Report by ANGELA SINGER THE mother of a baby girl who choked on a piece of apple at a Cambourne nursery told an inquest of her earlier concerns about the staff there and the level of care. She said that only days before her daughter s death she had asked

Georgia's parents Jason  and Sharon Hollick.

Report by ANGELA SINGER

THE mother of a baby girl who choked on a piece of apple at a Cambourne nursery told an inquest of her earlier concerns about the staff there and the level of care.

She said that only days before her daughter's death she had asked the nursery to feed the child in a high chair instead of on the floor - after finding her sitting on the floor soaking wet and surrounded by strawberries she had been feeding herself.

A few days later, the baby was fed a piece of apple sitting on the floor and choked to death. Sharon Hollick, whose 10-month old baby daughter, Georgia, died on April 19, said food and drink parents took in for their children was not given to them. "I placed food and drink in the fridge myself and I noticed that bottles supplied by parents had not been taken out of their bags."

Mrs Hollick added that after her daughter died, she gave Georgia's full bottle of water to the police. The inquest heard that Mrs Hollick had supplied yoghurt for Georgia, who was being weaned, as a substitute for her bottle. However, on the day she died, Georgia had not been given her yoghurt. She had been tired and whimpering and had been given a piece of apple as she sat on the floor.

The nursery nurse in charge, Carla Woods, told the inquest she had been too busy cutting up the apple to give Georgia her yoghurt. She had asked someone else to cut up the apple but her colleague had said she had to get ready to show the nursery to prospective parents.

Farrah Mauladad, representing the Hollick family, said they believed that if Georgia had been given her yoghurt, she would not have wanted the apple. A post mortem examination found a piece of apple measuring less than a centimetre (0.8cm - about the size of a baked bean) had gone down Georgia's windpipe and lodged in one of her bronchial tubes.

The inquest, at Shire Hall in Cambridge, where Coroner, David Morris sat with a jury, heard that on the morning Georgia died, there had been three staff to four babies in the room, and one member of staff was sitting next to her.

Nursery assistant, Samantha Lloyd, said she was giving apple to another child when she realised Georgia was choking. She put her over her shoulder and patted her back. Then Ms Woods took the child, lay her face down on her arm and started to hit her back to dislodge the obstruction.

Neither of them had up-to-date first aid training. Another nursery nurse, Charlene Smith, who was in an adjoining room separated by a baby gate, was a trained first-aider, but told the inquest she could not leave her room because two babies were sleeping there. She called out to the other two from across the room to strike the baby higher up between the shoulder blades and not to put their fingers into her mouth.

She said Ms Woods and Ms Lloyd turned the baby on her back to look into her mouth and after that she stopped moving. Ms Woods said she first asked Ms Lloyd to fetch some water, then immediately changed her mind and told her to bring the nursery manager, Julie Haynes who she thought could hit the child harder because she was in charge. The inquest heard that by the time Mrs Haynes was given Georgia, the child was already floppy and not moving.

Mrs Haynes, who had at that time been manager for only six weeks, said: "Her head flopped, there was no control over her head or arms and she started to go blue." She told coroner David Morris, sitting with a jury in Cambridge: "My intentions were to get Georgia to breathe and save her life but I couldn't do it."

The inquest heard that Mrs Haynes had 30 years of experience in child care. She had worked in the special care baby unit at Peterborough Hospital and run a residential care home for children but had never carried out resuscitation procedures on a baby before, though she had seen it done. Peter Kilburn, area manager for Ofsted at the time of the incident, which closed the nursery for investigation and then cleared it to reopen, said: "There is a difference between having a first aid certificate and putting it into practice. There is a perception that the staff were panicked by the incident and hadn't fully put into practice their training. They need to practice in a safe environment. Being able to deal with an incident when it occurs is not the same as having theoretical knowledge."

Dr Peter Heinz, consultant paediatrician at Addenbrooke's in Cambridge, who tried to revive Georgia once she reached the hospital, said: "Once a cough fails, everything else from then onwards is a measure of desperation. It is a matter of mimicking the cough to dislodge what is in the airway. The usual action is to compress the chest and give sharp blows to the back."

He added: "Giving resuscitation risks pushing the blockage further but there is no choice because the child needs air. Trying to remove an obstruction and ventilate an unconscious child is a complex operation, there are no clear guidelines, even medical personnel sometimes get it wrong. It is not an easy thing to do."

Detective Superintendent John Raine, whose team investigated the incident, told the court that at first "there were reasonable grounds to suspect evidence of neglect".

However, he concluded: "There was no personal or corporate liability. It was a tragic accident, notwithstanding some identified shortcomings." The inquest had heard about gaps in staff training and a lack of written policies on procedures and a failure to log complaints including those from Mrs Hollick, whose three year old daughter, Jasmine was also at the nursery. After the jury's majority verdict of accidental death, a statement on behalf of Sharon Hollick and her husband Jason was read out by their solicitor, Robert Curry.

The couple said Georgia was a smiling, happy and contented baby. The jury had heard that her mother had asked for her to be fed in a high chair. Instead she was given a piece of apple sitting on the floor and she had choked. They understood the interest of the press and public but asked them to respect the need for the family to reflect on their wonderful 10 months with their daughter and move on.

Jonathan Bell, managing director of Just Learning, a chain which opened in Darlington in 1996 and now has 49 nurseries in England, said there had been a lot of evidence and he would reflect on what he had heard. In a statement he said: "We want to place on record the sadness felt by everyone at the nursery. Georgia and her family are never far from our thoughts. We pay tribute to the courage and dignity displayed by Georgia's family in the face of their dreadful loss."

What the experts said

# Dr David Vickers, consultant paediatrician, asked by the police to help investigate the event, told the court the key point was that the apple should have been given under supervision. "Children need to be supervised with solid foods at that age. Somebody being around doing something else is not the same thing. It means watching, not just being there." He added that when a child is choking "ideally, you should tip them up and also apply pressure to the abdomen".

# Carol Archibald, team leader for health and safety at Cambridgeshire County Council, told the inquest there was very contradictory evidence on whether babies being weaned should be given apple. She added: "There are a number of benefits to being seated round a table, it is easier to supervise and the eye contact is better."

# Detective Superintendent John Raine said the evidence from dieticians, including those from the NHS, the National Childbirth Trust and the Vegetarian Society, on whether 10-month old babies should have apple was varied. Some sources said yes, others said leave hard fruit until later.