Comprehensive early care and education policies that start at birth have the potential to identify health and developmental issues, link families to necessary supports, and assure that those who care for very young children have the tools to stimulate healthy child development. A growing number of states are interested in helping the educational and life prospects of poor children, but are looking for guidance on how to build a continuum of early care and education policies that start at birth. This policy paper points to a number of illustrative strategies and ideas that could be employed by states to build a birth to 5 early care and education system. More research into state initiatives for infants and toddlers is needed to draw distinctions between different state approaches. Finally, federal and state governments need to increase their focus on infants and toddlers, as well as funding for these initiatives, to ensure all young children have opportunities for positive early learning experiences that contribute to future success. The appendix contains a List of Primary Contacts for State Examples. (Contains 7 figures and 71 endnotes.)