First comes love, then comes marriage, then comes the baby in the baby carriage — and now Tennesseans can expect a piece of mail in their mailboxes shortly after that.
Starting this month, all Tennessee families with newborns will begin receiving informational packets about child development, parenting and state programs from the Tennessee Department of Health.
Officials say the "Welcome Baby" mailings — headed to 79,000 homes per year — will give parents helpful information about the early years of childhood and help the state confront infant health challenges, such as unsafe sleeping and inadequate nutrition.
"This time is such a critical time. It's also the time when parents have the most questions, and need answers," said Loraine Lucinski, state administrator for early childhood initiatives.
Drawing a connection from a child's vocabulary at 18 months to third grade reading scores to high school drop out rates, Lucinski said those early months of life set the stage for future success.
"We know that nurturing parenting really promotes that growth," she said.
The mailings will arrive in tall, white envelopes within a few weeks of every Tennessee baby's birth, or at least those known to state officials. They will include information on programs, pointers about infant health screenings, sign-up material for local chapters of Books from Birth and a congratulatory letter from first lady Crissy Haslam.
Select families will receive follow-up calls from a trained nurse, and about 15,000 will be offered a free, in-home visit. No matter which form of contact a family receives, they'll be able to learn about nutrition, breastfeeding, child development, immunizations and the effects of second-hand smoking, Lucinski said.
Sitting in the hospital Tuesday morning with their newborn baby boy, first-time parents Kristen and Kevin Deal, of Burns, said they would welcome the state's pointers.
The birth of baby Colton was a whirlwind. They said they could hardly believe he'd arrived.
"Nine months have literally flown by," said Kristen, a dental hygienist.
Colton's arrival at TriStar Centennial Women's and Children's Hospital was more dramatic than they expected, but the healthy boy already had his eyes open the next morning.
His parents were calm and grateful. But they knew their parenting had just begun.
"This is all new — so any kind of help we can get is great," said Kevin.
The couple wants to start a college fund right away, but they're not sure what to expect, day to day, with a little one in their home.
"We've got a lot of learning to do," Kevin said.
Looking for elevated risk
The "Welcome Baby" initiative identified 32 counties with high risks of infant mortality. The state will review birth certificates there for further signs of elevated risks to find families that would benefit from a phone call or in-home visit. They'll be looking for teen parents, single mothers and areas with high poverty, among other factors.
During home visits, the health worker will refer families to other programs. Lucinski said she hopes families will agree to additional visits to be timed at 6 months and 11 months into the child's life.
"It's saying to (parents): 'It's ok if you don't know everything, but these years are so important to your child's development.' "
The department is using approximately $1.3 million annually for the program — mostly federal dollars provided for home visitations. The department has the funding through 2016 and is looking for ways to sustain the program further, and will be surveying participants to gauge effectiveness.
It's the latest in a series of state efforts to bring down the state's above-average infant mortality rate, which improved between 2006 and 2010, the last year for which numbers are available. In addition to home visiting, Tennessee has been working to reduce unsafe sleeping deaths and to stop early elective deliveries.
Home visiting has become one of the best tools health officials have for helping children become healthy and successful, Lucinski said. She used to be a home visitor herself, she said, and that allowed her to see the relationship between parents and children.
Studies have shown that in-home programs help on measures of school readiness, prevention of child abuse and family economic self-sufficiency.
Lucinski wants Tennessee to establish a "culture of care."
"It's creating this idea that Tennessee has resources and we want you to use them for your child," she said. "I hope people start looking forward to their letter, and know that their neighbor got one."
And the letter from the first lady that each family receives — she hopes those land in the pages of baby books.