State and Local Strategies to Strengthen Infant and Toddler Care During Pre-K Expansion

Kids with toys smiling, biracial
June 5, 2023


Whether children are four years old and enrolled in a pre-K program or four months old and being cared for in an infant classroom, they deserve to receive education and care that is responsive and high-quality. Too often policy discussions around early childhood education encourage separate systems: one for infants and toddlers and another for pre-K. But young children and families would benefit from a single, coherent birth-to-five system made up of a well-resourced infant and toddler sector followed by a strong pre-K system. In this brief, I will put forward ideas to help build that system by arguing that a rise in pre-K availability should not come at the expense of infant and toddler programs.

The Growth of Public Pre-K

As the benefits to children and families of high-quality pre-K have become better understood by policymakers and the public, access to public pre-K has steadily expanded. Over the past 20 years, total state pre-K enrollment in the United States has nearly doubled, from just under 700,000 children in 2001–02[1] to 1.36 million children in 2020–21.[2] Over that same period, state spending on pre-K more than doubled, from $4.1 billion to just under $9 billion.[3]

And it is not just states that are recognizing the importance of investing in the care and education of three- and four-year-olds. When running for mayor, Bill de Blasio made his proposal for free, full-day pre-K for all New York City four-year-olds a centerpiece of his successful campaign. As mayor, de Blasio increased full-day pre-K enrollment from 19,000 in 2013 to 68,000 in 2015.[4] About 90,000 students now attend the program.[5] And New York City is not alone: as of 2020, 33 of the nation’s largest cities operated a public pre-K program.[6]

American public pre-K seems likely to continue to expand at both the city and state level over the next decade. In the November 2020 elections, voters in Portland, in Oregon’s Multnomah County, approved a progressive income tax on high earners to fund pre-K for three- and four-year-olds.[7] On the same day, voters in Colorado overwhelmingly voted in favor of a sales tax increase on tobacco products to help fund statewide universal pre-K.[8] This winter, Democratic lawmakers in Michigan[9] and Vermont[10] put forward proposals to significantly expand access to free pre-K.

Possible Unintended Consequences of Pre-K Expansion

The steady increase in pre-K access throughout the country is a positive, but the economic realities of caring for young children means pre-K expansion can lead to negative unintended consequences for the already limited supply of infant and toddler care. Providing education and care for infants and toddlers is more labor-intensive because a safe and nurturing environment for this age group requires a higher adult to child ratio. These higher staffing costs mean providing care for an infant can be three times as expensive as caring for a child in pre-K.[11] Providers typically subsidize the costly care of infants and toddlers with the tuition dollars of the children in pre-K. If the older children who help pay for the care of the youngest leave for pre-K programs offered in public schools, community-based organizations (CBOs) might be forced to raise prices for infant and toddler care, reduce quality to cut cost, or close altogether.[12] These concerns are not just theoretical: a study of New York City’s 2014 universal pre-K expansion found that the public pre-K program resulted in a reduction of 2,700 spots for infants and toddlers in private centers, with the entire reduction occurring in areas with high poverty.[13]

To avoid this scenario, many city and state pre-K programs embrace a mixed delivery approach, in which pre-K is provided by public schools and CBOs. While this approach has many benefits, including greater parental choice and a lower likelihood of destabilizing infant and toddler care, it still has potential drawbacks. When CBOs receive pre-K funding, they may be incentivized to serve three- and four-year-olds rather than infants and toddlers, since it is less expensive to provide care and education for older children. If providers find that funding for pre-K is more consistent and dependable than parent tuition or Child Care Development Fund (CCDF) subsidies, they may choose to serve more children in pre-K at the expense of providing infant and toddler care that is more labor-intensive and hence more costly.[14]

Pre-K expansion also has the potential to exacerbate the current shortage of early educators. As of 2019, the median wage for educators who serve infants and toddlers was only $11.65 per hour, compared to $14.67 per hour for pre-K teachers in all settings and $26.95 for pre-K teachers in public schools.[15] While raising pay for early educators who teach in public pre-K programs is positive, the expansion of public pre-K can lead infant and toddler teachers to leave their positions for the more lucrative jobs offered in pre-K settings, worsening the nationwide shortage of infant and toddler teachers.[16]

The Importance (and Lack) of Infant and Toddler Care

As brain science has advanced, the public has a greater understanding of just how important the first three years of life are for ensuring healthy development. These earliest years are a time of rapid brain growth and forming warm, caring relationships with parents and other caregivers is essential for laying a solid foundation for lifelong well-being. When not in the care of their parents, infants and toddlers need to be in a nurturing environment in which they can form secure attachments and engage in the serve-and-return interactions that are so important for building communication and social skills.[17]

Despite the importance of the first three years of life, infant and toddler care is out of reach for many families. As of 2018, center-based infant care ranged from a yearly median price of $7,461 in small counties with fewer than 100,000 people to $15,417 in very large counties of over a million people.[18] A 2022 survey found that over half of families said they spent more than 20 percent of their income on child care, well above the 7 percent that the Department of Health and Human Services has set as the benchmark of affordability.[19]

Even when families are able to afford infant and toddler care, the early educator staffing shortage that was exacerbated by the pandemic means many families are unable to find a provider. In February 2023, there were about 60,000 fewer people working in child care compared to February 2020.[20] A survey in the summer of 2022 found that over 365,000 adults reported that they lost a job because they needed to take time off to care for their young children.[21] Any policy that has the potential to further reduce the already-limited supply of infant and toddler care throughout the country should try to mitigate this possibility.

Possible Policy Solutions

With the defeat of President Biden’s Build Back Better legislation that would have made a historic $390 billion investment in child care and pre-K, it appears unlikely that the sort of major federal investment that is necessary to stabilize the infant and toddler sector is coming any time soon. Therefore, it falls on states and cities with a desire to expand public pre-K to design the expansion in a way that reduces negative impacts on this vulnerable sector. In the section below, I will highlight a state, a county, and a city that have enacted promising policies in this area.


While universal pre-K is set to launch in Colorado in the 2023–24 school year, lawmakers there took efforts to address a lack of infant and toddler care prior to voter approval of pre-K expansion. During the 2019 legislative session, the Colorado General Assembly passed SB63, a bill requiring the creation of a strategic action plan that addressed the declining number of family child care (FCC) homes and infant care throughout the state. The bill specifically noted that infant care in the state is more often provided by FCC providers than centers, so the loss of 1,582 FCC providers since 2010 resulted in a decline of over 7,300 infant spots between 2010 and 2018.[22]

In order to ensure that the action plan reflected the views of diverse stakeholders, the Colorado Department of Human Services engaged in a robust stakeholder engagement process that included 18 community conversations and follow-up surveys that reached over 1,200 stakeholders, including many current infant and toddler care providers. This engagement process led directly to the final recommendations that are included in the action plan.

The resulting “Infant and Family Child Care Action Plan” explicitly focused on increasing the supply of FCC providers since they provide such a large amount of infant and toddler care in the state and noted the need for at least 7,000 additional infant spots and over 200 FCC providers.[23] The plan’s recommendations are broken down into five different areas (listed below), with numerous recommendations for each, such as:

  • Operational supports: Funding grants to prospective and existing FCC providers and centers serving infants; funding local partners to create staffed FCC networks that can handle paperwork, taxes, and reports.
  • Professional development: Using provider input to create additional training focused on infant teachers.
  • Child care licensing: Hiring additional licensing specialists to reduce caseloads and better provide technical assistance, guidance, training, and mentoring; hiring additional background check staff to allow for quicker licensure processing times.
  • Regulation: Reviewing state licensing rules to eliminate unnecessary or duplicative rules.
  • Policy review: Ensuring a mixed delivery system of early childhood education where there is a balance of center care, FCC, Early Head Start, Head Start, and district-based pre-K; strengthening policies that incentivize providers who serve priority populations like infants, such as by reforming the Colorado Child Care Assistance Program (CCCAP) to incentivize infant care and FCC homes.[24]

According to Mary Alice Cohen, deputy executive director of the Colorado Department of Early Childhood (DEC), the thinking at the time of the creation of the action plan was, “We know that the babies in our state are being cared for primarily in FCC homes, both licensed and unlicensed. So how can we do everything in our power to support our FCC homes?” This early work on policies to increase the availability of licensed infant care and FCC providers proved essential when Colorado voters went to the polls in November 2020 and approved Proposition EE, a tobacco and nicotine tax measure, to guarantee 10 hours a week of pre-K for all four-year-olds statewide.[25]

“It was helpful that our advocates knew that this infant and toddler issue was something we needed to have a focus on,” said Kristen Lang, program access administrator at DEC. “We had the benefit of having SB63 before Proposition EE even passed. Having that study in advance of the discussion of universal pre-K (UPK) meant that our state had that framing in mind when we started the conversation about UPK,” she said. “Some of the design features you see, like the fact that it’s a mixed delivery program and that we were inclusive of FCC home providers flowed from a focus on not wanting to lose the type of provider that so often provides infant and toddler care,” she said.[26]

When the COVID pandemic led to an influx of federal relief funds for the state, policymakers had the money to pursue many of the recommendations included in the action plan. “We prioritized preserving infant and toddler care through those stimulus opportunities wherever we could,” said Lang.[27] DEC spent approximately $750 million in state and federal relief funds on 49 strategies to stabilize the child care sector, retain and grow the early education workforce, and help families thrive.[28] Many of these stimulus-funded strategies were explicitly focused on increasing the supply and quality of infant/toddler care. These strategies included providing child care stabilization grants with additional bonus payments for infant and toddler care providers,[29] paying those who accept subsidies based on enrollment rather than attendance,[30] reducing or eliminating child care tuition payments,[31] and providing one-time bonus incentive payments to infant/toddler programs that move up a level in the Colorado Shines Quality Rating and Improvement System (QRIS).[32]

One of the specific stimulus-funded initiatives involved the creation of a $5,000 licensing incentive to providers who successfully became licensed. According to Cohen, “one of our greatest successes around infant and toddler care was encouraging new FCC homes to become licensed. We actually had 397 providers become licensed through this licensing incentive, which increased almost 18,000 slots.”[33]

With the deadline for spending pandemic relief funding looming, the Department of Early Childhood is working with the University of Colorado Denver on an objective, evidence-based decision-making model to decide which strategies are worthy of sustained funding via state general funds, philanthropic organizations, and federal grant programs like Preschool Development Grants (PDG). “There’s not a simple strategy to support infant and toddler care. It requires multiple levers to do this well and there’s still so much work to be done,” said Cohen.[34]

Multnomah County

On November 3, 2020, a majority of voters in Portland, in Oregon’s Multnomah County, voted in favor of establishing a marginal income tax on high earners to establish a universal pre-K system for the county’s three- and four-year-olds, known as Preschool for All. The newly established marginal income tax raised $187 million in 2022, $68 million more than was initially projected.[35] In the 2022–23 school year, the first year of operation, Preschool for All opened 718 spots and has plans to increase the number of spots until there is a spot available for every interested family in 2030.[36]

Early on in the Preschool for All planning process, advocates and policymakers learned from other communities that had expanded pre-K access and then witnessed a negative impact on infant and toddler care.[37] “We heard from multiple communities about how a preschool expansion negatively impacted their infant and toddler slots. We have a responsibility to do what we can to stabilize infant and toddler care in Multnomah County as we expand,” said Leslee Barnes, director of the county’s Preschool and Early Learning Division.[38] In an effort to mitigate any unintended consequences pre-K expansion could have on the supply of infant and toddler care, the county took a few different actions.

First, the county embraced a mixed delivery approach to pre-K that includes home-based, center-based, Head Start, and public school-based providers.[39] This approach has multiple benefits: not only does it provide more choices to families in terms of settings and schedules, but it also lessens the risk of destabilizing current providers by taking away their more lucrative three- and four-year-old students and leaving them with only infants and toddlers, for whom it is more expensive to provide care.

The county also developed the plan for Preschool for All by engaging with current child care providers, working with over 95 individuals representing over 50 organizations.[40] “We included current and former early educators and preschool directors within our community planning process, as well as organizations that work closely with child care providers,” said Barnes.[41] In August 2021, the county appointed 15 early childhood advocates to two-year terms on the Preschool for All Advisory Committee that provides guidance and feedback on implementation. The members include current and former pre-K providers as well as child care educators.[42]

Also noteworthy is the fact that Multnomah County recognized the importance of setting a realistic pace for pre-K expansion and not implementing the expansion too quickly. The county’s Preschool for All Plan from July 2020 details the dangers in a hasty implementation of pre-K expansion, including potentially “reduc[ing] the availability of infant and toddlers slots in a community that is already considered an infant and toddler child-care desert” and funneling investments primarily into larger programs, such as school districts and large centers.[43] “Creating a new, more racially diverse system requires slowing down enough to invest in supports for providers as part of our growth strategy,” said Barnes.[44]

Last, and perhaps most importantly, planning for pre-K expansion led to the establishment of an Infant and Toddler Slot Preservation Fund (“the fund”). The fund will include up to $25 million a year in incentives for providers to keep their infant and toddler spots and are available to home-based providers, licensed public charter schools, and child care centers that participate in Preschool for All.[45] The funding structure includes $5,000 annually per infant and toddler spot and tiered base pay that are added to providers’ monthly allotments (see Figure 1). For example, a pre-K provider who keeps six infant/toddler spots will receive a total of $55,000 per year in additional funding under the Infant and Toddler Slot Preservation Fund. She will receive base pay of $25,000 for her six spots plus an additional $30,000 ($5,000 per infant/toddler spot multiplied by six spots). The first tier of allowable costs includes increasing the wages of infant and toddler teachers as well as assistants and aides working in infant and toddler classrooms, increasing staff benefits, and reducing staff insurance contributions.[46]

In addition to receiving this additional funding for retaining infant and toddler spots[47], Preschool for All providers must complete an annual survey of these spots for the upcoming year. Programs are permitted to have up to 25 percent of the stabilized spots vacant as long as they are currently recruiting families. Providers are required to inform county officials if more than 25 percent of their infant and toddler spots are vacant at any time and ongoing vacancies could result in a reduction in the amount of their stabilization funding.[48]

The county’s Infant and Toddler Slot Preservation Fund is similar to the set-aside approach that some states have used to support infant and toddler services amid pre-K expansion. Illinois, for example, funds pre-K via the state’s Early Childhood Block Grant (ECBG). Starting in FY 2016, at least 25 percent of any ECBG funding over and above the previous year’s allocation has been used to fund programs for families with infants and toddlers.[49] The set-aside supports the Prevention Initiative, which funds research-based services such as home visits, doula services, and mental health consultations.[50]

A recent planning report related to Rhode Island’s pre-K program was required by statute to include details about how the state will “[e]nsure that access to infant and toddler care is not at risk as the state prekindergarten program is expanded.”[51] The report acknowledges that “on its own, there is little economic incentive to offer infant and toddler care” and recommends the establishment of an infant and toddler spending benchmark similar to Illinois to “ensure aligned investment in the infant/toddler sector” as pre-K expands. An infant and toddler set-aside of between 10 and 30 percent of total pre-K funding is recommended. Those funds would be used to increase the capacity, sustainability, and quality of the sector through strategies such as a higher reimbursement rate for infant care providers who accept subsidies to reflect the higher cost of providing such care.[52]

Washington, DC

The nation’s capital has offered pre-K since the 1960s, but it was the passage of the Pre-K Enhancement and Expansion Amendment Act of 2008 (Pre-K Act) that significantly increased the city’s investment in early education. The culmination of decades of activism, the Pre-K Act was designed to expand pre-K access to all of the city’s three- and four-year-olds through a mixed delivery system that includes District of Columbia Public Schools (DCPS), public charter schools, and publicly funded community-based organizations.[53]

The legislation aimed for universal pre-K availability for all of the city’s three- and four-year-olds by 2014, and by the 2016–17 school year the city was providing pre-K to 89 percent of four-year-olds and 69 percent of three-year-olds.[54] Today, DC is considered a national leader in pre-K access and funding, ranking number one in access for three- and four-year-olds as well as in overall state spending, averaging over $19,000 in spending per student in the 2020–21 school year. Sia Barbara Kamara, advocate and former executive director of the Office of Early Childhood Development, said, “by the time I retired, DC had moved from being at the bottom to being number one in the country for pre-K.”[56]

While provisions related to infant and toddler care were originally included as part of the Pre-K Act, those components were ultimately stripped from the bill because legislators were not convinced that such reforms were necessary.[57] Kamara said, “I remember some council members were adamant that babies are not a part of education. They said, ‘Take that out if you want this law passed,’ and so we had to make a decision.”[58]

That sentiment began to change, however, as new research revealed more about the needs of the District's youngest children. A 2015 report commissioned by the Bainum Family Foundation found “wide disparities between neighborhoods in terms of support for healthy births, quality child development, and school readiness.”[59] The report described Washington, DC, as a “tale of two cities” in which 89 percent of infants and toddlers living in Ward 8 lived in neighborhoods of concentrated poverty, compared to just 4 percent in Ward 3.[60] It also found that quality child care spots for infants and toddlers were in especially short supply for families with low incomes and that home visiting programs only reached about 15 percent of eligible families.[61] A 2018 cost estimation model published by the Office of the State Superintendent of Education (OSSE) concluded that infant and toddler care was the most financially challenging program to operate and that “[t]he biggest gap between costs and available revenues occurs in small centers that primarily serve infants and toddlers.”[62]

In June 2018, after years of community organizing led by a multi-sector coalition of nearly 50 member organizations,[63] the DC Council responded to these concerns about infant and toddler care by unanimously passing the Birth-to-Three for All DC Amendment Act of 2018 (Birth-to-Three Act). Estimated to cost $500 million over the next decade, the Birth-to-Three Act is a comprehensive road map for supporting children’s healthy development. The Act includes a variety of recommendations, including ensuring that child care subsidy payments rise to cover the true cost of care, improving compensation for early educators, expanding access to home visiting programs, assisting providers with licensing, and setting payment rates to ensure that no family spends more than 10 percent of its income on child care. It also increases opportunities for early educators to earn higher credentials by requiring a local university to partner with child development centers to provide the on-site classes and scholarships necessary to earn an associate degree.[64]

DC’s FY 2019 budget included $1.3 million to pay for certain components of the Act, such as expanded home visiting programs and the development of a salary scale for early educators.[65] The FY 2020 budget included about $15 million in funding for the Birth-to-Three Act, of which over $9 million was committed to increasing reimbursement rates for providers who accept subsidies.[66]

While the Birth-to-Three Act called for the creation of a competitive salary scale for lead teachers and assistant teachers in child development facilities that provides for pay parity with elementary school teachers employed by DCPS, that provision was unfunded until 2021, when the DC Council voted to create the Early Childhood Educator Pay Equity Fund. The council allocated about $54 million to the fund for FY 2022 and roughly $73 million for FY 2023, 2024, and 2025.[67] The Pay Equity Fund was financed by raising the marginal tax rate on DC’s highest earners.[68] The fund was focused on “going beyond pay parity for pre-K teachers and making sure the birth-to-five workforce has access to the same compensation as DC Public Schools teachers,” said Hannah Matthews, director of Policy, Planning, and Research for OSSE’s Division of Early Learning.[69]

The fund provides direct payments to early educators working in child development programs licensed by OSSE, payments worth up to $14,000 for lead teachers and $10,000 for assistant teachers between October 2022 and September 2023.[70] In FY 2024, the direct-to-educator payments will end and “the funds will transition to a program where we pay child development facilities directly,” said Matthews, “and in exchange they agree to meet minimum salaries established by OSSE.”[71]

Under the salary scale proposed by the Early Educator Equitable Compensation Task Force, lead teachers will earn between approximately $48,200 and $66,700 per year, depending on their credential level.[72] Starting in 2023, the Pay Equity Fund has also been used to provide premium-free health insurance for DC residents working in licensed child development facilities, regardless of income or citizenship status.[73]

Takeaways for Policymakers

While Colorado, Multnomah County, and Washington, DC, have pursued different strategies in their efforts to stabilize the infant and toddler sector as pre-K expands, their experiences highlight a few takeaways that state and local policymakers might consider in developing their own plans.

Embrace a mixed delivery approach for pre-K.

A mixed delivery approach was viewed by many interviewees as a necessary, but not sufficient strategy for ensuring a vibrant infant and toddler sector as pre-K expands. An approach to pre-K that includes public schools and community-based organizations not only increases parental choice, but also poses less risk of destabilizing infant and toddler care because it reduces the likelihood of having providers lose the three- and four-year-olds that help to subsidize the more costly care of infants and toddlers.

Grow pre-K slowly to avoid unintended consequences.

A hasty expansion of pre-K can potentially lead to several negative outcomes, including reducing the availability of infant and toddler spots and funneling investments into larger programs, such as school districts and large centers. A slow, flexible expansion, on the other hand, allows ample opportunity for adjustment if evidence emerges of a negative impact on infant/toddler care. It also allows for reassessment as part of the growth process and the opportunity for providers to provide input during both the planning and early rollout phases of pre-K expansion.

Include infant and toddler care providers in early pre-K planning phases.

Colorado and Multnomah County repeatedly emphasized the importance of ensuring that infant and toddler care providers were part of the conversation about possible pre-K expansion from the earliest stages. This allowed for the possibility of unintended consequences for infant and toddler care to be considered throughout expansion plans, rather than as an afterthought.

Set aside a certain percentage of pre-K dollars to be used to help mitigate unintended consequences for the infant and toddler sector.

Many interviewees referenced Illinois’s 25 percent set-aside as inspiration for their own plans to set aside a certain percentage of pre-K funds to support infant and toddler care providers. Funds from the set-aside can be used to increase reimbursement rates for these providers and increase staff compensation and benefits.

Help family child care providers become licensed and improve quality.

Nearly 30 percent of infants and toddlers in the U.S. receive care and education in home-based settings.[74] Therefore, any efforts to stabilize and improve the infant and toddler care sector during pre-K expansion must include a focus on family child care providers. Colorado was able to nudge almost 400 providers to become licensed by providing $5,000 licensing incentives. While licensing is not a guarantee of high-quality care and education, it does ensure that minimum health and safety requirements are met and allows for regular monitoring. Licensing can also be a first step in encouraging providers to join staffed child care networks that can handle paperwork, taxes, and reports as well as provide ongoing resources and training.

Use an evidence-based approach to decide which stimulus-funded infant and toddler initiatives can be continued with other types of funding.

Many infant and toddler care providers would not have survived the pandemic if not for the billions of dollars received as a result of COVID relief funds. Since federal relief funds will soon expire, it is up to states and localities to decide which stimulus-funded initiatives that helped the infant/toddler sector should continue to be funded via state and local funds, philanthropic organizations, and federal grant programs like Preschool Development Grants (PDG). The use of an objective, evidence-based decision-making model to decide which strategies are worthy of sustained funding is critical for ensuring funds are spent in the most efficient manner possible.

Focus on workforce preparation and compensation support.

While it is important to take steps to preserve the supply of infant and toddler care providers during pre-K expansion, it is also imperative that steps be taken to improve the quality of these providers. Washington, DC, has been a leader in this area with its commitment to achieving pay parity between early educators and public-school teachers, as well as through its partnership with a local university to provide financial supports to enable educators to earn higher credentials. DC has also repeatedly raised reimbursement rates to provide infant andvtoddler care providers with the funds necessary to improve quality.

Consider additional revenue sources to fund early childhood education programs.

In the absence of the significant federal investment in early childhood education proposed in the Build Back Better legislation, states and localities must be creative in raising funds to help young children and their families. There are a variety of methods for raising additional revenue to fund these sorts of programs. Washington, DC and Multnomah County, for example, both used a tax on higher earners to fund early childhood education programs, while Colorado is using a tax on nicotine products to fund its universal pre-K program.



The author would like to thank Cara Sklar for editing this brief, Sabrina Detlef for her copyediting support, and Fabio Murgia and Mandy Dean for their communication and data visualization support. The author would also like to thank advocates and policymakers in Colorado, Multnomah County, Rhode Island, and Washington, DC, for sharing their knowledge.

We would like to thank the Alliance for Early Success, the Bainum Family Foundation, the Heising-Simons Foundation, the Richard E. and Nancy P. Marriott Foundation, the David and Lucile Packard Foundation, and the W. Clement & Jessie V. Stone Foundation for their generous support of this work. The views expressed in this report are those of the author and do not necessarily reflect the views of the foundations, their officers, or their employees.