IT was with great sadness that we learnt of the passing of five-month-old Adam Rayqal Mohd Sufi as a result of traumatic brain injuries. Our condolences to his grieving family.
As paediatricians, we would like to remind Malaysians that injuries are an important preventable cause of death among children. Studies published more than two decades ago as well as recently have shown that children under the age of two years admitted to Malaysian hospitals with unexplained head injuries are suspected to be victims of violence. A significant proportion of these have occurred on children receiving care outside their home in unregistered childcare facilities. Some have died and many more have been left permanently disabled. Apart from violence, poor supervision and unsafe care practices have also resulted in unintentional injuries, accidental drowning and inadvertent poisoning.
Children in the care of individuals who lack proper training and have a poor understanding of their developmental needs are vulnerable to injury. Lack of attention or ignorance about safe care practices, lax supervision, inadequate support or poor coping skills to deal with the needs and emotions of young children can have devastating consequences.
Prevention of such injuries requires commitment and a multi-pronged approach involving policy makers, legislators, law enforcement agencies, social services, healthcare providers, educators and the community at large. It is imperative that we apply our available knowledge and resources to prevent the recurrence of tragedies.
The Child Care Centre Act 1984 has provisions for the registration and regulation of childcare centres based in homes, workplaces or within the community under the director-general of social welfare. But there are gaps in enforcement.
An industry of home-based untrained child minders exists outside the scrutiny of the Department of Social Welfare. This has emerged in response to the demand for affordable childcare from working parents, especially those who perform shift duties.
Another loophole in the Child Care Centre Act 1984 is that it does not cover facilities which have evolved to provide a combination of kindergarten and childcare services. This limits mechanisms to monitor and address safety issues in such facilities.
In the absence of legislation governing the advertising of childcare, anyone can offer these services on social media and even label themselves as an informal organisation of childcare providers without a requirement for specific training, qualifications or adherence to minimum standards.
Our encounters with families of young children reveal that it is not uncommon for parents to engage childcare services advertised on social media without checking the background of care providers, verifying their registration status or inspecting their premises. Some parents are not able to provide details beyond a contact telephone number of the persons to whom they have entrusted their baby. In fact, there’s not even a house number or street address.
The proverb “It takes a village to raise a child” recognises that the upbringing of children is a collective responsibility. In traditional village communities, young mothers have benefited from the practical assistance, experience and wisdom of grandparents and older women.
We need a holistic approach to create alternative support systems for working parents in the urban setting, particularly those living in nuclear or single parent families who may be isolated from extended family support.
At the present time, parents in the lower and middle income bracket may compromise safety standards in their selection of child minders due to limited choice, lack of accessibility and lack of awareness. Many do not know what criteria to apply in their selection of a nursery or babysitter.
A study published recently found that the most common category of neglect experienced by primary school children in Selangor is lack of supervision. Thus, there is a need to educate parents about the importance of safe care and supervision of their children.
A range of solutions to address childcare is needed to suit the needs of families in different circumstances. It is heartening to note that there are initiatives to introduce workplace-based childcare services in various government agencies. The introduction of workplace-based nurseries and crèches would address the issues of convenience and accessibility.
Tax incentives and subsidies could promote the provision of these facilities by employers, as well as reduce the financial burden of families. Other options that should be considered are more flexible working hours and extended maternity leave.
A recent postgraduate study which examined injuries and sexual assaults on children who were poorly supervised found that poverty was an associated factor. In families struggling below the poverty line, mothers work for a meagre income just to pay for basic necessities, leaving their children unsupervised or receiving substandard care.
A safety net that provides the basic necessities for young children within these families may reduce their financial burden, enabling mothers to exercise the choice to focus on caring for their children.
Commitment to the safety of children needs to be exercised in every sphere of family and community life, with coordination and cooperation across different agencies. For example, public education and tax exemption for the sale of child car seats should precede legislation to make their use compulsory.
It is the basic right of children to receive adequate care and protection. They should not be sidelined or ignored because of their inability to vote or demand their rights. We have a collective responsibility to speak up and act in their best interests.
ASSOCIATE PROFESSOR DR MARY JOSEPH MARRET
Chair, MPA Child Protection Subcommittee
ASSOCIATE PROFESSOR DR MUHAMMAD YAZID JALALUDIN
President, Malaysian Paediatric Association