A childcare watchdog group is calling for tighter rules after a Rotorua toddler suffered brain damage after choking on an apple at his daycare centre.
A report by Dr Sarah Alexander of the watchdog group Child Forum says 22-month-old Neihana Renata suffered hypoxic brain damage after choking on an apple at Little Lights Kindy in the Rotorua suburb of Western Heights on May 31, 2016.
"The toddler now has a hypoxic brain injury and severe cerebral palsy - he is unable to talk, swallow normally or move his body," she said.
"Giving food, such as popcorn, nuts and raw apples, that young children can easily choke on is against health advice in New Zealand and internationally."
Alexander said Neihana was "normal for his age and had no health conditions or disabilities" before the accident.
But after choking on the apple he was in hospital for two months and since then has been back to hospital many times because he is prone to chest infections.
His mother, a fully qualified general practitioner, had to give up her work as a doctor to look after him.
The centre describes itself on its website as "underpinned by Christian values and beliefs". It was bought by Evolve Education Group, a company listed on the NZ sharemarket, in 2015.
Evolve has been contacted for comment.
The Ministry of Education was notified of the accident on the day it happened, but Alexander she said the ministry did not take any action to suspend the centre's licence or downgrade its licence to provisional.
"It seemed to treat the incident as an accident that could not have been prevented," she said.
"The ministry also did not question the first aid given to the child, for example was he first asked to try coughing?
"Why were (blind) mouth sweeps done and could this have contributed to the injury that resulted?
"The ministry made no contact with the family. The family were not informed of their right to make a complaint. The ministry's actions appeared aimed at keeping the incident quiet."
But the ministry's deputy secretary, Katrina Casey, said the case was already covered by standing advice to childcare centres.
"This terrible accident changed the lives of this child and his family forever," she said.
"We know young children are particularly susceptible to choking, even on things they may have eaten many times before or while under supervision, as was tragically the case here.
"WorkSafe NZ's report shows the centre followed first aid and supervision guidelines, had suitably trained staff and called emergency services immediately. Staff at the centre did all they could to help this little boy.
"Following WorkSafe NZ's investigation we worked with WorkSafe NZ to review our guidelines. We concluded that our existing guidelines for keeping children safe while eating were clear and fit for purpose.
"We reinforced the importance, more generally, of closely supervising children in our guidelines on hazard management. We communicated this to the sector through our early learning bulletin in May 2017.
"Our standing advice for the ECE sector links to the Ministry of Health's advice on preparing food safely for young children.
"We continue to share information and guidance to services on best practice education and care."