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Watch me grow Washington mail

Photo courtesy Watch Me Grow Washington

Watch Me Grow Washington: Where snail mail equals equity

State program reaches parents of nearly 90,000 new babies each year

My daughter was less than a month old when I received a tell-tale blue government issue envelope in my mailbox. Still recovering from a long birth and very sleep deprived, I’ll admit I was a little suspicious. 

“I’m not going to open it. You open it,” I dared her dad as I laid the envelope on the table. At 29, I assumed any mailing from the government contained bad news.

No need to worry

As it turned out, it was I who was wrong. Rather than bad news, the packet was full of baby health information, not the least of which were the key developmental milestones that we should look for and encourage in our newborn. It told us where to turn if we had concerns. After reading the contents and assessing my kid by those standards, I’m sure the glow of my pride would have been visible a mile away. Our plump baby was right on target. 

More importantly, the mailing, and several others that followed it that year, gave us both confidence as parents: We were doing all the right things by our child. Despite our foibles and mistakes – like the time we called Aunt Sheila at 3 a.m. to rescue us when our daughter would not stop crying – she was thriving.

More than three decades of parents

That letter came nearly 30 years ago. And a version of it is still being mailed to new parents today. 

The Watch Me Grow Washington mailing program (formerly called CHILD Profile) is operated by the Washington State Department of Health and is mailed to the parents of nearly 90,000 new babies born in Washington each year. It is the only such health and safety promotion program in the country.

Along with child development milestones, mailings offer new parents health, wellness, nutrition, vaccine and safety information in five posts during a baby’s first year. Parents continue to receive annual age-appropriate health and wellness mailings until a child reaches age 6. As of 2022, Watch Me Grow annually sends out 1.5 million mailings to parents — that’s  30,000 each week. 

Seattle’s Child talked to program supervisor Sherry Carlson, MPH, MCHES, at the health department’s Center for Health Promotion & Education, to learn more about the program. Here’s what we learned:

What’s the history of Watch Me Grow Washington?

Watch me grow washington mailWatch Me Grow Washington started in King County in 1991 when Public Health – Seattle & King County received a grant to develop CHILD Profile, a number of health and vaccine promotion materials for families. In 1993, CHILD Profile began sending materials in King and Snohomish counties, expanding to 12 additional counties in 1995. By 1998, the program was sending health materials to families across the state. 

Watch Me Grow washignton mailThe state health department took over the program in 2002 and in 2021 the program’s name was officially changed to Watch Me Grow Washington. 

What kind of information is mailed and where does it come from?

Each Watch Me Grow Washington mailing includes current thinking and evidence-based practice and research in several key child-health arenas, including the timing of well-child doctor visits, growth and child development, vaccines, nutrition and physical activity, safety, school readiness and family support and routines. Mailings are synced with the Academy of Pediatrics’ well-child visit schedule; each mailing is timed to arrive in the mail close to the time of a child’s next recommended doctor visit. 

“That way it provides information and can spark questions for parents to talk with their doctors about,” says Carlson. 

All of the infant and child health and wellness information shared in the mailings is developed from Bright Futures guidelines set by the American Academy of Pediatrics. Once drafted, any content in the 125 separate materials mailed by the program are reviewed by subject experts – for example, nurses, nutritionists, experts in child safety or environmental health officials. 

Program partners, including Seattle Children’s, Washington Poison Control and other organizations, also supply some content delivered through Watch Me Grow Washington.

Watch me grow washington mailing

What’s the goal of the mailing program?

According to Carlson, the main goal of Watch Me Grow Washington is to inform parents of childhood developmental milestones, share reminders for parents and caregivers about healthy behaviors like providing good nutrition to kids and encouraging physical activity, promote the safety and efficacy of vaccines and connect parents to resources. At the same time, the program seeks to encourage parents doing a good job with their children’s health and wellness to keep it up. 

“We’re highlighting what you should be looking at developmentally with your child and what you need to know to keep them safe,” she says. “But really we are trying to give parents support and reinforce the healthy parenting behavior that they’re already demonstrating. We do let them know about resources or services that might help them, but mostly it just helps parents know that they’re doing things right, they’re doing things well.”

Why snail mail?

Carlson says the program is mail-based rather than primarily website- or email-based because mailing to parents is the most equitable way to ensure all parents get the same information. 

“It doesn’t require the use of a computer or the internet or a smartphone. We do have those options available, but we find we’re able to give the same exact information across Washington State for all parents by mail and that equitable distribution of health and safety information provides a really big benefit to all. We try to make sure that all the resources we are promoting are available to everyone.” 

In an age of Googling and ample misinformation, Carlson says the state mailing system ensures that all families receive vetted, evidence-based child health information to inform their parenting. Not to mention that many parents like the novelty of opening a useful piece of mail (as opposed to the junk that piles up in the box). 

“Sometimes what happens online is a sense of overload and parents have told us it’s just nice to have something in your hand,” says Carlson.

Still, in case you missed a mailing or want to see what these information packets are all about, you can find them here on the DOH website. 

Wait a second! How’d they get my baby’s address?

Hospitals, birth centers and home midwives all send birth information to the state within days of a baby’s birth, including the address of the parents. Once it reaches the state, it is entered into the Washington State Immunization Information System (WAIIS). Each time a child gets a vaccine, it’s added to their WAIIS immunization record. 

Can you opt out?

Parents can opt their child out of the WAIIS, from receiving mailings, from state documenting of vaccination records or from both.

Why stop at age 6?

Carlson says a child “graduates” from Watch Me Grow mailings at age 6, “mainly due to budget constraints.” Still, parents have said they are interested in continuing to receive annual updates about their kids’ health and development, so Carlson says she plans to keep advocating to expand the program. She adds that a program cost-benefit analysis is underway. 

“We want to get to a point where we can say that every dollar spent in this program will save X amount in future healthcare costs for Washington,” Carlson says.

How effective is Watch Me Grow Washington at reaching parents?

Carlson reports that the program has a “98% reach.” That is, 98% of all families in Washington with children from birth to age 6 receive the 17 mailings that are the core of the program over the first six years of a child’s life. About five mailings are sent to parents of kids over the first two years of life, followed by one per year after that.

Are the materials available in languages other than English?

All Watch Me Grow Washington materials are available in English and Spanish. Carlson says the program is seeking funding for translations and printing in other languages.

Will the program eventually move to email and other digital delivery?

Carlson realizes that receiving mail is not everyone’s preferred style of communication, so materials are available by email as well. But so far, “pretty overwhelmingly, people still tell us they want the paper mail or prefer both paper and e-mail.”

Read more at Seattle’s Child:

“Early childhood evaluations help kids reach their developmental milestones”

“Why does breastmilk reduce allergies?”

About the Author

Cheryl Murfin

Cheryl Murfin is managing editor at Seattle's Child. She is also a certified doula, lactation educator for and a certified AWA writing workshop facilitator at