how to run a business and how to take care of young children鈥攈er own and the two dozen or so who attend her center. She can do it all, pretty much.

But sometimes even an irresistible force like Osowski comes up against an immovable object, for example, a little boy on the playground who insists on taking off his shoes. His socks are getting dirty. And the other children see what he鈥檚 doing and start thinking maybe it鈥檚 a good idea to take off theirs too.

鈥淚t鈥檚 not enough to tell him to stop,鈥� she says. 鈥淵ou have to get down on the ground with him and find out why he鈥檚 taking off his shoes. Maybe there鈥檚 a pebble in there. Maybe his sock feels funny.鈥� When you find out his 鈥榳hy,鈥� you can explain your 鈥榳丑测鈥櫬�鈥�his socks will get dirty, he might step on something sharp鈥攁nd then maybe he鈥檒l change his behavior.

Finding out why doesn鈥檛 just work on the playground. It also helps when you鈥檙e talking policy with legislators. 鈥淚t was a very honest discussion,鈥� Osowski reports. 鈥淚 told them, 鈥榊ou鈥檙e the experts on bills and laws. I鈥檓 the expert on kids.鈥欌��

Osowski and her husband, who sells insurance, have two children of their own, with a third due in October. Her Rocking Horse journey started when she was working at a florist while pregnant with her first child. When her mother-in-law died suddenly, the family had to grieve鈥攁nd also find a way to make up for the free child care they were counting on. 鈥淭he possibilities were few and far between,鈥� she recalls. 鈥淎nd we were way behind.鈥�

Having worked in the field, she knew it was important to look for quality. The second oldest of seven children, she knew she understood children. Coralea was born in November 2016, and Rocking Horse opened in August 2017. They started with 10 children. Now they have 24, and seven teachers. Teachers, bankers and farmers know they can trust Rocking Horse with their children. 鈥淭he waiting list is as long as my leg,鈥� she says.

鈥淐learly this is what I was meant to do.鈥�

That doesn鈥檛 mean it has been easy. The pandemic has been the most significant but by no means the only challenge. 鈥淓ven with CARES dollars,鈥� she notes, 鈥渨e took a hard hit during COVID.鈥� Twice they had to shut down when teachers tested positive.

鈥淪taffing is a huge issue,鈥� she says, acknowledging that this isn鈥檛 the most glamorous job. 鈥淲e work our buns off for other people鈥檚 kids. There are a million different things to do every day.鈥� Finding and keeping good teachers is important, because turnover really affects the kids, so she strives to be accommodating with schedules and also to pay a fair wage.

Public funding isn鈥檛 just a nice idea; it鈥檚 vital for her to keep the doors open. 鈥淭hat money is an investment in our community鈥檚 future,鈥� she says.

During her Strolling Thunder conversations, Osowski explained how the parents rely on Rocking Horse so they can get to work. She described the desperation of parents in nearby Drayton, North Dakota, whose center shut down鈥攕omething she says happens all the time. To make matters worse, , depriving the community of Child Care Aware resources to help find quality options.

Above all, Osowski stressed that the education she provides prepares the children for kindergarten and beyond. She describes a 3-year-old boy鈥攏ot the one who kept taking off his shoes鈥攚ho initially couldn鈥檛 count the tater tots on his plate. 鈥淗e didn鈥檛 know his letters or numbers at first,鈥� she recalls. 鈥淲e had to play catch-up to get him ready for school. Where would he be without me?鈥�

The birth-to-preschool years really matter, Osowski asserts. This is the age when they learn they鈥檙e good at things, that they can become bosses in the future, or do anything if they set their mind to it. 鈥淭his is when their knowledge and passion come into being,鈥� she says. 鈥淎nd we can鈥檛 risk that.鈥�

You know the game: the big person covers their face with their hands or ducks out of sight. They鈥檙e gone! They suddenly reappear and say, 鈥淏oo!鈥� and the baby is delighted. This delight delights the big person, who does it again. Hilarity ensues; rinse, repeat, in a social interaction that, though nonverbal, is the back-and-forth, call-and-response of baby鈥檚 first conversational turn.

It is played in many languages (鈥淜uu Kuck Daa!鈥� in German; 鈥淚nai inai Ba!鈥� in Japanese); parents all over the world say that it鈥檚 right up there with tickling for eliciting baby laughter and is the funniest game they play with their babies.

For nearly a decade, baby psychologist Dr. Caspar Addyman has run the project for the University of London鈥檚 , collecting videos, stories and data from parents all over the world. His book, 鈥淭he Laughing Baby: The Extraordinary Science Behind What Makes Babies Happy,鈥� is a popular science book about baby psychology 鈥� a field that is much more sparsely populated than it ought to be, given the fact that babyhood is every human鈥檚 foundation for being in the world. In fact, realizing that is what led Addyman to be a baby psychologist in the first place.

鈥淚 picked babies because that seemed like the best place to start if you鈥檙e trying to understand people,鈥� Addyman says. 鈥淭hese are the crucial years. But as academics, we approach our research 鈥� academically: 鈥榃hen can they say their first word? When do they have their first concept? When can they tell male faces from female?鈥欌�欌�� Researchers are able to test infants鈥� learning through a tested-and-true method of making the babies bored by showing them the same thing repeatedly, then slipping in something different. For example, dog, dog, dog, dog, then suddenly, cat. In observing his infant niece, he thought he might have stumbled on another means of getting the data, but soon realized that babies only laugh when they get the joke. You can鈥檛 fake it with a baby, and they won鈥檛 fake it with you (except when they get a bit older and are completely bored with your silly peekaboo and feign a little laugh to be polite. A different story for another time). A stranger popping into a lab and trying to make a baby laugh is, from the baby鈥檚 perspective, pretty weird. They have a nose for manipulation and if it isn鈥檛 spontaneous? No ignition.

Babies laugh a lot, and most researchers don鈥檛 pay attention to that. Psychology has often been more focused on pathology 鈥� what鈥檚 wrong, what happened and how can it be prevented 鈥� rather than really looking at happiness and lives that are flourishing. Addyman decided to take babies鈥� laughter seriously and soon realized how deep a vein of research gold he had struck.

Humans evolved to be completely helpless at birth. In much of the animal kingdom, within minutes or hours of birth, the young animal is able to stand, walk and keep up to some degree with the group. Human infants have a long period of complete dependency, and during that time it is crucial to their survival that adults care for them through an extended development period. The success of human survival is more than anything social success.

鈥淚t really does take a village to raise a child,鈥� Addyman says. 鈥淲hen we were hunter-gatherers in the African savannah, it took the whole village to survive as a group and raise every child. The success within that is getting on with everybody else.鈥� It pays for a helpless little creature to be beguiling: smiles and laughter are the social lubricant that bind the baby to the group.

As survival strategies go, beguiling is a great one. The act of nursing, having one鈥檚 diaper changed or playing peekaboo, create delicious opportunities for social bonding. Babies become aware at a very early age of that heady rush when they hold another鈥檚 gaze, and they can do so for a surprisingly long time. Think about a time you swapped glances with a potential romantic partner and felt that rush of reward if the glance became mutual, Addyman says. Maintaining that connection is a matter of survival for human infants, and in this case, survival can be a lot of fun.

In fact, he says, researchers have found that the brainwaves of baby and adult become synchronized when there is mutual eye contact. The game of peekaboo is an extension of this mutuality. When the big person goes away briefly, there鈥檚 a moment of suspense as the baby wonders what鈥檚 happened, where did my person go? When their person pops back into view, the baby is joyful to see them, but also 鈥� most important from a developmental perspective 鈥� the baby鈥檚 hypothesis that they actually were coming back has been supported. Babies are scientists, Addyman says, and their entire existence practically from birth is positing one hypothesis after another. Part of the joy of peekaboo is the triumph of a prediction confirmed. Yesss! I knew she鈥檇 pop back up. She always does! We all love being right.

The game of peekaboo starts out very simply and doesn鈥檛 even require that the big person completely disappear. With very young babies, the surprise of withdrawing out of the field of vision 鈥� not well developed at this point 鈥� then coming in close is a big surprise. When the experience is repeated, and the baby observes the big person鈥檚 delight at their response, the child quickly catches on and game on! As baby grows, the game grows with them, and by six months, peekaboo is the best game there is, the adults are tweaking their comic timing and the game is rewarded with lots of big people smiles and baby belly laughs.

And babies do belly laugh, though not right away. For ages, psychologists and the medical establishment have held that what looks like smiles in babies younger than six weeks is actually gas and isn鈥檛 a communication of any kind. Addyman points out that these same experts have no trouble believing that babies鈥� crying is a form of communication. Believe the parents, he says: babies smile very early in response to pleasure, and infants three months old and younger, laugh.

鈥淚 have videos parents have sent me of much younger babies laughing,鈥� he says, 鈥渁nd it鈥檚 a very delicate, breathy sound. It鈥檚 not a full guffaw because their lungs aren鈥檛 really ready for that. Crying is easy, you just have to go ahhhhhhhh and take a breath and ahhhhhhhh. It鈥檚 all one thing. Laughter is an in-out, in-out, ha-ha-ha and it鈥檚 harder to achieve.鈥�

The whole time a baby is engaged in this way with the big people is a moment of pure social connection and pure learning for the child, Addyman says. Babies don鈥檛 laugh when they鈥檙e by themselves; it鈥檚 all about the interaction. They鈥檙e learning not only from the adults but from themselves. They realize the can do something and it will have a dependable effect. I laugh, mommy laughs back and hugs me 鈥� hmmm. This has promise. It is, he says, their first taste of a sense of agency and they like it.

As wonderful as babies鈥� laughter is, Addyman says, it also has its limits. Babies like things that surprise them; they don鈥檛 like actually scary things. Excitement and fear both cause our bodies to react in a similar way, releasing adrenaline and getting our hearts racing. Adrenaline prepares us to react. When the situation turns out not to be dangerous after all, there鈥檚 a sense of relief and excess energy to be expended 鈥� in a baby belly laugh.

When tickling a baby or paying peekaboo, it鈥檚 essential that the adult pay close attention to the child鈥檚 reactions. The little one can鈥檛 say, 鈥淥k, I鈥檝e had enough now. Lay off.鈥� They may look away or tire of the game, a signal that tears may come soon if their communication isn鈥檛 needed.

鈥淏abies are not great at controlling what they can and can鈥檛 do,鈥� he says. 鈥淪o especially with things like tickling, you have to pay proper attention and know when you鈥檙e pushing them too far. Laughter means let鈥檚 keep this going; tears mean time to stop. The child鈥檚 laughter isn鈥檛 just a toy for your amusement.

鈥淭he best way to make a baby laugh is to take them seriously and remember that all the way through the interaction. You鈥檙e not playing the clown to get validation from the baby. That鈥檚 definitely a temptation for parents, especially with the mobile phone in their hands.鈥�

Babies find men and women equally funny, according to Addyman鈥檚 survey. Nobody scores the highest, though, he says, 鈥淢ums might feel like, 鈥業鈥檓 there more often, so pro rata, shouldn鈥檛 I be getting more laughs?鈥欌�� Though babies do develop their individual tastes, he says his research hasn鈥檛 identified any preference for particular members of the family. If someone is playing with baby and they鈥檙e laughing, baby is happy.

鈥淥ne thing I can tell you that鈥檚 different from adults,鈥� he says. 鈥淎dults find cats very funny. Babies think dogs are hilarious.

鈥淐ats? Not so much.鈥�

Diapers are not what automatically comes to mind when we think of poverty, but to Joanne Samuel Goldblum, co-author with Colleen Shaddox of 鈥淏roke in America: Seeing, Understanding, and Ending U.S. Poverty,鈥� diapers are a keystone staple whose absence underpins big problems, not just for the families affected, but for our economy and society.

鈥淎s a rule, our government thinks about 鈥榖ig things,鈥欌�� Goldblum says. 鈥淚t doesn鈥檛 think about the small things that can have such an impact. But if you think about what it takes to put yourself together in the morning to get out the door, those hygiene products cost a lot of money.鈥�

Goldblum points out that there鈥檚 no food-stamp equivalent that enables people to purchase hygiene items like diapers, toothpaste, shampoo or period products, and few nonprofits offer them for free. Hygiene does not figure into the government鈥檚 support equation, though remembering the times in our lives when we were not able to get to a shower for a couple of days, got caught out without a tampon or had to make a mad dash to the store when baby had a blowout can give anyone an appreciation for the urgency to feel clean. For people living in poverty, those needs are too often a relentless, daily constant.

Goldblum said she first became aware of the level of need when she was working at Yale Child Study Center as a social worker doing community-based work, which involved home visits with her clients.

鈥淲hat they had in common was a level of poverty that shocked me, even as somebody who thought they understood what poverty in the United States looked like,鈥� she says. 鈥淭he crystallizing moment was working with a developmentally disabled mom who had three children under 3 and they never had toilet paper in the house. There I was, a clinician, supposed to help them learn better parenting skills. There is no clinical intervention for not having toilet paper.

鈥淚 saw the same woman take the diaper off, empty out the solids and put it back on. She didn鈥檛 need to be taught that her baby needed a fresh diaper. She needed enough clean diapers.鈥�

Goldblum began to research the scope of the situation and found that in the U.S., lack of basic hygiene necessities is just not part of the conversation about poverty. She chose to focus on diapers because their lack serves as a window into poverty, as does the lack of period products for those who need them. Goldblum started the New Haven Diaper Bank, which is now the . After seven years, Huggies came on as a partner and served as the founding sponsor for the (NDBN), of which she is founder and chief executive, now connecting and supporting 225 member diaper banks across the country, with one in every state.

They still don鈥檛 meet the need. Before the pandemic, millions couldn鈥檛 afford diapers; now, the need is exponentially worse. The NDBN member diaper banks report an average 86% increase in the number of diapers distributed to children and families since the beginning of the pandemic, with many programs distributing 400% or more diapers in 2020 than 2019. Diaper banks are reporting an average 39% increase in the number of children served each month during the pandemic.

Diaper Need: A Public Health Issue

Beginning with the physical and emotional impacts on the baby, not having enough diapers has profound effects that go far beyond one little baby being forced to sit in their own filth 鈥� which, the indignation vibrating in Goldblum鈥檚 voice tells us, ought to be motivation enough. Babies without clean diapers are exposed to greater health risks and are prone to urinary tract infections and diaper rash.

鈥淚t鈥檚 important to keep sight of how difficult that is on the parent as well. For any parent to have to decide between food and diapers, or heat and diapers? I don鈥檛 know how you make that decision.

鈥淢y kids are grown but I still remember what it鈥檚 like to have a baby with diaper rash,鈥� she says. 鈥淚 had hot water and enough diapers to change my baby regularly, but they still got diaper rash sometimes and I still remember the stress that caused. It was visceral for me.鈥�

It’s visceral for mothers in poverty as well, she says.

鈥淲e did a study in 2013 with our colleagues at Yale University, the first peer-reviewed study done about diaper need,鈥� Goldblum says. 鈥淲e found that diaper need was more highly correlated with maternal stress and depression than lack of anything else 鈥� even food. Not having enough diapers also impacts children鈥檚 mental health, being exposed to toxic levels of stress over long periods of time. It affects how children develop.鈥�

Diapers: Keystone to Our Economy

Beyond the fact of physical and emotional stress on mother and child, diaper need has a powerful effect on our economy. Most day care centers require that parents provide a day鈥檚 supply of disposable diapers for their children. Disposable diapers cost, on average, $80 per month, per child 鈥� for America鈥檚 poorest families, that amounts to around 14% of their after-tax income. If a mother doesn鈥檛 have enough diapers, she can鈥檛 take the child to day care.

鈥淣o diaper, no day care. No day care, no job. No job, no pay,鈥� Goldblum says. The cumulative effect of those absences takes a toll on the families and on the workplace, with ripples throughout the economy.

In 2017, a study by the University of Connecticut鈥檚 Center for Economic Analysis found that 57% of the families receiving diapers from The Diaper Bank of Connecticut had been unable to take their babies to child care at some point during the previous month because they didn鈥檛 have enough diapers. As Goldblum and Shaddox report in 鈥淏roke in America,鈥澨齣n most of the 2,679 households the researchers analyzed, the parents reported missing an average of four days of paid work or school a month. The study鈥檚 authors calculated an increase of $11 in personal income for every dollar鈥檚 worth of diaper aid that a family received.

The families鈥� incomes also rose because parents could complete educational programs qualifying them for higher-paying jobs when they had sufficient diapers. The study found that 1.2 to 1.3 jobs are created for every $10,000 of diaper aid 鈥� a ROI that leaves many taxpayer-funded 鈥渏ob creation鈥� incentives in the dust.

To those who helpfully offer that mothers in poverty should 鈥渏ust use cloth diapers,鈥� Goldblum agrees that鈥檚 a great solution for those who can get it.

鈥淐loth is absolutely an option for some people and in those cases, we encourage it. When it comes to cloth versus disposable, though, the National Diaper Bank is Switzerland: We don鈥檛 care. We want babies to be clean, dry and healthy. And we want it to work for families. As 95% of Americans use disposable, that鈥檚 going to be true of people in poverty as well.

鈥淔or people working a couple of jobs, living someplace without laundry facilities, struggling to get by, well 鈥� quality is a bit of a privilege.鈥�

Dismissing diaper need with 鈥渏ust use cloth鈥� or 鈥� another unhelpful and oft-offered opinion 鈥� 鈥渄on鈥檛 have a baby if you can鈥檛 afford it,鈥� indicates a deep lack of awareness of what life is like on the ground, in the trenches for America鈥檚 poor, who are often our working poor. As the authors point out in in 鈥淏roke in America,鈥� the people suffering from diaper need are often those pushing our cheeseburgers out the drive-through window or changing the sheets in that nice hotel we snagged for the weekend.

Though Welcome, Rescue is No Longer a Long-Term Solution

President Joe Biden鈥檚 American Rescue Plan Act of 2021, a $1.9 trillion economic stimulus bill that Biden signed in March, is the federal government鈥檚 greatest initiative toward fighting poverty in the U.S. since Lyndon Johnson鈥檚 Great Society in the 1960s.

鈥淚t isn鈥檛 the answer,鈥� Goldblum says, 鈥渁nd it won鈥檛 end poverty. It is going to lift a huge number out of poverty, though. It鈥檚 not enough, but it鈥檚 in the right direction. Now we need to ask, what will we do post-COVID? What will we do in the long term?鈥�

At stake, she says, is our nation鈥檚 view of poverty and people on the margins 鈥� margins that are growing every day because of the one-two punch of the pandemic and income inequality. Historically, America has been a land of haves and have-nots, where people in poverty are viewed as somehow not deserving of help.

鈥淲hat I believe and what our diaper banks are about is that children deserve a level playing field,鈥� she says. 鈥淪o much of what happens in a person鈥檚 life is shaped by the first three years. Our goal is to have everybody come out of those first three years as strong as they possibly can be 鈥� and to do that, people need access to basic needs: laundry facilities, toilet paper, period supplies 鈥� and diapers.鈥�

Semuels鈥� article asks important questions about this grave imbalance, but she overlooks the crucial opportunity鈥攊ndeed, the obligation鈥攊t presents for philanthropy to demonstrate its value. Baby Bundle, an initiative of the United Way of Coastal Fairfield County鈥檚 , represents a sweeping effort to equip young children and their families in Connecticut鈥檚 largest city with the supports they need to thrive. Local philanthropists, as well as the fund the Baby Bundle. I interviewed Bridgeport Prospers鈥� Allison Logan and Janice Gruendel and they introduced me to two people taking part in the systems change it is bringing about.

The United Way Team

Dr. Gruendel, a senior consultant with Bridgeport Prospers and a fellow with the in Child Development & Social Policy at Yale University, notes that a single statistic 鈥渕ade the community shudder鈥� and gave rise to the Baby Bundle: three-quarters of the city鈥檚 three-year-olds were not hitting their developmental markers. It didn鈥檛 take a Ph.D. to understand the long-term ramifications of letting this predicament fester year after year. In the absence of targeted intervention, toddlers who don鈥檛 meet their developmental milestones become kindergarteners who aren鈥檛 ready to read, with dire outlooks for later metrics such as high school graduation and avoiding incarceration. Behind the statistic about three-year-olds, Dr. Gruendel said, was 鈥渁 community in deep pain.鈥�

鈥淲e knew we weren鈥檛 going to program our way out of this,鈥� recalls Logan, the executive director of Bridgeport Prospers. As she explained, in the past, when a crisis reared its head, the tendency was to fund or launch a series of scattered programs to try and fix things. The result was usually disappointing at best, with similar organizations competing for grant money to carry out home visits and other services. In one egregious example of what happens when services aren鈥檛 coordinated, an individual mom might have a dozen different case managers.

This time around, Gruendel conducted a six-month landscape analysis, which included extensive listening to families and the community agencies that serve them. These conversations revealed a shocking deficit of infant and toddler care, widespread intergenerational trauma, and ubiquitous implicit and explicit bias among other issues鈥攂ut also a wealth of lived experience and an impressive lineup of natural community supports, including within the city鈥檚 128 houses of worship. The word resilience came up a lot. Gruendel recalls one woman looking her in the eyes and saying, 鈥淚f we weren鈥檛 already resilient, we鈥檇 be dead.鈥�

Logan and Gruendel don鈥檛 consider themselves the leaders or the architects of the Baby Bundle. Rather, they are facilitating the redesign of resources that community members indicated would be useful for improving their own lives. The United Way team engages a group of 鈥渃ommunity messengers鈥� who are paid for their time, engaging with families at the neighborhood level to ensure that community voice is ever present.

The Doulas

The Baby Bundle comprises a range of supports that extend well beyond the usual complement of early-childhood programs. Health care was one area that the landscape analysis illuminated. Doulas, the professionals who care for women before, during and after birth, were identified as one uniquely affordable and effective solution. Most births in Bridgeport take place at two hospitals, and ongoing health care is provided by two federally qualified health centers. Seventy percent of resident births are to moms on Medicaid鈥攖he health care program for low-income Americans, which is federally funded but administered by states. According to the National Academy for State Health Policy, only four states allow Medicaid funding for doulas. (鈥淢aybe Connecticut could be next,鈥� Gruendel says.)

Doulas have been around as a profession since the 1970s, but they are not well known in many of the communities where they could have the greatest impact, even though study after study shows that their presence leads to healthy outcomes for babies and mothers. Benefits include shorter labor length, less vacuum and forceps use, less use of pain medications, higher APGAR scores (an index capturing the condition of the newborn infant) and reduction in medical costs ().

SciHonor Devotion, proprietor of a doula collective that operates in 13 states, often has to explain what she does for a living. 鈥淎lthough the support we provide can lead to medical benefits, we鈥檙e not medical providers.鈥� she says. 鈥淲e provide constant guidance and support. And we are advocates for our clients.鈥�

When young mothers lack adequate social supports, their doulas go the extra mile, helping them navigate food, transportation, baby items, car seats and more. The Earth鈥檚 Natural Touch 14-month training program covers not just childbirth but the complexities of systems, the social determinants of health, structural racism, grief and loss, and issues specific to teen pregnancy. Switching to online training during the pandemic has meant they can extend their reach globally.

According to Logan, it took a shift in attitudes within the health care profession to welcome doulas into the delivery room. Devotion concurs, describing a teen, who had just given birth and was asking to breastfeed her baby, but the medical staff ignored her, and the hospital social worker insisted that teen moms never want to breastfeed. 鈥淏ut this one did,鈥� Devotion says, 鈥渁nd she needed someone to support her in doing so.鈥� Another mom was suffering from postpartum preeclampsia鈥攁 condition that requires immediate treatment鈥攁nd it was a doula, not the doctor or nurse, who spotted the symptoms.

The Deputy Commissioner

鈥淒oulas can have a lot more credibility than the nurse or doctor on duty,鈥� agrees Michael Williams, Deputy Commissioner for Operations, at Connecticut鈥檚 Department of Children and Families. He credits the Baby Bundle team for listening to the community and for adding value through data collection and science-informed technical assistance.

Williams, whose previous experience as a pastor and a social worker inform his government work, says, 鈥淔or too long, authorities were confusing 鈥榟elp鈥� with 鈥榠nvestigation鈥� and 鈥榮urveillance.鈥� A more human public policy doesn鈥檛 blame the victim. Maltreatment prevention is still our goal, but we do that through keeping families together, not tearing them apart.鈥� The shift in approach has brought about an increase, from 14% to 48%, of foster children placed with relatives or someone they know.

鈥淣ow that we know better,鈥� he says, 鈥渨e can do a whole lot better. And Baby Bundle fits right in the middle of that.鈥�

At , based in the department of psychology at Harvard University, researchers are trying to find out how and why the human mind is designed in such a way that we all hear, understand and respond to music. Researchers do experiments with people all over the world from many different social, cultural and socioeconomic backgrounds; the lab also hosts the project, a large body of studies and recordings of music throughout the world.

We鈥檝e all heard the old adage, 鈥淢usic is the universal language.鈥� The Music Lab has plenty of data to back that up: nearly 5,000 descriptions of songs and song performances from 60 human societies. And babies have been a big help, at least with one piece of the puzzle.

In a study led by Music Lab researchers Constance M. Bainbridge, a doctoral student at the University of California, Los Angeles, and Mila Bertolo, a Harvard researcher, 144 infants aged 2 months to 14 months were monitored as they listened to lullabies and non-lullabies they had never heard before. The researchers fitted the babies with heart rate and skin monitors 鈥� like a baby Fitbit, they say 鈥� and tracked the babies鈥� eye movements as they listened to the songs. Each of the songs was played for 14 seconds.

The songs were all in unfamiliar languages from 16 cultures, half of them sung by men and half by women, all without instrumentation. Whether the baby was hearing an Iroquois lullaby sung by a woman or one from the Ona people of Patagonia sung by a man, the babies鈥� heart rates went down, their skin鈥檚 electrodermal activity decreased, and their pupils became smaller 鈥� all indicators of relaxation. This response didn鈥檛 occur when the babies heard the other songs, a finding that indicates that lullabies鈥� calming effects might be innate to human beings, not learned.

鈥淭he fact that we saw the effect very young and that it was constant between the ages of 2 months and 14 months is a pretty surprising finding for something we didn鈥檛 need to learn. It鈥檚 the fact of having a human brain that has us perceive certain sounds in certain ways,鈥� she says.

When the songs were played for the babies鈥� parents, they too were able to predict which of the songs would calm their babies, distinguishing lullabies from love songs, healing songs or songs intended to inspire listeners to dance. (Listen to the songs .)

As is often the case with research, the lullaby project has brought up even more questions than it鈥檚 answered at this point, and it鈥檚 too early in the project to come to solid conclusions. Though they can鈥檛 say for sure, the researchers speculate on how the role of lullabies in human society evolved. Singing to a child requires focus and awareness, they say, and that could signal safety.

鈥淵ou need to be focused and have your attention on that infant,鈥� Bainbridge says. 鈥淚f you鈥檙e singing to the child, that means you aren鈥檛 communicating to other adults or responding to potential dangers. So, it might be an honest signal of parental investment in the welfare of the child.鈥�

For parents who might have performance anxiety about the idea of singing to their babies, the researchers offer an encouraging word: You don鈥檛 have to be a professional musician to sing your baby to the Land of Nod.

鈥淚t鈥檚 really the kind of music that everyone engages in,鈥� says Bertolo, 鈥渟o even if someone thinks they can鈥檛 carry a tune in a bucket, they鈥檙e probably comparing themselves to a performer. They鈥檙e probably capable of much more music than they realize, so I would think their musical ability is not a worry.鈥�

The researchers have a paper in the works that looks at what elements in lullabies drive the relaxation response. Does it have to do with the melody, smaller intervals between notes, a particular rhythmic profile and more repetition? Lullabies are recognized globally as different from other kinds of songs and the researchers are hot on the trail of why.

And from that question, another arises: If a certain element 鈥� the melody, say 鈥� sets the lullaby apart and the scientists manipulate the songs to make them even more melodic in that specific way, will that make the infants even more relaxed.

It stands to reason that a smooth tempo is part of the equation.

鈥淲ith other songs, you might hear a surge in volume at the onset, or emphasis on a particular word,鈥� Bainbridge says. 鈥淲ith dance songs, you need to have something that each listener can reliably track so they can move to the beat. And love songs can be quite all over the place, with really dramatic jumps and volumes. But with lullabies, you don鈥檛 want to startle the infant, so generally there鈥檚 a nice, gliding melody and their rhythm is very smooth.鈥�

The Natural History of Song鈥檚 ethnographic record indicates that lullabies are a vocal form of music, as opposed to being primarily instrumental.

鈥淭his is pure speculation at this point,鈥� Bainbridge says, 鈥渂ut I would imagine that because it lacks human touch, instrumental music wouldn鈥檛 be such a signal that there鈥檚 caregiving or safety available. As adults we all experience that there are some songs that get us hyped up or songs that soothe us, so I imagine there鈥檚 at least a little of that effect. But I imagine the human touch figures in (to lullabies鈥� soothing quality).鈥�

The researchers are looking at whether there is a health benefit to lullabies and whether training parents to sing more lullabies and introduce more music into the home might translate long term to having better health outcomes for both parent and child.

They鈥檙e also investigating whether lullabies foster a child鈥檚 social intuitions relating to caregivers. If the child sees an adult singing to a different infant, will they look to that caregiver to attend to them when they get upset, or would they perceive another adult as equally likely to come take care of them?

Again, this inquiry goes to the evolutionary function of music. If it is a universal language 鈥� and it sure seems to be鈥攖he message of lullabies the world over is some version of, 鈥淵ou can wind down now and close those baby eyes of yours. I got you, Boo.鈥�

One might think a life鈥檚 work focused on ending humans鈥� inhumanity to other humans arose out of a place of sweetness and light, born of loving kindness. But no.

鈥淚t was born out of rage,鈥� Gordon says. 鈥淚t was born because I swore and cried from frustration at the generational violence I was encountering.鈥�

Prior to the time of this pound-the-steering-wheel moment, Gordon had been working as a kindergarten teacher in Toronto. In that role, she saw firsthand high levels of domestic violence and child abuse, and knew intimately the damage already done to children before they even got to kindergarten.

Children came into her classroom 鈥渨earing their wounds in their behavior,鈥� she says. Learning was hard for them, as was simply getting along with their classmates. From the day they were born, these children were swimming upstream, and the idea that a child鈥檚 circumstances at birth would determine their destiny was an idea she found 鈥渧icious and unfair.鈥�

In working to address the violence, she realized that the common thread in all that suffering, the common denominator of violence, aggression and cruelty of all kinds, is the absence of empathy. Her first social innovation (1996) was to start Canada鈥檚 first Parenting Centers in schools, which later became public policy, to coach young parents in what babies and young children needed.

One day, she visited the illegal boarding house where one of her young moms lived. The young woman came to the door with her face bruised, her eyebrow gashed where her boyfriend had punched her glasses into her eye and her new little baby girl in her arms. Another little girl, a toddler, clung to her mother鈥檚 leg.

鈥淚 felt such despair when I saw that and cried from frustration all the way home, knowing that these little girls and this young woman deserved so much more. But her mother had been abused 鈥� and we know that story, right? I decided on the way home, 鈥極K, I鈥檓 going to break this intergenerational cycle and bring the attachment relationship to school so those two little girls and every other little person who goes to school will have an opportunity to see one version of love.鈥欌��

鈥淭here鈥檚 no one right way to be a parent, but children know when they鈥檙e in the presence of love,鈥� Gordon says. 鈥淚 wanted to put another track down in children鈥檚 brains of what was possible.鈥�

Gordon describes the attachment relationship 鈥� the child鈥檚 first deep connection to a significant, reliable person 鈥� as the 鈥渟ecret sauce鈥� in being able to create a more caring, empathetic world. The roots of empathy, the realization of human potential 鈥� all that we wish for in the world 鈥� are in this first relationship, she writes in 鈥�.鈥�

In these times especially, Gordon says, there is a yearning for empathy because our common humanity is the connection we need most during fraught times. It can鈥檛 be taught, but neuroscience tells us empathy can be caught.

鈥淲hen you are immersed in an experience where mirror neurons can be at play and you can see, feel, hear, maybe even touch a demonstration of empathy or kindness, you have the capacity to develop that same empathy in your own brain,鈥� Gordon says. She set about developing a novel way to expose children to the contagion of empathy and turned to humanity鈥檚 best little professors in graduate-level openheartedness: babies.

At the heart of the program, designed for children from kindergarten age to high school age, and its younger sibling, , for 3- to 5-year-olds in early learning settings, is a baby. Babies love without borders or definitions, Gordon says, and they respond intuitively to love, which makes them perfect transmitters of empathy.

Here鈥檚 how it works. The 2- to 4-month-old infant and parent, chosen from the community, visit the classroom every three weeks over a school year along with a Roots of Empathy instructor who coaches the children to observe the baby鈥檚 development and identify the baby鈥檚 feelings. The vulnerable baby is the 鈥渢eacher鈥� (and wears a little tee shirt that says so), the parent is the 鈥渆xpert,鈥� the ROE instructor is the coach and the children are the 鈥渃hangers,鈥� learning the vocabulary of feelings and developing the capacity to recognize them in themselves and others.

Children who participate in the Roots of Empathy program sometimes are seeing a loving parent-child relationship for the first time, says Mary Gordon, the program鈥檚 founder. She tells of one boy who had been in foster care for years and more group homes than he could count, after having seen his mother murdered in front of him when he was 4.

He was in eighth grade, trying hard to appear aloof and unaffected, cultivating as much of a dangerous look as he could manage, with a shaved head, a ponytail on top and a tattoo at the base of his skull.

鈥淚f you don鈥檛 have a word for something,鈥� Gordon says, 鈥測ou can鈥檛 think of it. We give the children a language for their feelings and also real, relaxed, supportive opportunities over a whole school year to relate to the feelings of the baby, to anchor that awareness in themselves. And we have a dialogue over the whole year about recognizing those feelings in their friends.鈥�

The babies are chosen not by the education level of the mothers or by socioeconomics, but through a home visit to orient the parent to the program and to make sure that the parent and child manifest a secure attachment. For some children in the program, this is the first such parent-child bond they鈥檝e ever encountered.

The program鈥檚 core includes neuroscience, in which the children learn that love grows brains. Rather than being told this, the children can see for themselves how the baby lights up at the parent鈥檚 empathic, nurturing interactions with the infant. Another element at the core is the children鈥檚 exploration of the baby鈥檚 temperament. As they move from observing the baby鈥檚 temperament to a discussion of their own, they begin to understand that their classmates and even their parents will have different emotional reactions to situations.

鈥淚t鈥檚 sad to me, but teachers don鈥檛 really know this work about temperament,鈥� Gordon says. 鈥淥ne of the workshops I give most around the world is on temperaments, explaining to teachers that not all of the little people in their class can sit at a desk for an hour at a time, and if you understand where they鈥檙e coming from, you can help them get with the game.鈥�

Central to Roots of Empathy is the development of a vocabulary for feelings, so that the children learn to use art, music, storytelling or other means to communicate, 鈥淚 feel sad鈥� or 鈥淚 feel so angry,鈥� rather than striking out or hiding away. The children learn the principle of authentic communication, meaning that the adults in the program honestly reveal their feelings and don鈥檛 ask questions to which they already know the answers.

鈥淥ur instructors don鈥檛 judge or say, 鈥楪ood answer, Johnny.鈥� And they never ask the child whose hand shoots up first to share 鈥� they wait for the seventh person,鈥� she says. 鈥淲e aren鈥檛 rewarding being able to quickly get your brain and mouth in gear. We want children to genuinely have something to say when they put up their hand and not answer to get an adult to acknowledge them. We want them to consider what they鈥檙e saying and then acknowledge themselves.鈥�

Roots of Empathy is grounded in social inclusion, recognizing that every human has a deep need to be heard, seen and to belong. The program creates an environment where everyone has a voice, where children break down barriers and where the classrooms become a microcosm of democracy and collaboration.

鈥淲hat we have seen all over the world where we have offered our programs is a reduction in aggression, violence and bullying,鈥� Gordon says. 鈥淲e have rock solid international research that supports that and tons of anecdotal evidence.鈥� The Roots of Empathy classroom is creating children with empathic ethics and a sense of responsibility to each other, she says 鈥� citizens of the world.

Roots of Empathy began with a pilot in Toronto, Ontario, in 1996, and has expanded to every province in Canada and 13 other countries, and is delivered in seven languages. In Canada, it is funded under the umbrella of mental health, social and emotional learning or bullying prevention. In Canada and in New Zealand, the program is doing deep work with indigenous people, trying to undo some of the damage done by decades of colonization and neglect. Throughout the world, funding comes from various sources 鈥� foundations, philanthropists and government entities. Funding in the U.S. is a challenge, she says, as is finding families with sufficient family leave time to be able to bring their babies into the program.

鈥淚t’s not so hard, really, to develop empathy in children,鈥� she says. 鈥淚t’s not so hard to eliminate cruelty of all kinds, which includes violence and bullying. It’s not hard. We’ve done it. What is hard, is to get the commitment that you care about that.鈥�

Among African American mothers and babies, the crisis is even more acute. Across the income spectrum, from all walks of life and all levels of education, Black women die from preventable pregnancy-related complications at three to four times the rate of non-Hispanic white women. The death rate for Black babies is twice that of infants born to non-Hispanic white mothers.

The (CAP) reports that African American mothers are twice as likely to have an infant who dies by the baby鈥檚 first birthday, and are twice as likely to experience life-threatening pregnancy-related complications known as severe maternal morbidity (SMM), compared with non-Hispanic white women. Although other women of color 鈥� notably American Indian, Alaska Native and some Latina communities 鈥� also experience an appalling increased risk of poor outcomes, data show that racial disparities between Black women and non-Hispanic white women are the most glaring.

In the U.S., a pregnant woman鈥檚 health, her baby鈥檚 ability to thrive, survive and even her own chance at life, depend to large degree on her race and geography, says , senior policy analyst for early childhood policy at CAP. An CAP released late last year analyzed vast racial disparities state-by-state in infant health outcomes throughout the nation in both infant mortality and low weight birth.

鈥淎s more research has come out over the years, one thing becoming increasingly evident is that these disparities in maternal and infant mortality are mostly rooted in racism,鈥� says Novoa, who authored the issue brief for the report. 鈥淭he reason we can say this is that, even when you control for social-economic status, education or access to resources, all those factors, we still see that Black women and infants have worse health outcomes on average.鈥� Racism 鈥� not race itself 鈥� and the systemic barriers fueled by both explicit and implicit bias are the drivers of these outcomes, she says. Structural racism compromises health.

In CAP鈥檚 state-by-state analysis, geographic disparities are stark; racial disparities are starker. For example, white babies born in New Jersey die at a rate of 3.4 deaths per 1,000 births, which is comparable to Germany鈥檚 infant mortality rate. But Black babies born in Wisconsin are dying at nearly five times this rate: 15 deaths per 1,000 births 鈥� a rate higher than that of Syria. With , users can explore the infant mortality rate and the percentage of babies born at low birth rate by race, ethnicity and state to see where and for whom the infant health crisis is most severe. Available data show estimates for five demographic groups: white, Black or African American, Hispanic, Asian or Pacific Islander, and American Indian or Alaska Native, and users can compare two groups to see how outcomes differ by race and ethnicity across states, except in some states where the sample sizes were too small to yield precise estimates.

What Birth Weight Really Measures

A baby鈥檚 weight at birth is a major determinant of their chance at surviving and thriving in life. Low birthweight is defined as when a baby is born weighing less than 5 pounds 8 ounces; babies are considered premature if they are born before 37 weeks鈥� gestation. Though some low birthweight babies are healthy, and some are born small because their parents are, many others have serious short-term health problems that need treatment, such as trouble eating, gaining weight, staying warm enough and fighting off infections. Low birthweight babies can have breathing difficulties and later development difficulties. Again, in the U.S., race has a distinct impact on an infant鈥檚 birth weight, with nearly twice as many Black infants being born at a low birth weight as non-Hispanic white babies.

, a pediatrician and senior fellow for the , stresses that low birth weight in itself is neither a death knell nor destiny. With plenty of medical, family, nutritional and other supports, underweight and premature babies can recover and thrive, particularly given the almost miraculous developments in recent years in neonatal care. But when that preventive care and those needed interventions don鈥檛 come into play, he says, the result can be a dangerous vulnerability that affects brain development, brain function and a variety of physical issues for the child鈥檚 lifetime.

鈥淯nfortunately,鈥� he says, 鈥渨hen a small, premature baby is born into an environment of stress and poverty, we have 鈥榙ouble jeopardy.鈥欌�� If you have low birth weight and, simultaneously, a context of, poverty, family stress, discrimination, insecurity and insufficient nurture, then unfortunately, that double jeopardy grows exponentially 鈥� 1 + 1 = many more than 2 鈥� meaning it鈥檚 additive into future vulnerabilities. The majority of time, if the environment is strong, supportive, simulating, safe and secure, there鈥檚 a lot of natural recovery, resilience and healing capacity for a low birthweight baby. But that鈥檚 not the usual story.

鈥淎nd then, unfortunately as this vulnerable child does not experience a strong and supportive environment of relationships, their development falls off its trajectory and is increasingly more difficult to bring back on track,鈥� Willis says.听 鈥淚n our current culture, once a child falls start falling off track, there are too many forces, attitudes and belief structures that make it very hard to recover 鈥� not the least of which is often insufficient treatment services. If you have a 4-year-old child who is struggling, has trouble paying attention because his environment is stressed and there鈥檚 not been enough attention to nurturance and building essential capacities, the stressed and unsupported child may start 鈥榓cting out鈥� in pre-school and get kicked out. And that begins a spiral toward greater and ongoing difficulties. From the family standpoint, they鈥檙e worried about his/her future. From the child鈥檚 standpoint, he is developing his behavioral and social habits and patterns of being. And from the teacher and environment, the child is a problem 鈥� and now you鈥檙e off to the races. The bad-kid track.鈥�

The Costs of Low Birth Weight and Prematurity

The societal costs of premature birth are substantial, but those dry numbers can鈥檛 capture the devastation low birth weight and prematurity bring to babies, mothers and families. For every baby who fails to thrive, there is a mother who experiences the stress of dealing with a child in precarious circumstances or a father and extended family that have to deal with getting time off to care for the mother and child and the multiple layers of worry, stress and economic hardship that can involve.

鈥淭hese young infants may have to spend significant amounts of time in the neonatal intensive care unit (NICU), and that鈥檚 costly,鈥� Novoa says. 鈥淚t鈥檚 financially costly for the healthcare system. It鈥檚 also costly on a micro level for individual families. Parents with newborns in the NICU often want to be with their baby at the hospital, but many parents have to go back to work right away because they don鈥檛 have paid time off of work. Even parents with paid leave often burn through it and have to take unpaid leave or go back to work sooner than they鈥檇 like. In either case, financial and job-related stress can compound the emotional stress鈥攊ncluding sadness, guilt, fear鈥攖hat parents experience when they have a preterm or low-weight baby.鈥�

Again, the load of stress weighs especially heavily on Black women and women of color, according to the CAP report. The stress isn鈥檛 garden-variety worry, Novoa says. It鈥檚 a physiological burden of emotional and mental anguish, decades of bracing for fight-or-flight from the tigers of economic hardship and psychosocial adversity that create a form of premature aging called 鈥渨eathering鈥� that increases Black mothers鈥� susceptibility to numerous negative health outcomes. Being devalued on a daily basis quite literally wears a person out.

Addressing the Disparities

But just because this is the current state of affairs throughout the U.S., Novoa says, doesn鈥檛 mean it has to be. The interactive report shows the steps various states have taken to improve infant health on three interrelated domains: healthy families, economic and work supports and infant health outcomes. Addressing the infant-maternal health crisis in the U.S. is an all-hands-on-deck moment, she says, and will take a variety of approaches. But the improvements observable in states that have made policy changes show that implementing evidence-based policies and investing in family support programs can go far in ensuring that all infants have the opportunity to thrive.

鈥淲e know addressing these disparities is something that will require changes to our current healthcare policy,鈥� Novoa says. 鈥淲e also have to think expansively about what we are doing to support families and parents better beyond healthcare. We want to talk about the opportunities the states have to do things better, not just about what鈥檚 wrong. Each state has room for improvement and most states are doing something well. Louisiana, for example, has expanded Medicaid, and it has a modest, refundable to help low income families. So even though a state may not have great health outcomes yet, there is a glimmer of hope that some state policymakers have taken appropriate, right action on this.鈥�

Avoiding the Good-Bad Paradigm

A pitfall in looking at how dire the situation is would be to fall into a right-wrong, good-guys/bad-guys view of the situation, both experts say. The CAP created the interactive report as a tool to help citizens and political leaders see the gaps and where improved policies can have an effect.

鈥淪olving this will take an any-and-all-in approach,鈥� Novoa says. 鈥淲e鈥檙e encouraged to see how this information is gaining momentum at both the federal and state level. I鈥檝e been working on this issue for a few years and it鈥檚 heartening to see the attention that policymakers are paying to these issues since I鈥檝e started.鈥�

Just the fact that we are having the conversation now is encouraging news, Willis says. 鈥淲e鈥檙e talking out loud at many, many levels about the realities of structural racism that have been the foundation of this country and are still disruptive to child flourishing.

鈥淭here are some policymakers and the public who appear not to care about the challenges of so many families. This segment of society believe that people create their own destinies and believe that national and state polices best support self-determination. But knowledge from the research is building about the impact of poverty on health and wellbeing and the effect of racism on health outcomes 鈥� and this means impacts on the economic and workforce of the future for our country. The youth in this county seem to have a stronger sense of equity and the importance of supporting the wellbeing of all.听 They see that building the capacity of our next generations for our nation鈥檚 economic vitality is essential and I鈥檓 hopeful we鈥檒l see major shifts soon in social policy.

鈥淭he situation we鈥檙e facing is tragic,鈥� he says, 鈥渂ut it is also full of hope and opportunity. We know the forces that drive both vulnerability and resiliency. But we also know how to assure the wellbeing of all young children. Now we have to do it at a scale that meets the challenge. I find that thrilling for the future.鈥�

For other mothers, though, the feelings of sadness, exhaustion and anxiety run much deeper and can overtake the woman鈥檚 ability to care for herself or her family. This deep level of stress has a medical diagnosis 鈥� postpartum depression (PPD) 鈥� and it is treatable: Medical guidelines recommend counseling and possibly antidepressants for all women experiencing it. Untreated, PPD can have serious consequences for both mother and child and can even spiral into psychosis where the mother may be a danger to herself or her baby.

Medical treatment recommendations don鈥檛 matter if women suffering PPD never receive that diagnosis, are not able to access care or are constrained from seeking help by culture and family standards 鈥� as is particularly the case for African American and low-income mothers.

About one in seven women in the U.S. develops postpartum depression, or about 15% of American women. For Black women, the risk is much greater, says Dr. Joia Crear-Perry, an OB/GYN who is the founder and president of the , dedicated to eliminating racial disparities in birth outcomes and a co-founder of .

鈥淔or Black women, the risk is almost twice that 鈥� and that鈥檚 just the people we know about,鈥� Crear-Perry says.

For Black women dealing with PPD, seeking help can be particularly fraught with cultural and familial expectations, she says. The Strong Black Woman ethos has served African American women for many generations, describing and affirming the fortitude they鈥檝e needed to prevail in the face of countless challenges. When it comes to childbirth, however, that same strength-based identity can isolate a woman just at the moment she needs the most support, authenticity and connection.

Postpartum depression is not caused by something the mother is doing or failing to do. Though the causes are not entirely clear, the mood disorder likely results from a combination of physical and emotional factors. Chemical changes take place in a woman鈥檚 brain after childbirth as hormone levels drop drastically. This chemical seesaw creates mood swings that can set everything in the mother鈥檚 life off balance. Fragmented sleep is a major contributor to postpartum depression 鈥� from getting up every two hours to feed the baby to chemical changes in the mother that keep her brain so revved up sleep becomes impossible. The result can be an unrelenting exhaustion that feeds on itself and creates a dangerous downward spiral.

鈥淭here is a lot of shaming and stigma around mental health,鈥� Crear-Perry says, 鈥渁nd a great deal of stigma about being seen as weak for having to ask for help. We鈥檙e supposed to be able to take care of our families, to keep it together and keep marching, right?鈥�

Overcoming that internal and external judgment can feel out of reach to depressed mothers, and even their best intentions can be thwarted by knowing implicitly if not explicitly that as a woman of color, the cards are stacked against her. According to the , women in the U.S. are more likely to die from childbirth or other pregnancy-related complications compared to women in other developed countries. The data show that Black women are three to four times more likely to die from pregnancy-related death than their non-Hispanic white counterparts, and research shows that half of these deaths 鈥� primarily from hemorrhage and hypertension 鈥� are preventable. Pregnant Black women are to be murdered by their intimate partners than white women. And according to the National Institutes of Health, Black mothers are several times more likely to suffer from PPD but less likely to receive treatment and follow-up.

鈥淭o be clear,鈥� says Crear-Perry, 鈥渢hose statistics aren鈥檛 because of physiological differences. Being Black isn鈥檛 a risk factor for illness, death and depression 鈥� being exposed to racial bias is the risk factor.鈥�

According to the , this bias disproportionately affects the quality of care mothers receive during childbirth; research has shown that doctors spend less time with Black patients and the care Black mothers receive is less effective. Providers are less likely to believe Black women鈥檚 self-reporting of pain and support their breastfeeding, and more likely to ignore their symptoms and dismiss their complaints. Education, socioeconomic status and even fame offer no protection from the bias Black women encounter, demonstrated by high-profile stories such as tennis superstar health catastrophe and the death of Shalon Irving, an epidemiologist at the Center for Disease Control and Prevention.

The reports that Black women were less likely than white women to initiate mental health care after delivery and more likely to put off seeking treatment longer after the child鈥檚 birth. Early detection and treatment can reduce the negative impacts of the illness, but even in that regard, Black women who started treatment were less likely to receive follow-up or continued care compared with white women who initiated treatment. The study reported that Black women generally preferred psychotherapy over taking antidepressants, but for many, getting psychological services can be nearly impossible because states are not required to offer those benefits in their Medicaid plans.

Some African American women suffer in silence because they are afraid of being reported to child protective services if they admit that they are having trouble caring for their children. There鈥檚 reason for worry: Numerous studies have shown that child welfare workers are more likely to deem Black mothers unfit to care for their own children and to recommend that the children be removed from their home. According to Child Welfare, two Texas studies found that while Black families on average tended to be assessed with lower risk scores, they were 20% more likely to have their case opened for services, and 77% more likely to have their children removed instead of being provided with family-based safety services.

鈥淪o, if you鈥檙e worried about someone taking your baby from you and about not being listened to by your doctors and all these other concerns, that makes you even more depressed, right?鈥� says Crear-Perry. 鈥淓specially if you鈥檙e substance abusing and need help, you worry about trying to get treatment because they鈥檒l take your baby.鈥� Small wonder that fewer than 15% of African American woman with PPD seek professional care.

Altering this complex situation will take nothing less than a transformation of multiple systems in U.S. society 鈥� medical, social and political 鈥� and a number of non-profits and professional groups are working toward those ends. In the meantime, Crear-Perry says two of the most effective solutions are deeply rooted both in culture and in history: midwives and .

鈥淐hildbirth is not a medical phenomenon,鈥� she says. 鈥淚t has been medicalized, but prior to it becoming white men anesthetizing you and pulling the baby out with forceps, it was indigenous. Even if the role wasn鈥檛 called a 鈥榙oula,鈥� there was someone to care for the mother and support her throughout her pregnancy and birth.

鈥淲hen I first heard 鈥榙oula,鈥� it was from a wealthy friend who was pregnant, and I saw it as a thing for rich people. But when you understand what a doula actually provides, doesn鈥檛 everybody deserve that support, that person to watch out for them?鈥�

According to , some research shows that one of the greatest triggers for depression is a significant deviation between what a woman expects or plans and what actually happens 鈥� whether an unplanned C-section, complications at delivery, a baby with medical issues or difficulties with breastfeeding鈥攑articularly with those mothers who do not have support. Supporting the mother through the anticipated and the unforeseen is the work of the doula; caring for mother in a highly individualized way has always been the work of the midwife. Helping the mother get set up for successful breastfeeding is the work of both.

鈥淔or Black mothers,鈥� Crear-Perry says, 鈥渕idwives and doulas aren鈥檛 a luxury, they鈥檙e the fix.鈥�

Although it sounds like a sweet job almost anyone could enjoy, being a toy waver in this context is actually a tricky task involving significant training, according to Dr. Sarah Lytle, I-LABS鈥� Director of the Outreach and Education division.

The toy waver keeps infants鈥� and toddlers鈥� attention while they sit for as long as possible in one of the most technologically advanced brain-imaging devices in the world, specifically modified to scan the brains of the youngest humans. As the baby focuses on the stuffed animal, soap bubbles or cloth Slinky the toy waver deploys, the lab鈥檚 magnetoencephalography, dubbed , silently measures minute changes in the electric field of the child鈥檚 brain 鈥� giving researchers a clear idea of how and when the child responds to various stimuli. The torrent of data these scans provide has given scientists鈥� unprecedented information particularly in relation to how human babies learn language and our practically endless capacity for statistics and computation.

I-LABS is the first lab in the world to put an awake baby in a MEG; it鈥檚 one of the only MEG devices used primarily for research with infants and toddlers. One of the key features of this MEG is that it鈥檚 noiseless, which, as any adult who has endured an MRI can affirm, is a huge plus. Because the machine measures minuscule alterations in the magnetic field, the room has to be free of metal 鈥� requirements that combine to create a significant design challenge, Lytle says. Ultimately I-LABS purchased a MEG machine from Finland and re-engineered it somewhat to create a molded-plastic, hydraulic high-chair apparatus that operates silently and gives the babies room to move their heads so they don鈥檛 feel constrained or pinned down 鈥� a recipe for upset, as any parent can attest.

A little cap fitted with GPS sensors tells the machine where the baby鈥檚 head is located at all times so measurements can be adjusted instantly for head movements. The child鈥檚 parents watch from a waiting room where a video feed provides up-to-the minute feedback on the baby鈥檚 responses.

Then, the toy waver鈥檚 job really gets under way.

鈥淲e use noiseless toys that are interesting for a child,鈥� Lytle says, 鈥渂ut not so interesting that they want to reach out and grab the toy. Ideally, we keep the children in this sort of glazed-over state where data collection happens best. We have a short window of time with younger kids because of their tolerance level.鈥�

An especially important finding of this precise imaging technology has been that children apparently have no limit to their capacity for language learning, Lytle says. Researchers have suspected this for some time, she says, but seeing in real time how the baby鈥檚 brain responds to language learning provides the science-based evidence.

Further, she says, I-LABS researchers have discovered that learning multiple languages appears to help with cognitive flexibility, as the scans have revealed increased activity in the frontal lobes of children who are bilingual. The frontal lobe is the area of the brain responsible for higher-order thinking skills, which scientists refer to as 鈥渆xecutive functions鈥� 鈥� tasks like inhibition and activation of actions.

鈥淎 bilingual child gets natural practice with these skills as they toggle back and forth between each of the languages in their lives,鈥� Lytle says. 鈥淔or instance, if Mom is speaking to you in Spanish, you need to activate your Spanish response and inhibit your English response, and if your teacher is speaking to you in English, you need to activate English and inhibit Spanish.

鈥淎 child who has greater cognitive flexibility is going to be the one who waits with their hand raised to be called on instead of blurting out the answer, because they have that impulse control. They might be better at switching between the transition time in a classroom when they鈥檙e done with recess and have to go do math.鈥�

One inestimable value of the I-LABS鈥� MEG research has been that the lab has studied thousands of infants at different ages and have created maps of babies and toddlers鈥� brains, which provides a collection of brain atlases of data-based information about the functional area of the brain signals are coming from. I-LABS has made these atlases open source so any researcher anywhere in the world can have unprecedented access to data that shows what鈥檚 going on in those brilliant baby brains.

As co-director of the at the University of Washington, Kuhl holds the Bezos Family Foundation Endowed Chair for Early Childhood Learning and is an internationally recognized authority on early language and brain development. She is also an enthusiastic believer in the brilliance of babies, with plenty of scientific data to back her up.

鈥淣o computer, no matter how sophisticated, can do what a baby can do in listening to language input and deriving the words, grammar and the sound contrasts that create language,鈥� she says. 鈥淣o artificial intelligence in the world has been able to do that so far.鈥�

Thanks to the University of Washington I-LAB鈥檚 magnetoencephalography (MEG) brain-imaging machine, a one-of-a-kind mechanical tour de force, researchers have been able to scan babies鈥� brains in a way that is safe, noninvasive and silent to pick up with millimeter accuracy the magnetic fields that respond as a baby is listening and learning. It is the first machine in the world able to record babies鈥� brain imaging as they are learning, providing what Kuhl calls a 鈥渢sunami of data鈥� about what鈥檚 going on in their brains.

Long before a baby can understand a single word, their brains are crunching statistics to sort out the frequency with which a particular sound occurs. Babies start out as 鈥渃itizens of the world,鈥� Kuhl says, able to distinguish all the sounds associated with human language from background noise no matter what country or what language they encounter. At six to eight months, the brain scans of babies throughout the world light up equally in response to all human language sounds. About two months later, an incredible shift occurs: babies begin to ignite only to the languages around them to the exclusion of other languages. If the language in the baby鈥檚 environment is Japanese, for example, their brain scans will show no response to English Rs and Ls. But if the language in their world is English, multiple areas of their brains will light up in response to the abundance of Rs and Ls they hear. By 10 months, she says, a trained ear can hear that Chinese babies are babbling differently from the French babies who are babbling differently from the American infants.

Babies鈥� brains are not automatons though, Kuhl says, and this rich learning only happens when the input comes from social interaction with other human beings.

鈥淥ur studies contrasted a foreign language tutor, who spoke either Mandarin or Spanish, with the exact same material presented over a DVD,鈥� she says. 鈥淭he babies crawl up to the television and watch it. But the tests afterwards that measure learning demonstrated that those watching TV (or listening to an audio recording) learned nothing. They were just like the control (subjects) who had only listened to English.鈥�

The only group of babies who actually learned were listening and interacting with a person, which lit up their brain scans in ways that showed that they were 鈥渟ocially electrified, watching everything that was going on and learning like crazy,鈥� Kuhl says.

The takeaway is that the brain鈥檚 statistical learning is only part of the language equation. Those statistical processes launch when babies are engaged with a social 鈥渙ther,鈥� she says. The human mind is hard-wired to pick out patterns, and babies need social interaction to put those patterns in context, to receive the smiles and nods and reinforcement that say, 鈥淵es, you鈥檙e really onto something with that 鈥榖a ba鈥� thing.鈥�

Some parents think that because their babies aren鈥檛 saying words yet, the parents don鈥檛 need to talk to them, but precisely the opposite is true, Kuhl says. The brain is waiting for the back-and-forth that helps it sort language out of the sound soup that surrounds the baby. And that call-and-response not only activates the auditory centers in their brain but the areas that involve motor response, which indicates that even before the baby can talk, engaging with people speaking to them activates the motor centers that will be needed for response once the child鈥檚 vocal mechanism develops enough to form words.

A third, equally important, finding in Kuhl鈥檚 research is the particular way in which parents and caregivers speak with their babies.

Researchers call the speech pattern 鈥減arentese,鈥� and it is distinctly different from baby talk 鈥� not 鈥淯m鈥檚 a widdle cutie patootie,鈥� but 鈥淚s that a ball? Is it a red ball?鈥� Parentese is a grammatically simple, here-and-now vocabulary that is slow and deliberate, with a singsong, upbeat tone that grabs the baby鈥檚 attention. As the child鈥檚 brain tries to map what sounds are happening most frequently, the 鈥渓inguistic units鈥� need to be clear. Parentese makes them clearer and cleaner.

As further evidence of babies鈥� sophisticated computational capacity, the researchers鈥� data show that babies in bilingual or even multilingual environments are learning those languages, too. As long as the input is happening and social interaction is present, Kuhl says, babies can hear Mom speaking one language, Dad speaking another and even Grandma speaking a third and their brains keep learning the sounds, words and grammar of the additional languages, with no confusion and no slow-down on the developmental timeline.

Plainly, Kuhl says, the U.S. needs to start teaching foreign languages much, much earlier 鈥� before the first birthday, if other languages are to be natural for the child.

With this incredible human gift of language comes great responsibility, Kuhl says. A baby鈥檚 mind-boggling on-board computer isn鈥檛 a turn-key operation: It needs deliberate language input, stimulation and interaction, early and often. Experience builds the brain.

鈥淚t鈥檚 not as though you just birth the baby, turn it on like a Christmas tree and it鈥檚 done,鈥� she says. 鈥淣o computer in the world can learn like a baby, but that comes with a responsibility for the adults in the culture to provide the social, cognitive and linguistic world that brain needs.鈥�

Disclosure: The Bezos Family Foundation provides financial support for Early Learning Nation.

It鈥檚 one thing to say, 鈥淐hildren are our future.鈥� It鈥檚 another to be guided by this statement to take action and marshal resources to create the emotional, educational and financial infrastructure that supports children in getting what they need to succeed in life. A nation deeply connected with the reality that its future belongs to its children would prioritize the resources that help families provide a solid foundation for their babies and young children.

So how is the United States serving its 12 million infants and toddlers? For the first time, a careful, in-depth state-by-state report card answers that question in unambiguous detail. The State of Babies Yearbook: 2019, a collaborative effort between and , is a first-of-its-kind resource that provides a state-by-state snapshot of how babies and their families are doing. Backed by Child Trends鈥� analysis of 60 population-based metrics, the The State of Babies Yearbook reports on each state鈥檚 individual data to provide lawmakers, families and advocates the reliable data needed to craft policy that addresses actual needs rather than hunches or best guesses.

鈥淲e now have a really good picture across this country for what it鈥檚 like to be a baby,鈥� says Myra Jones-Taylor, chief policy officer for ZERO to THREE. 鈥淚t鈥檚 not necessarily a pleasant picture, not what we want to see for our young children. But this tool is not intended to be punitive or shaming; we hope it will galvanize people and have them spring into action to change these numbers. We hope that people feel a sense of urgency, then use this Yearbook as a roadmap for changing the picture.鈥�

One of the Yearbook鈥檚 most powerful revelations is that the state a baby is born in makes an outsized difference in the child鈥檚 chance for a strong start in life. Babies in every state face different circumstances that affect their development, but the unavoidable fact this report reveals is that inequality begins at birth for babies in the United States, and some states are doing much better than others at meeting the requirements for a strong start. Because low-income families rarely have the resources to move to a state with better resources, the child鈥檚 birth state becomes one of the greatest influences on the start that child will have in life.

Snapshot State-by-State

Research shows that babies鈥� brains grow fastest during their first three years than at any later point in their lifetimes, making connections that form the foundation upon which all later learning and development will rest. This brain development depends on multiple inputs, from relationships and social interactions to basic needs such as secure housing, having enough to eat and personal safety. The unrelenting stress of a precarious daily existence can keep a family from providing its infants and toddlers with the nurturing experiences they need to thrive.

The State of Babies Yearbook applies a tiered system that objectively measures these multiple inputs, reporting on progress related to good health, strong families and positive learning experiences. (Download the Yearbook from the website to see individual state profiles and a full list of indicators, definitions and sources.)

Rather than ranking states鈥� measures as worst-to-best, the Yearbook takes a more nuanced approach that ensures statistics that really count. States are tiered as, 鈥�Getting Started, Reaching Forward, Improving Outcomes or Working Effectively,鈥� and the categories that comprise those assessments provide a clear picture of what鈥檚 working and what could use more attention.

The approach to this system is strength-based, Jones-Taylor says, so advocates can see a meaningful assessment of each state鈥檚 situation while not slipping into hopelessness or despair.

鈥淭he fact is, no state is serving all infants and toddlers and their families perfectly,鈥� she says. 鈥淓ven the states in the top tiers have room to grow. Every state has a handful of areas where they can do better for babies.

鈥淥ne thing that has been so gratifying for our team is that the states in the lowest two tiers are really taking this to heart,鈥� she says. 鈥榃e鈥檙e seeing a lot of usage of the tool and people sharing it on social media. It鈥檚 clear that people are really using it, that it鈥檚 filling a void and is a tool people have been wanting to see for a long time.鈥�

So far, the Yearbook and related resources have been downloaded more than 9,500 times and has received almost 106,000 page views. ZERO to THREE posts about the Yearbook, most with the hashtag #stateofbabies, earned more than 1 million impressions, and tweets from others earned 1.4 million more.

Start Storytelling Early

Though some of the more challenging and entrenched issues can seem daunting 鈥� homelessness, violence, addiction 鈥� some remedies are close at hand and relatively simple.

鈥淥ne thing that really surprised me was the number of infants and toddlers who are being read to on a regular basis,鈥� Jones-Taylor says. 鈥淚t鈥檚 38% nationally, which means that the overwhelming majority of children are not being read to. And that number goes beyond the low-income figures, so it鈥檚 children along the economic spectrum.

鈥淭his is something that could change overnight in individual homes across the country. Some of the goals like Medicaid expansion, paid family leave or changing income eligibility for subsidies might feel like a bigger reach but changing reading practices in the home could start tonight if a parent is informed that it鈥檚 important.鈥�

Jones-Taylor said she thinks the failure to read to children arises primarily from a misperception that learning begins at 3 or at 5 or whenever the child starts school. Science has proven what many parents have already observed: learning begins at birth. Children are learning-and-wondering machines, eager for input.

鈥淭his is such a critical time for a child. Reading to them or telling stories to them helps the child form critical attachments and provides the foundation for strong early literacy and numeracy skills,鈥� she says. 鈥淪o that 38% is a number we really want to change 鈥� and we鈥檙e confident that it can.鈥�

Another improvement that has been shown unequivocally to make a difference in the lives and futures of children is Early Head Start, the gold standard in supporting infants, toddlers and their families, she says. The federal Early Head Start program was created to help mitigate the disparities caused by poverty by supporting the healthy development of expectant mothers, and low-income infants and toddlers. Unfortunately, only 7% of U.S. children who are eligible for the program now have access to it because of funding issues. If a state seeks relatively painless ways to improve the futures of its babies, Early Head Start would be a good place to begin.

Plainly, the United States has work to do in supporting its young children. The nation ranks 31^st for relative child poverty among 38 economically advanced countries, with the youngest people in America living disproportionately in low-income and poor families. One in four American babies lives in poverty; 21% live with a single parent and 9% live in households headed by their grandparents. More than 60% of mothers of infants and toddlers are in the work force.

The cultural mosaic that has always been this nation鈥檚 strength is evolving dramatically and, with more than half of babies in the U.S. now children of color, our future is certain to be more diverse than it has ever been. The research could not be clearer: the poverty and racial disparities young children in low-income families face cause notable differences in their access to resources and their chance at a solid foundation for the rest of their lives. A nation that hopes to remain creative, entrepreneurial and strong cannot afford to squander the potential of even one of these children, and the time to ensure their robust participation in its future is now. The path is clear and the State of Babies Yearbook: 2019 can show the way.