ITERS scoring checklist for infant toddler rooms in licensed centers

Last updated 2026-07-10

What is the ITERS-3 and why does your licensed center need to know it?

The Infant/Toddler Environment Rating Scale, Third Edition (ITERS-3) is the main standardized observation tool used to measure quality in group care for children from birth through 36 months ^[1]. Thelma Harms, Debby Cryer, Richard M. Clifford, and Noreen Yazejian at the Frank Porter Graham Child Development Institute (University of North Carolina at Chapel Hill) wrote it. It came out in 2017.

If you run a licensed infant or toddler room, you'll meet ITERS scoring in one of three places. A Quality Rating and Improvement System (QRIS) review. A Child Care Development Fund (CCDF) quality set-aside grant requirement. Or a state licensing inspection that has adopted environment rating scales into its annual or biennial cycle. As of 2024, 39 states plus Washington D.C. run some form of QRIS, and most of them use ITERS-3 or the older ITERS-R for infant and toddler classrooms ^[2].

Scores run 1 to 7. A 1 means inadequate. A 3 means minimal. A 5 means good. A 7 means excellent. Most QRIS programs want a classroom average of at least 3.0 to participate at any funded tier, and a 5.0 or better to reach the upper tiers that pay higher subsidy reimbursement rates ^[2].

Knowing the tool ahead of time is not cheating. FPG publishes a companion scoring guide and training videos exactly so providers can see what quality looks like before an observer walks in.

How is the ITERS-3 structured? What are the 6 subscales?

The ITERS-3 sorts its 33 items into 6 subscales. Each subscale groups related pieces of the room's environment and teaching practice.

Subscale	Items	What it covers
Space and Furnishings	4 items	Indoor space, furniture for care and learning, room arrangement for play, display for children
Personal Care Routines	6 items	Greeting/departing, meals/snacks, nap, diapering/toileting, health practices, safety practices
Language and Books	5 items	Books and pictures, encouraging children to communicate, staff use of language, helping children expand vocabulary, singing and music
Activities	7 items	Fine motor, active physical play, art, nature/science/math, dramatic play, sand and water, use of TV/video/computers
Interaction	6 items	Supervision of play and learning, peer interaction, staff-child interaction, discipline, staff responsiveness to child
Program Structure	5 items	Schedule, free play, group activities, provisions for children with disabilities, staff continuity

Every item uses the same 7-point rubric with quality indicators at levels 1, 3, 5, and 7. Observers mark each indicator "yes" or "no" based on what they see and hear during a minimum 3-hour window ^[1]. The classroom average is the mean of all 33 item scores.

Here's what new providers miss. The ITERS-3 scores what actually happens during the observation, not what your policies say. A beautifully written diapering procedure taped to the wall earns zero credit if the observer watches a caregiver skip the health steps during a real diaper change.

What score do you need to pass ITERS for licensing or QRIS?

There is no single national passing score. The threshold depends entirely on your state's licensing rules or QRIS framework, and those vary more than most people expect.

Here's the practical landscape. Under the CCDF Final Rule (45 CFR Part 98), states that take CCDF funds must set health and safety standards for all licensed providers, but the rule does not mandate a specific ITERS score ^[3]. States have room to decide. The 2014 reauthorization did require states to run a transparent quality rating system and report their quality improvement activities, which is why most states tie ITERS scores to QRIS funding tiers rather than to baseline licensure.

Several states go further. North Carolina, where the scale was born at UNC-FPG, uses environment rating scale scores inside its 5-Star Rated License system, with higher stars requiring higher averages ^[4]. Tennessee's QRIS uses a minimum classroom score of 3.0 for entry-level participation. Colorado's Qualistar system weights ERS scores at 40 percent of a program's total quality points.

Pull your state's QRIS technical manual before you do anything else. That document tells you the exact score cutoffs for each tier, whether they score at the classroom or program level, and how many classrooms they observe per visit. Child Care Aware of America publishes a state-by-state CCDF policy tracker that links straight to those documents ^[2].

For baseline compliance, most states won't yank your license just because your ITERS average is a 3.2 instead of a 5.0. But a low score can trigger a corrective action plan, cut your subsidy reimbursement rate, or knock you out of quality improvement grants. That's real money.

ITERS-3 scoring checklist: Space and Furnishings subscale

This is what observers check in the physical environment. Walk your room with these questions before your assessment.

Item 1: Indoor space. Is the room big enough for the number of infants and toddlers enrolled? Most licensing regulations require at least 35 square feet of usable floor space per child, and some states require more ^[5]. Is lighting adequate without being harsh? Is ventilation good? Is the space maintained and free of hazards? A score of 5 needs the space to be comfortable for children and staff and accessible for children with disabilities.

Item 2: Furniture for care and learning. Are cribs, changing tables, feeding chairs, and activity surfaces sturdy, clean, and sized for infants and toddlers? Adult-sized or worn equipment gets dinged here.

Item 3: Room arrangement for play and learning. Providers underestimate this one constantly. Observers look for defined interest areas where children can play without constant redirection, enough open floor for gross motor activity, and a soft area (carpet, foam mat, or cushions) separate from hard surfaces. The level-7 indicator wants at least two clearly distinct interest areas with appropriate materials in each.

Item 4: Display for children. Are pictures and visual materials mounted at infant and toddler eye level, meaning very low, at crawling or standing-toddler height? Are the images age-appropriate, diverse, and tied to the children's real lives? Generic clip art at adult eye level scores a 1 on this item.

ITERS-3 scoring checklist: Personal Care Routines subscale

Personal Care Routines bites providers most often because it's almost entirely behavioral, not physical. You can have a spotless room and still fail this subscale if staff don't follow through on the routines an observer can watch.

Item 5: Greeting and departing. Do staff acknowledge each child warmly and individually at arrival and pickup? Does a primary caregiver greet the child by name, make eye contact, and engage the parent briefly? Observers watch for this in the first minutes of the session.

Item 6: Meals and snacks. Are feeding experiences responsive and individualized for infants (on-demand feeding, held during bottle feeding, no propped bottles)? For toddlers, do staff sit with children during meals and turn mealtimes into language time? The American Academy of Pediatrics advises against propped bottles because of aspiration and ear infection risk, and ITERS-3 scores propped bottles as a level-1 indicator ^[6].

Item 7: Nap and rest. Are crib assignments consistent (same infant, same crib)? Is sleep-surface guidance followed, meaning infants placed on their backs with no soft bedding, per AAP safe sleep guidance ^[6]? Observers check this directly. A safe sleep violation here is usually a licensing violation too.

Item 8: Diapering and toileting. This item is highly procedural. Observers check that staff wash hands before and after every change, that the surface is cleaned and sanitized between children, and that children are treated with dignity throughout. The CDC's childcare hygiene guidance lines up closely with these indicators ^[7].

Item 9: Health practices. General handwashing frequency, illness exclusion practices, and hygienic handling of food and objects that infants mouth.

Item 10: Safety practices. Are sharp corners covered? Are outlets protected? Are cords out of reach? Is the outdoor space checked before use? Observers note whether hazardous items are within a child's reach.

ITERS-3 scoring checklist: Language and Books subscale

Early language is one of the strongest predictors of later school readiness, and ITERS-3 gives this subscale real weight.

Item 11: Books and pictures. Are at least 5 board or cloth books accessible to children during the observation (not stored out of reach)? Are they in good condition? A score of 5 wants books that show diversity in people and experiences. A 7 adds that staff read with individual children more than in group settings.

Item 12: Encouraging children to communicate. Observers track whether staff respond to vocalizations, cries, gestures, and early words as real communication rather than ignoring them or answering only crying. This is the turn-taking in early conversation that researchers at the Harvard Center on the Developing Child link directly to executive function and language outcomes ^[8].

Item 13: Staff use of language. Do staff describe what they're doing during care routines? Do they narrate play? Do they ask toddlers open-ended questions? Do they avoid long silences during caregiving?

Item 14: Helping children expand vocabulary. Do staff introduce new words naturally? Do they label objects and actions? The level-5 indicator expects staff to use varied vocabulary beyond the most basic words.

Item 15: Singing and music. Are songs, fingerplays, or music worked into the day rather than parked at a single "music time," woven into transitions and care routines? A lullaby at naptime and a song during handwashing both count.

ITERS-3 scoring checklist: Activities subscale

This subscale covers the learning materials and play opportunities available during the observation. Observers count accessible materials in real time. What's in the storage cabinet doesn't exist as far as the score goes.

Item 16: Fine motor. Are several types of fine motor materials accessible? Rattles and graspable objects for infants. Stacking rings, simple shape sorters, and large-bead toys for older toddlers. A score of 5 wants at least 5 types accessible without a child having to ask.

Item 17: Active physical play. Is there time and space for infants on the floor for tummy time and movement? For toddlers, is there large-muscle activity indoors or out? Observers note whether children are stuck in swings, bouncers, or seats for long stretches. The AAP recommends limiting time in infant seats and swings for that exact reason ^[6].

Item 18: Art. For toddlers (roughly 18 months and up), is there some open-ended art experience going? Coloring books and pre-stamped pages don't count. Process-based finger painting or dough exploration does.

Item 19: Nature, science, and math. Are children handling real objects from nature? Do activities include simple cause-and-effect? A tub of water with cups, or a basket of pinecones and rocks, earns credit here.

Item 20: Dramatic play. Are pretend-play props accessible to toddlers? Baby dolls, simple hats, toy phones, play food. Observers look for children actually using them rather than props sitting on a shelf.

Item 21: Sand and water play. Is sensory play available during the observation or clearly part of the regular schedule? It doesn't have to be an elaborate sensory table.

Item 22: Use of TV, video, and computers. For children under 24 months, the AAP advises against screen media other than video chatting ^[6]. ITERS-3 scores screen use for infants and very young toddlers at the low end. A screen running in the background can drop your score all by itself.

ITERS-3 scoring checklist: Interaction subscale

Interaction ties most directly to caregiver behavior, and it shows the widest gap between high-scoring and low-scoring rooms. You can upgrade a physical environment with a purchase order. Interaction quality takes time to build.

Item 23: Supervision of play and learning. Are staff positioned to see and hear children at all times? Do they move around the room instead of clustering? Is supervision active, not passive?

Item 24: Peer interaction. Do staff help positive interactions happen between children? Do they narrate what other children are doing to build early social awareness?

Item 25: Staff-child interaction. This is often the highest-weighted item in observer training. Are staff warm, responsive, and engaged? Do they get down to the children's physical level (crouching, sitting on the floor, kneeling) and make eye contact? Do they smile? Cold, mechanical caregiving scores a 1 even when every physical item is perfect.

Item 26: Discipline. Observers look for developmentally appropriate guidance. Redirecting a 14-month-old who is biting is appropriate. Scolding, shaming, or using timeout as punishment for an infant scores a 1. Physical punishment of any kind is an automatic 1 on this item and is a licensing violation in every U.S. state ^[5].

Item 27: Staff responsiveness to child needs. Do staff respond quickly to distress? Do they recognize each child's communication style and cues? A toddler crying for several minutes with no adult response is a level-1 indicator here.

ITERS-3 scoring checklist: Program Structure subscale

Item 28: Schedule. Is the daily schedule flexible enough to follow individual infant feeding and sleep rhythms instead of forcing one group schedule on everyone? A rigid group schedule for infants under 12 months is a level-1 indicator.

Item 29: Free play. Do children get regular child-initiated, adult-supported free play? Is most of the day (outside care routines) spent in play rather than adult-directed activity?

Item 30: Group activities. When toddlers do group activities, are they brief, voluntary, and age-appropriate? A 30-minute mandatory circle time for 18-month-olds is developmentally wrong and will pull your score down.

Item 31: Provisions for children with disabilities. This item applies even if no children with IFSPs (Individualized Family Service Plans) are enrolled right now. Observers look for evidence that the program has a process for including children with varying abilities and that the space is accessible. This connects to IDEA Part C, which covers children from birth through age 2 with developmental delays ^[9].

Item 32: Staff continuity. Do the same caregivers work with the same infants and toddlers day to day? High turnover or floating staff across rooms gets noted. Primary caregiving assignments (one consistent caregiver as the main contact for a small group) score higher.

Item 33: Staff awareness of diversity. Do materials and interactions reflect cultural awareness and respect for family differences? This goes past having diverse books. It includes how staff talk about families and whether the program bends to cultural caregiving preferences.

How do ITERS observers score items during an actual observation visit?

Understanding the scoring process pulls most of the anxiety out of assessment day. Here's how it works.

A certified ITERS observer arrives and watches the classroom for a minimum of 2.5 to 3 hours without stepping into the activity. They take detailed notes. At the end, they may ask the lead caregiver a short set of clarifying questions to catch things they couldn't observe directly (what happens at nap for children who don't sleep, or how often outdoor play happens on a typical day).

Then they score each of the 33 items against the published indicators. Each item has indicators at levels 1, 3, 5, and 7. The rule is simple. If all level-3 indicators are met, the item scores at least a 3. If all level-5 indicators are also met, it scores at least a 5. And so on up. But a level-1 indicator that isn't met (an inadequate condition observed) anchors the score at 1 no matter how many positive indicators show up above it.

The classroom total is the mean of all 33 items. Subscale scores are the means of the items inside each subscale. Most QRIS programs report both the total and the subscale scores, so a program that aces Language but fails Safety Practices can see exactly where to spend its effort.

Published reliability data for ITERS-3 shows exact agreement between trained observers at about 81 percent and agreement within one point at about 97 percent ^[1]. Two observers watching the same room at the same time usually land very close, which is better than most people expect from a qualitative tool.

If you want a structured way to walk through compliance documentation alongside the ITERS checklist, a compliance toolkit like the one from ChildCareComp can pair these environmental checklists with your state licensing paperwork so nothing slips.

What are the most common reasons infant/toddler rooms score below a 5?

Across the published literature on ITERS and ECERS scores in multiple states, the items that most often drag classroom averages below a 5 cluster into a few predictable spots.

Language interaction is the most consistent weak point. A 2019 review in the Early Childhood Education Journal found staff-child verbal interaction items among the lowest-scoring across multiple state QRIS databases, with language subscale averages often landing in the 3.0 to 4.0 range even in programs that scored well on physical environment ^[10]. Caregivers focus on safety and hygiene, which is right, but underestimate how much narration and responsive conversation matter to an observer.

Propped bottles and screen use are the two items that most often anchor a score at 1. Both are usually licensing violations too. Kill those two practices and you immediately floor those items above a 1.

Furniture arrangement gets overlooked all the time. Plenty of infant rooms are set up so staff can scan the whole space easily, but the children's play areas aren't really defined. A low shelf to build a book corner, or a foam wedge to carve out a tummy-time zone away from the main floor, can move Item 3 from a 3 to a 5.

Staff clustering is the interaction problem observers flag most. When two or three caregivers stand together talking near the door while children play across the room, that hits Item 23 (supervision) and Item 25 (staff-child interaction) at once. Fixing it costs nothing. It just takes intentional positioning habits.

Primary caregiver assignment records often don't exist, or nobody told the staff. Item 32 on staff continuity can be partly supported with documentation showing consistent room assignments beyond what an observer catches in one session. Bring that paperwork to assessment day.

For a broader look at what a quality infant space should hold, the preschool curriculum overview covers developmental principles that apply downward to toddler programming too.

How do you prepare your infant/toddler room for an ITERS assessment?

Start at least 60 days before your scheduled observation. That sounds like a lot of runway, and it is, but most of the work is behavioral, and changing adult habits in a group care setting takes longer than painting a wall.

Week one. Do a self-assessment with the ITERS-3 score sheet, which is sold separately from the full instrument for self-study. Walk the room and honestly score yourself on every physical indicator you can judge without a full session. Note your 1s and 3s. Those are your targets.

Weeks two through four. Fix the physical items. Get books down to child level. Mount pictures at child eye level. Build at least two defined interest areas with a low shelf, or a tape line on the floor if you don't have furniture. Buy or borrow at least five types of fine motor materials and leave them accessible, not in a bin on a high shelf.

Weeks five through eight. Work the behavioral subscales. Record 30 minutes of your room during free play and watch it with your staff. Count how often staff narrate activity, respond to child vocalizations, and get down to child level. Use that count as your baseline and set a target for the next recording.

Two weeks out. Walk your Personal Care Routines in real time with a colleague observing and scoring. Diapering, handwashing, mealtime, and arrival all get scored as if the observer were in the room. Fix anything that doesn't hit at least a 5.

Assessment day. Pull your documentation for staff assignments, daily schedules, disability inclusion procedures, and outdoor play logs. The observer may ask about these in the post-observation interview. Having them organized shows program-level intent, even though the observer can only score what they see.

Keeping your daycare cleaning records organized also supports the health practices items, since observers may ask how often surfaces get sanitized.

How does ITERS scoring connect to your subsidy rates and CCDF funding?

This link is more direct than most providers realize, and it's real dollars.

The Child Care and Development Fund (CCDF), run by the Office of Child Care inside HHS, is the main federal funding stream for child care subsidies. The 2014 Child Care and Development Block Grant Act reauthorization required states to tie their CCDF quality set-aside spending to measurable quality improvement activities ^[3]. Most states use QRIS tier ratings (which fold in ITERS scores for infant and toddler rooms) to set subsidy reimbursement rates, so higher-quality programs get paid more per subsidized child.

Child Care Aware of America's 2023 cost report put center-based infant care at $1,324 per month nationally, with wide variation by state ^[11]. The gap in subsidy reimbursement between a Tier 1 and a Tier 3 QRIS rating can run 10 to 30 percent per child per month in states with tiered reimbursement, based on state QRIS documentation compiled by the National Center on Early Childhood Quality Assurance ^[2]. For a room of six infants, that gap can mean $800 to $2,400 more per month in program revenue.

That's the financial case for investing in your ITERS score. It isn't an abstract quality badge. It's tied to your reimbursement rate in most states that serve subsidized families. And because infants have the highest subsidy-eligible share (lower-income families with infants lean heavily on subsidy), your infant room's ITERS score is often your highest-stakes classroom.

For context on overall daycare cost structures and where subsidy rates fit the broader picture of running a center, that resource covers the numbers.

The Office of Child Care also publishes CCDF state plans and state profiles showing each state's tiered reimbursement structure and quality standards ^[3]. Reading your state's plan takes about 20 minutes and answers most questions about how your ITERS score turns into a dollar figure.

Frequently asked questions

How long does an ITERS-3 observation take?

A standard ITERS-3 observation runs a minimum of 2.5 to 3 hours of direct classroom observation, plus a short question-and-answer with the lead caregiver that usually lasts 15 to 20 minutes. The observer needs to see all the major care routines (at least one diaper change, one feeding or snack, and free play) to score the Personal Care Routines and Activities subscales reliably.

Can you use an older version of the scale (ITERS-R) instead of ITERS-3?

Some states haven't moved from ITERS-R to ITERS-3 yet. Check your state QRIS technical manual. The two versions don't score the same way, and an observer certified on one isn't automatically certified on the other. If your state still uses ITERS-R, prepare for that tool specifically. ITERS-3 came out in 2017 and most states have switched, but a few keep ITERS-R for continuity in long-running ratings.

Does ITERS apply to home daycare providers or only licensed centers?

ITERS-3 was built for group care and shows up most in licensed centers. Some states use it for licensed family child care homes serving infants and toddlers, mostly at higher QRIS tiers. The Family Child Care Environment Rating Scale Revised (FCCERS-R) is the more common tool for home-based providers. If you run a licensed home program, check your QRIS framework to confirm which scale applies to you.

What happens if your ITERS score is below a 3?

A score below 3 on any subscale or on the overall average signals inadequate conditions. Depending on your state, that can trigger a corrective action plan, a follow-up observation within 90 to 180 days, suspension of subsidy payments, or removal from QRIS. A score of 1 on any item tied to a health or safety violation (propped bottles, unsafe sleep, physical discipline) may also kick off a separate licensing complaint investigation.

How often are ITERS observations conducted for licensed centers?

Frequency varies by state and by how you participate. Programs in QRIS usually get observed every one to three years for rating purposes. State licensing agencies that use environment rating scales on their own may observe on their standard inspection cycle, which in most states is annual or biennial. Programs holding CCDF quality improvement grants may agree to more frequent monitoring as a condition of the grant.

Do observers tell you your score on the day of the observation?

Usually no. Most QRIS and licensing programs require observers to finish scoring on their own and have it reviewed for reliability before results go out. Providers typically get written results within two to four weeks. Some programs offer a feedback conference where the observer walks through subscale scores and priority improvement areas. Ask your state QRIS office whether a feedback session is part of your process.

What qualifications do ITERS observers need to have?

ITERS-3 observers complete official training through Teachers College, Columbia University (which holds the ITERS-3 training license) and prove reliability on practice videos before running scored observations. Most state QRIS programs require observers to pass a reliability test with agreement at or above 85 percent within one point of a master score. Ask for your observer's credentials. A legitimate assessment program will hand them over.

Can you appeal an ITERS score you disagree with?

Most state QRIS programs have a formal appeals or review process. You usually have 15 to 30 days from getting your score report to file a request for review. Appeals typically mean a second observation by a different certified observer rather than a re-scoring of the original notes. Your state QRIS technical manual spells out the exact process. Keep a copy of your score report and document any conditions that may have differed on observation day.

Does having a high ITERS score guarantee a licensing renewal?

No. ITERS is a quality measurement tool, not a licensing checklist. Your state's licensing standards are separate rules covering staff-to-child ratios, physical space minimums, health and safety codes, and staff qualifications. A high ITERS score shows quality practice but doesn't substitute for meeting every specific licensing regulation. You have to satisfy both independently.

What is the average ITERS score across licensed centers in the U.S.?

Published research suggests average ITERS scores in licensed center infant and toddler rooms cluster between 3.0 and 4.5, with language and interaction the weakest subscales. A 2019 review in the Early Childhood Education Journal found language subscale averages often in the 3.0 to 4.0 range across state QRIS data. Reaching 5.0 or above puts a program in the upper quality tier for most benchmarks.

How do infant-to-staff ratios affect ITERS scores?

Ratios aren't a scored ITERS item on their own, but they shape almost every interaction and supervision item. When a caregiver has more infants than she can reasonably manage, responsive interaction drops, supervision lapses, and care routines get rushed. Licensing ratio requirements for infants are usually 1:3 or 1:4 depending on the state. Tighter ratios track with higher ITERS interaction subscale scores in the research literature.

Are there free resources to prepare for an ITERS assessment?

Yes. The Frank Porter Graham Child Development Institute at UNC-Chapel Hill publishes overview materials and training information at fpg.unc.edu. The Office of Child Care's National Center on Early Childhood Quality Assurance offers free technical assistance to providers in many states. Your state's Child Care Resource and Referral agency is also required under CCDF to offer quality improvement support, which often includes ITERS preparation coaching at no cost.

Sources

1. Frank Porter Graham Child Development Institute, UNC-Chapel Hill: ITERS-3 overview: ITERS-3 rates infant/toddler classrooms across 33 items in 6 subscales on a 1-7 scale; published reliability shows exact observer agreement at approximately 81 percent
2. National Center on Early Childhood Quality Assurance (NCECQA), Office of Child Care: 39 states plus D.C. operate QRIS programs; most use ITERS-3 or ITERS-R for infant/toddler classrooms; tiered reimbursement differentials can reach 10-30 percent per child
3. U.S. Department of Health and Human Services, Office of Child Care: CCDF Final Rule (45 CFR Part 98): CCDF Final Rule requires states to have health and safety standards for licensed providers and to link quality set-aside spending to measurable quality improvement
4. North Carolina Division of Child Development and Early Education: Rated License system: North Carolina uses environment rating scale scores as part of its 5-Star Rated License system, with higher stars requiring higher average classroom scores
5. National Database of Child Care Licensing Regulations, Child Care Aware of America: Most states require a minimum of 35 square feet of usable floor space per child; physical punishment is a licensing violation in every U.S. state
6. American Academy of Pediatrics: Safe Sleep and Infant Care Policy: AAP advises against propped bottles due to aspiration and ear infection risk; recommends infants be placed on their backs on firm surfaces with no soft bedding; recommends limiting time in infant seats and swings; advises against screen media for children under 24 months other than video chatting
7. Centers for Disease Control and Prevention: Childcare Health and Hygiene Guidance: CDC childcare guidance aligns with ITERS diapering and handwashing indicators including washing hands before and after diaper changes and sanitizing diapering surfaces between children
8. Harvard Center on the Developing Child: Science of Early Childhood Development: Researchers link serve-and-return verbal interaction (turn-taking in early conversations) directly to executive function and language outcomes in infants and toddlers
9. U.S. Department of Education: IDEA Part C (Individuals with Disabilities Education Act, Early Intervention): IDEA Part C covers children from birth through age 2 with developmental delays and requires that programs have processes for inclusion via Individualized Family Service Plans (IFSPs)
10. Early Childhood Education Journal: Review of ITERS and ECERS scores across state QRIS databases (2019): Language subscale averages in licensed infant/toddler rooms frequently landed in the 3.0 to 4.0 range across state QRIS data; staff-child verbal interaction items were among the lowest-scoring
11. Child Care Aware of America: 2023 Child Care Costs Report: Center-based infant care averaged $1,324 per month nationally in 2023, with wide variation by state