Based on the view that strong state child care licensing policies can influence the quality of child care and thereby enhance children's health and development, this report examines the status of state efforts to improve the quality of child care programs. Almost all data were collected for a 1993 Parenting Magazine survey, and were verified by state administrators. The report is divided into six sections. The first section summarizes the findings and identifies gaps in state efforts to protect children. The second section covers selected health and safety regulations. The third section describes state policies on caregiver-child ratios and maximum group sizes. The fourth section examines guarantees for parents to visit programs unannounced and compliance visits by state licensing staff. Exemptions from regulations for family child care providers are highlighted in the fifth section. The sixth section consists of appendixes on the importance of child care, liability insurance requirements, corporal punishment restrictions, and state contacts for child care licensing information. Key findings from the survey indicate that, although several states have improved efforts to protect children in child care, in a number of states, inadequate protections persist. Forty-five states require all children in child care to have basic immunizations, but 15 states do not require children to have the vaccine against bacterial meningitis. Twenty-two states do not require that family child care providers have first aid training. Eighteen states allow one caregiver to care for five 6-month-olds, but a majority of states require programs serving 6- to 12-month-olds to meet national recommendations on child-caregiver ratios. Almost half the states do not limit the number of children per group. Parents are generally allowed unrestricted access to their child's program, but many states have infrequent inspections of family day care homes. Appendices include a summary of the impact of child care on children and tables showing state requirements regarding liability insurance and corporal punishment. (KDFB)