How Safe are our Children in Nurseries?

In the present generation, where both parents often tend to be employed, many parents send their young children to nurseries or other child care services. When we entrust our much loved children into the care of others, we need to ask how competent are these individuals to look after our children when emergencies occur.

The Clinical Research Centre (CRC) at Perak recently audited 42 registered nurseries as to their knowledge in managing emergencies. This study tested the knowledge of Kinta district nursery teachers on paediatric emergencies. We included 6 common emergencies: choking, poisoning, seizures, drowning, head injuries and simple fractures. We had approached 81 registered nurseries and 42 consented to participate in the study. The most senior teacher from each nursery was approached to participate. They were given 6 different scenarios and were asked to identify the emergency and outline the first aid steps that they would perform to help the child.

The results were not encouraging. Remember that this evaluation is based on the most senior/experienced person in the centre and that 69% of participants had prior first aid training. Although teachers were good in identifying the emergencies, none of them (0%) possessed good or average knowledge in managing common emergencies (see info-graphic attached). The majority knew less that 70% of the right steps to take and were often out of sequence. Only 4 nurseries had first aid algorithms to refer to during an emergency and these teachers tended to faired better in the assessment


Current policies require registered nurses to have some minimum safety standards. These include making available a first aid kit (all but one nursery audited had first aid kits available) and having some training in handling emergencies (69% had prior first aid training). But our study shows that these are insufficient to support our young children.

We would like to thank these nurseries for the courage to allow us to audit them. This offered them opportunities to improve the quality of care at their centre. Participating nurseries were given a copy of the algorithms to serve as a reference guide in case of an emergency.

We are certain that teachers working at nurseries would like to have the knowledge and skills to support children when faced with an emergency. Calling for help, while useful, may take too long to help a child. We recommend that all nurseries have:
1. Display important first aid algorithms to aid action during emergencies (available from this link: or ).
2. A complete first aid kit that is checked periodically.
3. Have all teachers trained in first aid. This should include a formal Paediatric Basic Life Support (BLS) course for at least one staff member.
4. We also strongly encourage parents to evaluate the safety profile of nurseries before enrolling their children.

If this study showed the limited safety capacity of registered nurseries, imagine the situation in the numerous unregistered child care providers and nurseries in our country! We need to work together as a society to improve the quality and safety of child care providers and nurseries in our country.

Thank you.

Dr Arvinder Singh HS, Research Officer
Dato’ Dr Amar-Singh HSS, Head
Clinical Research Centre Perak

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