Forum: Mega childcare centres should employ trained paediatric nurse

As a paediatrician, I can fully understand Ms Jasmine Tay's concerns and those of parents when their children fall sick (Biggest headache in parenting is when a child falls ill, Nov 19).

They suffer from sleep deprivation as they monitor and try to settle their child through the night. Even if they have support from the grandparents the next day, they are tired and anxious over their sick child, wondering if the condition is serious. They feel inadequate, lost and exhausted.

They usually discover that their child is sick when they come back from work but, by then, the polyclinics are closed. Some general practitioners are available but they may be busy and stop consultations by 9pm. Only the Children's Emergency at KK Women's and Children's Hospital and the National University Hospital are available. These centres triage the sicker children, resulting in those who may just have a fever waiting for several hours.

I have a couple of suggestions.

There are at present nine mega childcare centres in Singapore, each taking 300 to 600 children. By next year, five more will be added, with some able to take up to 1,000 children.

With more resources, these centres should be able to employ a paediatric trained nurse who, with a letter of instruction from doctors, can look after the child in the sick bay, isolated from the rest of the children. There must be proper criteria for these children to be admitted to the sick bay. Those with infectious diseases will either have to be cohorted or not admitted.

Second, I find that the children in infant care centres are worse hit as they are younger and more vulnerable. Furthermore, they tend to take a longer time to recover once they are down. At present, infant care centres take in children from three months to 18 months old. It is usually the mobile toddlers who move around who transmit the viruses to the immobile younger ones.

Mega centres should consider cohorting infants from three months to 12 months old and the other groups from 12 months to 36 months old and 36 months to six years old.

Finally, family physicians, paediatricians and those in restructured hospitals need to come together to see how we can provide the best support and care for children and their parents.

Ong Eng Keow (Dr)