Neihana Renata is severely brain damaged after choking on apple at his Rotorua daycare - food which Government guidelines say is not recommended. Despite public pressure this week, the Ministry of Education says it will not change its policy, meaning other centres can continue legally feeding high-risk foods to children. Kelly Makiha reports.
It is just over a year after Marama Renata's active, chatty and loving little boy changed forever.
The Rotorua mother was at a rare community outing when the unthinkable happened.
A child choked on food. An adult tried her best to dislodge it, but the infant continued to struggle breathing.
Marama, a fully qualified general practitioner, took the child, encouraged him to cough, tipped him forward and slapped him firmly on the back between the shoulder blades five times. The child vomited, breathed and, most likely, his life was saved.
But Marama bursts into tears. Why wasn't anyone able to save her wee boy in 2016 when he choked at Little Lights Kindy on an apple that health guidelines say he shouldn't have been given, was starved of oxygen for 30 minutes and left severely brain damaged?
That's the question she and husband Wi, a manager at a log processing yard in Kawerau, want answers to. They also want the Ministry of Education to change childcare centre policy to ensure high-risk foods are not served to those under 3.
The Renatas don't blame the staff at the kindy for what happened. But they also say there are simple measures that can be put in place to prevent it from happening again.
The family have this week broken their silence about their tragedy when their twin son, Neihana, choked during afternoon tea on May 31, 2016.
It has taken the Renatas nearly three years to speak publicly about the incident and they have only done so after failing to get change.
ACC records show two children under the age of 5 choke each week in New Zealand to the point where they need medical treatment.
The Rotorua Daily Post asked the ministry this week what it would take to change its policy.
In a written response it said it had concluded "existing guidelines for keeping children safe while eating were clear and fit for purpose". The ministry said it links the Ministry of Health's advice on preparing food on its website and it had reinforced the importance of supervising children while eating in its bulletin published in May 2017.
Marama said she was "highly disappointed" the ministry was refusing to acknowledge they could improve.
WorkSafe's report into the incident, which the Renatas had to get through an Official Information Act request, concluded the incident was unpreventable, the centre staff followed first aid and supervision guidelines, had suitably trained staff and called emergency services immediately.
However, the Renatas wrote to the Ombudsman requesting a review of the report as they said it was never ascertained whether appropriate first aid was given as not all staff present were interviewed.
They told the Ombudsman the report was flawed as it lacked details, failed to consider all information and lacked a convincing recommendation. The Ombudsman referred the family to the chief executive of WorkSafe.
WorkSafe said its investigation was thorough and reviewed extensively. It concluded there were no breaches of the Health and Safety at Work Act 2015.
Marama said it wasn't clear what happened on the day Neihana choked. However, from reports and discussions with staff, they understood an ambulance was called, staff tried to dislodge the apple by doing the Heimlich manoeuvre, black slaps and chest compressions. The staff also did mouth sweeps twice, which is not recommended when someone is choking.
Neihana now has a hypoxic brain injury and severe cerebral palsy. He is unable to talk, swallow normally or move his body.
Dr Sarah Alexander, of the watchdog group Child Forum, has helped the family seek answers and change.
In her report, released this week, she said the Ministry of Education did not question the first aid given to the child, made no contact with the family and failed to tell the family of their right to make a complaint.
She said in her report the ministry's actions appeared aimed at keeping the incident quiet.
Marama and Wi told the Rotorua Daily Post they found it odd there had been no formal acknowledgement or contact from both the Ministry of Education or Evolve Education Group, the company that owns the kindergarten.
They said it was left up to staff from the kindergarten to visit them in their own time to express their sympathies.
"I just thought it would have been decency when something bad happens," Marama said.
Medical experts have told the Renatas they have no expectations for Neihana's future but his parents are happy he has made some progress.
"He's becoming more reactive and that means so much for us. It's nice for us to see he is happy because you get something back," Marama said.
The family juggles his care between his endless appointments, therapy sessions and education. His care is carefully mapped out down to the day and hour on diagrams displayed in their lounge.
With help from ACC carers and Marama's mother, Janet Wepa, described as their "biggest support, they get by.
"What has really helped us is our faith," Marama said. "And each other. We are stronger as a result of it."
She said it made her sad she hadn't been able to experience the joy of having twins.
"We were just coming through the fog and finally getting the benefits of twins and then this happened."
She said Neihana's twin sister, Aotea, was also a constant reminder of what they were missing.
"She develops and I see how he should be. Plus, she misses her playmate."
Aotea told the Rotorua Daily Post this week while hugging her brother tightly that she loves him and she wants to look after him.
"I want to be kind to him ... and I want to be kind to my mum and dad."
Response from the Ministry of Education
Young children are susceptible to choking, even on things they might have eaten many times before or while under supervision, Ministry of Education sector enablement and support deputy secretary Katrina Casey says.
She said a WorkSafe report showed 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.
"The centre communicated to its parents about this event the day after it occurred and we supported them in this."
She said the ministry worked with WorkSafe to review its guidelines around food safety and concluded they were fit for purpose.
"We categorically refute any suggestion that this situation was kept hidden. In any event, our duty of care is to do what we can to support affected children and their families, to ensure these events are appropriately investigated, changes in practice introduced if required and to ensure Early Learning Services have access to the latest advice on best practice education and care. This is what happened following this accident."
She said the accident was formally reported and recorded but the ministry only started publicly releasing incident notifications in 2017.
The ministry did not answer specific questions why it did not contact the family directly after the incident and why it did not inform the family of its right to make a complaint.
Response from Evolve Education Group
Evolve Education Group says the kindy has changed its food policy and no longer serves apple or equivalent hard vegetables or fruit to those under 3 unless it is peeled and grated, peeled and cooked or peeled and pureed or mashed.
In response to written questions, chief executive officer Rosanne Graham said they were continuing to support their teachers who were "impacted by the traumatic event, despite doing all they could to respond to the situation".
"While investigations into the incident found that practices and policies met national guidelines, and our teachers did all they could, our hearts continue to go out to Neihana and his family and all those impacted," Graham said.
When asked why it had not made contact with the family after the incident, the statement said it couldn't answer specific questions because operational members of the executive team had only been at Evolve for less than nine months.
Response from WorkSafe
WorkSafe chief inspector Hayden Mander says its investigation was thorough and reviewed extensively and it is satisfied with its final report.
"The Ministry of Education was considered the most appropriate agency to distribute learnings to the sector. First aid training at the childcare centre was in line with guidelines and we interviewed key staff members that were with the victim at the time of the incident as well as the manager of the centre."
When asked why it hadn't supplied the Ministry of Education with a copy of its critique of the report, as it promised to do, Mander said: "This was a regrettable administrative oversight which we corrected as soon as the error was alerted to us."
He said all requests for copies of WorkSafe reports were handled as Official Information Act requests, whether they were interested parties or not, as it "gives us the opportunity to review the report for privacy considerations".
The Renatas' wish list
• WorkSafe to have found the apple was not appropriately prepared according to Ministry of Health guidelines.
• WorkSafe to have recommended the Ministry of Education make food guidelines policy.
• Evolve to have met formally with family.
• Ministry of Education to have formally acknowledged and supported the family immediately after the incident.
• The industry made aware of the incident, learnings made known and followed.
• More education to the general public about preparing food safely for children.