This report is organized as follows. The opening section provides background and context, reviewing the latest findings on the importance of the earliest years--and especially the quality of early experiences and interactions with parents and caregivers--in terms of children's developmental outcomes. The second section focuses on supporting families as the first and most important influence on a child's well-being and early development. The next section addresses the enormous challenge of making child care affordable for families followed by a discussion on the issue of child care workforce quality as an essential element of ensuring quality care. The final section examines the impacts of the current opioid crisis on young children. In each section, a discussion of key issues and challenges is followed by a set of recommendations. Together, we believe these recommendations can unite policy makers and stakeholders from across the political spectrum in meaningful steps toward improving the well-being and life chances of America's youngest children. (author abstract)