The findings presented in this brief provide evidence that states are making changes in their licensing requirements and policies to protect the health and safety of children in out-of-home care. We found that nearly all states' licensing requirements address children’s health, nutrition, and medical care; supervision of children; and use of safe sleep practices with infants. States appear to recognize the key role that teaching staff play in the well-being of children in child care centers, with many adding requirements for educational qualifications, preservice training in health and safety topics, annual professional development, and criminal background checks for center staff. Manageable group sizes and child-staff ratios are also ways to keep children safe, and we found that some states improved their requirements in those key areas. In addition, the prevention of harm to children is related to how child care centers plan for and respond to emergencies and fires; several states increased their requirements in these areas. Licensing agencies have policies that address monitoring child care facilities for compliance with requirements, supporting child care providers to help them comply, and acting to enforce compliance when necessary. We found that more states are visiting child care facilities at least once a year, with nearly all states conducting unannounced inspections routinely. Also, more states are making licensing inspection reports available to the public by posting them on agency websites, giving families information they need to make choices about child care. (author abstract)