Economic security and the ability to meet basic needs is central to the well-being of every family. Financial and material hardship create instabilities in families with young children that can jeopardize babies’ development during their critical first 3 years and undermine lifelong development.
The economic and social impacts of COVID-19 have increased the incidence of material hardship and have deepened the need to support parents in nurturing the development of their young children. Families experiencing material hardship face substantial challenges in meeting their children’s basic needs and providing the stable physical environments required for optimal development. However, caring relationships with trusted caregivers can buffer babies’ exposure to adverse events and mitigate long-term negative effects.
How is Material Hardship Showing Up in the Lives of Vermont’s babies and families?
The selected set of State of Babies indicators below provides a pre-pandemic snapshot of families’ economic status, the specific areas in which they experience challenges meeting basic needs, the extent to which they have access to and are reached by existing policies; and offers a view of where your state’s policies currently address or can be expanded to further assist families in supporting their babies’ well-being. To deepen your understanding of how families’ experiences vary, select the + icon where it appears with an indicator to view the data by subgroup (race/ethnicity, income, and/or urbanicity).
Income
Poverty at an early age can be especially harmful, affecting later achievement and employment. Yet babies are the age group most likely to live in families with low income and in poverty. Prior to the COVID-19 pandemic, many of Vermont’s infants and toddlers lived in families that earned less than 200 percent of the FPL ($52,400 for a family of four in 2020), meaning they did not have the financial resources to make ends meet.
Challenges to Meeting Basic Needs
All babies need preventive care to support healthy development in the critical first three years, but families with low income often cannot afford or obtain health care. Infants and toddlers are also uniquely sensitive to challenges in their environments. Adversities experienced early in life, such as hunger or living in crowded housing, create stress that can undermine lifelong development.
Health Care Access & Affordability
Food/Nutrition
Housing
Economic Stability
Opportunities to Reduce Hardship through Supportive Policies
Babies benefit from unhurried time with their parents to form healthy attachments and parents benefit from family-friend employer policies that allow them the time to nurture and care for their children. Economic supports in the form of direct assistance, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Temporary Assistance for Needy Families (TANF) benefits, and tax credits are particularly critical for families with young children and directly contribute to lifting families out of poverty.
Which of the following policies are in place to assist parents in meeting their families’ needs?
Health Policies & Employer Leave Policies
State Tax Credits
- This is a new indication for the State of Babies Yearbook: 2023. The denominator is the total number of children ages 0-2. The numerator is the number of children ages 0-2 who live below 50 percent of the federal poverty line. For the State of Babies Yearbook: 2023 we report estimates using the 2021 ACS 1-year data because the Census
- This is a new indicator for the State of Babies Yearbook: 2023. The denominator is the total number of children ages 0-2 below the poverty line who live with at least one parent. The numerator is the number of children ages 0-2 below the poverty line who live with at least one parent who works full-time (at least 35 hours
- This is a new indicator for the State of Babies Yearbook: 2023. The denominator is the total number of children ages 0-2 who live with at least one parent. The numerator is the number of children ages 0-2 who live with at least one parent who works full-time (at least 35 hours a week, 50-52 weeks a year). We combined
- Exposure to unmanageable stress can interfere with the normal development of the body’s neurological, endocrine, and immune systems, leading to increased susceptibility to disease. Because their brains are developing rapidly, infants and toddlers are especially vulnerable, and the damage may be long-lasting. Survey items asked parents to indicate whether their child had ever experienced one or more of the following:
- The denominator is the total number of children ages 0-2. The numerator is those who live outside of metro areas. Metropolitan areas include central/principal cities, metro areas outside of central/principal cities, and metro areas with central/principal city status indeterminable. Non-metropolitan areas are areas outside of metropolitan areas. Cases whose metropolitan status is indeterminable or mixed are excluded from the urbanicity
- The denominator is the total number of children ages 0-2. The numerator is the number of children ages 0-2 with family incomes less than or equal to 150 percent of the state median income. In order to calculate the numerator, we took the following steps: a) obtained the state median incomes for 4-person families by state from the Low-Income Home
- The denominator is the total number of children ages 0-2. The numerator is the number of children ages 0-2 who live at or above 200 percent of the federal poverty line. For the State of Babies Yearbook: 2023 we report estimates using the 2021 ACS 1-year data because the Census Bureau did not release its standard 2020 ACS 1-year estimates
- The denominator is the total number of children ages 0-2. The numerator is the number of children ages 0-2 who live at or above 100 percent and below 200 percent of the federal poverty line. For the State of Babies Yearbook: 2023 we report estimates using the 2021 ACS 1-year data because the Census Bureau did not release its standard
- TThe denominator is the total number of children ages 0-2. The numerator is the number of children ages 0-2 who live below 100 percent of the federal poverty line. For the State of Babies Yearbook: 2023 we report estimates using the 2021 ACS 1-year data because the Census Bureau did not release its standard 2020 ACS 1-year estimates due to
- The denominator is the total number of children ages 0-2 below the poverty line who live with at least one parent. The numerator is the number of children ages 0-2 below the poverty line who live with only disconnected parents (i.e., parents who were not working in the past 12 months and were not working for a reason other than
- The denominator is the total number of children ages 0-2 who live with at least one parent. The numerator is the number of children ages 0-2 who live with only disconnected parents (i.e., parents who were not working in the past 12 months and were not working for a reason other than going to school). All residential parents must be
- The denominator is the number of children ages 0-2 who live with their mothers. The numerator is those whose mother is in the labor force (either employed or unemployed but looking for work). People in the armed forces are not in the universe for labor force participation. If there are two mothers in the household, the labor force participation of
- The denominator is the total number of children ages 0-2. The numerator is those who live in a household headed by their grandparent. Note that this classification is not mutually exclusive with other family structure categories. This indicator can be disaggregated by race/ethnicity, income, and urbanicity. Race/ethnicity: Race/ethnicity is reported by the survey respondent who is likely the child’s caregiver.
- The denominator is the total number of children ages 0-2. The numerator is those who have no parents present in their household. The definition of parent includes biological as well as social (step or adoptive) parents. This indicator can be disaggregated by race/ethnicity, income, and urbanicity. Race/ethnicity: Race/ethnicity is reported by the survey respondent who is likely the child’s caregiver.
- The denominator is the total number of children ages 0-2. The numerator is the number of children ages 0-2 who have one parent present in their household. The definition of parent includes biological as well as social (step or adoptive) parents. This indicator can be disaggregated by race/ethnicity, income, and urbanicity. Race/ethnicity: Race/ethnicity is reported by the survey respondent who
- The denominator is the total number of children ages 0-2. The numerator is those who have two parents present in their household. The definition of parent includes biological as well as social (step or adoptive) parents, and unmarried partners of a parent. Families with two same-sex parents present in the household are included as two-parent families. This indicator can be
- The denominator is the total population ages 0-2, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the non-Hispanic population of multiple races ages 0-2. Hispanic origin is considered an ethnicity, not a race, and Hispanic individuals may be of any race. The estimates are based on the 2020 Census; the Census Bureau adds births, subtracts deaths,
- The denominator is the total population ages 0-2, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the non-Hispanic Native Hawaiian and other Pacific Islander population ages 0-2. Hispanic origin is considered an ethnicity, not a race, and Hispanic individuals may be of any race. The estimates are based on the 2020 Census; the Census Bureau adds
- The denominator is the total population ages 0-2, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the non-Hispanic American Indian and Alaska Native population ages 0-2. Hispanic origin is considered an ethnicity, not a race, and Hispanic individuals may be of any race. The estimates are based on the 2020 Census; the Census Bureau adds births,
- The denominator is the total population ages 0-2, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the non-Hispanic Asian population ages 0-2. Hispanic origin is considered an ethnicity, not a race, and Hispanic individuals may be of any race. The estimates are based on the 2020 Census; the Census Bureau adds births, subtracts deaths, and adds
- The denominator is the total population ages 0-2, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the non-Hispanic Black population ages 0-2. Hispanic origin is considered an ethnicity, not a race, and Hispanic individuals may be of any race. The estimates are based on the 2020 Census; the Census Bureau adds births, subtracts deaths, and adds
- The denominator is the total population ages 0-2, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the non-Hispanic White population ages 0-2. Hispanic origin is considered an ethnicity, not a race, and Hispanic individuals may be of any race. The estimates are based on the 2020 Census; the Census Bureau adds births, subtracts deaths, and adds
- The denominator is the total population of all ages, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the Hispanic population ages 0-2. The estimates are based on the 2020 Census; the Census Bureau adds births, subtracts deaths, and adds net migration to the enumerated resident population from the 2020 Census. Source: U.S. Census Bureau, Population Division.
- TThe denominator is the total population of all ages, based on the Census Bureau’s vintage 2021 population estimates. The numerator is the population ages 0-2. The estimates are based on the 2020 Census; the Census Bureau adds births, subtracts deaths, and adds net migration to the enumerated resident population from the 2020 Census. Source: U.S. Census Bureau, Population Division. (2021).
- We use vintage 2021 population estimates for the number of infants and toddlers in the United States. The estimates are based on the 2020 Census; the Census Bureau adds births, subtracts deaths, and adds net migration to the enumerated resident population from the 2020 Census. Source: U.S. Census Bureau, Population Division. (2021). Annual state resident population estimates for 6 race
- Individual Family Service Plans (IFSPs) are early intervention plans for children, ages birth to three, who qualify under the Individuals with Disabilities Education Act (IDEA). The IFSP documents the child’s level of development, desired outcomes, and services to meet those goals. It is unique in that it uses a family-focused lens. This approach requires a partnership between the family and
- Early intervention services, also known as the Program for Infants and Toddlers with Disabilities, provide services for infants and toddlers with disabilities and their families. In some states, eligibility extends to those who are at risk for developing a disability. States’ eligibility criteria for early intervention services vary, as do the services they offer. The numerator is the cumulative number
- The federal Program for Infants and Toddlers with Disabilities, which is Part C of the Individuals with Disabilities Education Act (IDEA), is a grant program that aids states’ provision of early intervention services for infants and toddlers with disabilities, ages birth through 2 years. Under IDEA Part C, states provide services to children who are experiencing developmental delays, and children
- Developmental screening is an efficient, cost-effective way to identify potential health or behavioral problems. In primary health care settings, the most effective screening tools rely on parent-reported information. Children who get screened are more likely to have delays identified, be referred for early intervention, and be determined eligible for early intervention services. The American Academy of Pediatrics recommends that children
- Providing care for infants and toddlers is more expensive than for older children, because higher adult-child ratios are required, and additional costs are associated with maintaining appropriate hygiene around diapering, bottle feeding, bedding, and so on. Parents can pay more than $20,000 per year for center-based infant care, depending on where they live. The federal standard is that families should
- The federal Child Care and Development Fund (CCDF) is the primary source of financing for states’ child care subsidy programs. Within broad federal requirements, states set their own eligibility requirements. Even in the most generous states, however, various barriers (including waiting lists or frozen intake, high family copayments, and low reimbursement rates for care providers) restrict access to these programs.
- Higher-quality child care and early education has been found to benefit low-income children in promoting positive child development outcomes to a greater extent than their more affluent peers. In response to federal efforts to expand high-quality child care to more children, some states have begun to reimburse center-based child care for children receiving a child care subsidy at or above
- The Child Care and Development Block Grant (CCDBG) Act was signed in 2014, reauthorizing the Child Care and Development Fund (CCDF) program. CCDF is the primary federal funding source dedicated to helping low-income families pay for child care through child care subsidies, while also setting new requirements to improve child care quality across the country. Improving school readiness and promoting
- Families in every state need an income at least twice the federal poverty line to meet basic needs for food, housing, child care, transportation, and health care. In states with a lower income threshold for subsidy eligibility, families with an infant or toddler cannot afford child care without sacrificing other essentials. The National Women’s Law Center reports the income eligibility
- Early Head Start (EHS) is a comprehensive child development and family support program for infants, toddlers, and pregnant women in families experiencing poverty. Apart from family income, each EHS program sets its own eligibility criteria, targeting their services to best meet the needs of families and children in their community. Services may be delivered in centers, family child care homes,
- Reading is not the only way parents can promote their young child’s language development. Singing songs and telling stories are language-rich activities that are also typically rich in cultural traditions, thus contributing to a child’s positive identity. Important features of many songs and stories are repetition, internal structure, and multiple perspectives—all features that help children develop the skills that underlie
- Long before they are able to read, infants and toddlers develop literacy skills and an awareness of language. Since language development is fundamental to many areas of learning, skills developed early in life help set the stage for later school success. By reading aloud to their young children, parents help them acquire the skills they will need to be ready
- The quality of a child’s care and education depends on the care environment and the interactions that take place there. A professional credential can expose a teacher to a greater variety of knowledge and skills, which in turn benefit the classroom where the child spends most of the day. This indicator was not updated for the State of Babies Yearbook:
- The Child Care Development Fund (CCDF) program requires states to describe their standards for group sizes in their CCDF plans. Although each state has the ability to set their own standards for group size, the Office of the Administration for Children & Families (ACF) advises states to refer to the recommended standards in the Caring for Our Children: National Health
- One of the most important factors contributing to a child’s development is the care setting they are exposed to. The Child Care and Development Fund (CCDF) program requires states to develop a system for continuing professional development for teachers. Additionally, each state sets its own requirements around teacher qualifications. Teacher qualifications play a role in early childhood education quality and
- The Child Care Development Fund (CCDF) program requires states to describe their standards for child-to-provider ratios in their CCDF plans. Although each state has the ability to set their own standards for child-to-provider ratios, the Office of the Administration for Children & Families (ACF) advises states to refer to the recommended standards in the Caring for Our Children: National Health
- The federal Earned Income Tax Credit (EITC) is a federal tax credit for working people with low and moderate earnings. The EITC provides workers with a tax credit that is applied to some or all of a worker’s federal tax obligation, and thus can serve as a supplemental source of income. The EITC is currently targeted towards workers who are
- The Temporary Aid to Needy Families program (TANF) was designed to help families with low incomes with minor children by providing cash assistance, particularly while parents are seeking employment. However, states are allowed to spend TANF funds for a variety of other activities (for example, administrative costs, child care and pre-K programs, child welfare services, and work support activities) in
- The federal Child Tax Credit (CTC) is a federal program for parents with low and moderate earnings. For a child to be eligible, the parent must answer certain qualifying questions regarding the child’s age, relationship to the parent, support, dependency, citizenship, and residence. Because the CTC serves middle-income and most upper-middle income families, in addition to low- and moderate-income families,
- While the Family and Medical Leave Act provides unpaid sick leave for some employees, there is not a national paid sick leave policy. States, therefore, vary on provisions for paid sick leave. Paid sick leave may enable working parents to take care of sick children and provide them with routine medical care. For example, parents with access to paid sick
- In the absence of a federal paid family leave policy, states vary widely on if and how they require paid family leave. Family leave is used primarily to care for a newborn child, but also to meet other exceptional caregiving needs, such as for an older, disabled, or chronically ill relative, or a newly adopted child. In addition to economic
- Home visiting is a two-generation approach to serving the varied needs of families with an infant or toddler. Trained home visitors teach parents about milestones of early development and other appropriate expectations for very young children, and help parents promote good health and keep their homes safe for babies and toddlers, use effective parenting practices, and access additional resources within
- TThe U.S. Department of Health and Human Services recognizes four ways a young child can exit the child welfare system: through reunification with the parents or caregivers, legal adoption, placement with other relative(s), or through a placement with a non-relative legal guardian(s). Stability and permanency are crucial for children‘s wellbeing. The Adoption and Safe Families Act of 1997 (ASFA) was
- Unstable conditions at home can cause infants and toddlers to be placed in out-of-home care. The denominator is the number of infants and toddlers ages 0-2 in the population. The numerator is the number of infants and toddlers who were removed from home and placed in foster care. These indicators can be disaggregated by race/ethnicity. Classification of infants and toddlers
- Young children fare best when they experience stable and consistent caregiving. One stated goal of the child welfare system is to “ensure that every child and youth has a permanent family or family connection.” Multiple temporary placements, by contrast, can disrupt a young child’s sense of trust and security and contribute to emotional and behavioral problems. This indicator examines the
- Infants and toddlers are the age group most likely to suffer abuse and neglect, accounting for more than a quarter of all incidents that are formally substantiated. By far, the most prevalent form of maltreatment is neglect, defined as “the absence of sufficient attention, responsiveness, and protection that are appropriate to the ages and needs of a child.” Child maltreatment
- How families cope with challenges can make a difference in their overall well-being. Children who learn that families can solve problems together, participate in decision-making, and reduce conflict gain valuable skills related to planning, communication, managing emotions, and optimism that can improve their chances of being resilient when encountering their own challenges. The denominator is children ages 0-2. The numerator
- A lack of sufficient nutritious food is associated with a number of serious health, behavior, and cognitive deficits in children. Children living with food insecurity have poorer health than children who are in food-secure households. Infants who experience food insecurity are more likely to perform poorly on tests of cognitive development. For infants and toddlers, even mild levels of food
- Living in neighborhoods that are unsafe can be a source of stress and may pose threats—through violence or pollutants—to physical well-being. Neighborhoods that are unsafe are associated with high rates of infant mortality and low birthweight, child abuse and neglect, and poor motor and social development among young children. Parents in these neighborhoods may restrict children’s opportunities for outdoor play
- Overcrowded living conditions can also be associated with negative outcomes. In homes where families are crowded, parents may have fewer opportunities to be adequately responsive to infants and toddlers, and more likely to use punitive discipline. Crowding has also been associated with children’s health problems, including respiratory conditions, injuries, and infectious diseases, and with young children’s food insecurity. The denominator
- The stability of housing—as measured by the frequency of residential moves—plays a role in young children’s well-being. Frequent moves can disrupt many aspects of families’ lives and have been linked to adverse health outcomes. High rates of moving may also be indicative of economic insecurity and parents’ tenuous hold on employment. The denominator is children ages 0-2. The numerator is
- The Temporary Aid to Needy Families program (TANF) was designed to help lower income families with minor children with cash assistance, particularly while parents are seeking employment. However, states are allowed to spend TANF funds for a variety of other activities (for example, administrative costs, child care and pre-K programs, child welfare services, and work support activities) in addition to
- Because young children’s social-emotional development is so critical to their present well-being, as well as their later success, an accurate assessment of their status in this area is important. To fully understand social-emotional development, health care providers should use an instrument that identifies young children at risk of behavioral health problems, specifically, not just a general developmental screening. This indicator
- Mental health concerns arising during the first years of life can develop into serious problems if not identified and treated promptly. Families with low incomes may not be able to afford these services unless they care covered by Medicaid. To provide more robust services, state Medicaid plans can cover infant and early childhood mental health (I-ECMH) services in any of
- Vaccines are important for infants and toddlers because many of the diseases vaccines prevent are more common, and more deadly, at this age. Vaccination protects not only the child who receives the vaccine, but also others in the child’s community, including those who, for health reasons, cannot be vaccinated. The Centers for Disease Control and Prevention (CDC) recommends four doses
- Preventive medical care (also known as “well-child care”) is a critical opportunity to detect a developmental delay or disability, so that early treatment can reduce its impact on both the child and family. Well-child visits also allow medical providers to promote behaviors conducive to healthy development, and to share advice with the parents of infants and toddlers. For example, physician
- Early childhood tooth decay can be damaging to developing primary teeth, and can negatively affect child oral health quality of life, increase experience of dental pain, and negatively impact school performance. The denominator is children ages 1-2. The numerator is children ages 1-2 who ever had one or more preventive dental visits. State of Babies Yearbook: 2023 estimates are based
- Children are much more likely to die during the first year of life than they are at older ages. Infant deaths can reflect underlying problems, such as barriers to accessing prenatal care, living in violent neighborhoods, or circumstances that challenge parents’ ability to adequately supervise their young children. They can also highlight inequities: for example, in access to health care
- Low birthweight (less than 5.5 pounds) is strongly associated with poor developmental outcomes, beginning in infancy but extending into adult life. Low weight is often associated with pre-term delivery, but can occur also with full-term births. Research points to a number of factors that can contribute to the likelihood of low weight at birth, including smoking during pregnancy; low weight
- Preterm births are the second leading cause of death among children younger than five. The percentage of babies born preterm can be reduced through early intervention. The most effective interventions at improving infant survival rates are those that support the pregnant parent right before, during, and after the pregnancy. These can ensure that complications often associated with preterm delivery, such
- Regular, periodic well-child visits during the first year of life are an opportune time to screen for parental depression, which can have detrimental effects on caregiving and the well-being of both the parent and the child. Recent federal guidance allows states to include screening for maternal depression as part of a well-child visit, and limited treatment for depressed mothers, within
- The Pregnancy Discrimination Act of 1978 (PDA) established a law for pregnant people to be treated and be provided with the same benefits as non-pregnant workers. Without these protections and accommodations set in place, many pregnant workers may find themselves having to leave their jobs or work under non-accommodating conditions (e.g., unable to sit or take rest). However, despite the
- The links between parental mental health—particularly depression—and child well-being are well established in research. The negative effects of maternal depression can begin prenatally. Parents who are depressed are less likely to engage in the kinds of reciprocal social interplay that is so important to the healthy development of infants and toddlers. Untreated depression in mothers or fathers is also associated
- Maternal mortality can be defined as the death of a parent that takes place during pregnancy, childbirth or post-partum. A parent’s death is detrimental to the development of the newborn child and poses a great hardship to the affected household. This indicator is available at the national level only because the CDC does not suggest comparing state-level estimates. The State
- Pregnant people who receive no prenatal care, or whose care begins only in the last trimester of pregnancy, are more likely to have infants with health problems. Pregnant people who do not receive prenatal care are three times more likely to give birth to a low-weight baby, and their baby is five times more likely to die. In addition to
- The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal grant program that provides access to food, nutrition information, and health care referrals to women and children, from pregnancy through the time the child reaches the age of five years. A woman’s or child’s eligibility to participate in WIC is based on the caregiver’s income, as
- While obesity is not typically measured among very young children, it is important to monitor infant and child growth over time and identify any abnormalities in the child’s development that may arise. The American Academy of Pediatrics recommends using the weight-for-length growth standards to assess the nutritional status of children younger than two. These standards have been recognized internationally in
- Breastfeeding conveys advantages to both infants and their mothers. For young children, breastfeeding is associated with numerous benefits, including reduced rates of disease, overweight, and obesity. Breastfeeding is also associated with positive outcomes for the breastfeeding parent, including reduced rates of breast and ovarian cancers. The skin-to-skin contact in breastfeeding improves oxytocin levels and breastfeeding parents report higher rates of
- The postpartum stage (after delivery) is an important period of time both for the parent who carried the child and newborn baby. Parents can face a variety of health challenges postpartum including depression, anxiety, pain, and any other complication that may have taken place during childbirth. Medicaid coverage is a way for parents to receive financial support as it relates
- The American Academy of Pediatrics defines a medical home as a health care model that is “accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.” Having a medical home is associated with improved health outcomes and healthy behaviors, as well as decreased sick and emergency room visits for children without special healthcare needs. Medical homes are also linked to better
- Under the Affordable Care Act, states have the option of expanding Medicaid eligibility criteria to a broader group of people. By adopting Medicaid expansion, more children and families become eligible for Medicaid, and more children and families are covered by health insurance. Expanded eligibility for Medicaid coverage has been shown to improve children’s use of preventive care, reduce infant mortality,
- Health insurance is an important financial backstop for families. An infant or toddler with a serious injury or illness can incur medical expenses that are overwhelming, particularly for families with low incomes. While health insurance coverage for this age group is nearly universal, some groups of children are still uncovered. The denominator is the number of children ages 0-2 living
- Caring well for infants and toddlers begins with prenatal care. Medicaid and the Children’s Health Insurance Program (CHIP) help women from lower-income households pay for health services that help ensure a healthy pregnancy and birth. States have flexibility to set income thresholds for eligibility; these are expressed as a percentage of the federal poverty line (FPL). The eligibility limits for
- States take different approaches to providing health coverage to children of immigrants. Below we provide an overview of these options, and then detail the approach that we are tracking with this indicator, the “unborn child option.” Medicaid and the Children’s Health Insurance Program (CHIP) also provide health coverage for immigrants based on what may be matched with federal Medicaid funds.