The majority of brain development happens before children enter the formal schooling system, positioning the early care and education system ("ECE system") to have a profound and long-lasting impact on a child's health, learning, and ability to regulate emotion. However, the current ECE system in the United States is fragmented, under-funded, and lacks cultural competence. As a result, many children are being cared for in a system that does not always have resources to support optimal development for all, setting the most vulnerable on a trajectory aimed lower than their peers. Providing examples from Indian Country, this article examines systemic barriers to equity, and how the system's fragmentation leads to lower child care outcomes in some communities. It is imperative that we strategically focus attention on aligning systems in a way that decreases health inequities. (author abstract)