ATLANTIC CITY — Parents of medically fragile children have the same daily obligations as other mothers and fathers.

When they need day care, they must turn to specialists who have training to dispense medicines, look for warning symptoms and respond to emergencies.

Providence Pediatric Medical Daycare Inc., in Atlantic City, is one such business. The day care provider employs registered nurses, therapists and teachers to care for, educate and treat children with conditions ranging from asthma and diabetes to neurological impairments and feeding difficulties.

Owner Leeanna Roman Lozada bought the business in 1999. It has two centers in Camden and one in Atlantic City.

Lozada said the center tries to be a welcoming place for children as a day care that also provides ancillary medical services. The center is decorated in primary colors with children’s decorations in every room, including the medical examining room, which features a mural of a giant orca leaping out of the water.

Several rooms have medical equipment that is overshadowed by the pint-sized children’s furniture, toys and games.

One rolling medical cabinet was repurposed for storage with telltale labels: puzzles, music toys and coloring books.

Lozada said children with special needs sometimes live more isolated social lives than healthier children. One important function of the daycare center is to provide a social outlet so these children can play with others.

“A lot of sick children end up spending a lot of time in the house alone. They need the socialization they get here,” she said. “It’s one of our biggest goals.”

Medical day care centers in New Jersey face more intensive licensing than traditional centers. And insurance coverage is incredibly expensive, she said.

“We spend $110,000 per year on insurance alone,” said Lozada, of Lumberton, Burlington County.

Providence is suing the state to expand its list of enrollment beyond the 27 currently allowed.

Lozada said the Atlantic City center is large enough to accommodate as many as 65 children comfortably. The company decided to save money by hiring its own therapists instead of outsourcing those services. So, it makes more financial sense to increase enrollment, she said.

“There is no logical reason for our center to be limited to 27 children,” she said.

This was a point that several other independently owned pediatric medical day cares made to the state Department of Health and Human Services when the agency was amending its rules in 2009. When asked about the basis for the enrollment figures, the agency referenced the explanation it published in the New Jersey Register when it proposed the amendments.

The enrollment limit was determined as part of a 1989 model developed by the Robert Wood Johnson Foundation.

“A considerable body of research supports a finding that a smaller facilitywide census mitigates health and safety concerns,” the state concluded.

Likewise, children from 1 to 3 years old are less likely to spread colds, flu or other infectious diseases in smaller group settings, the state found.

Lozada and other pediatric centers argued that total enrollment is less relevant than the staff-to-children ratio, which would remain at 1-to-3 in keeping with state law.

Most of the center’s children come from eastern Atlantic County, including Pleasantville, Egg Harbor Township and Somers Point. The center accepts only children ages 5 or younger, so spaces regularly open up, Lozada said.

Staff are trained in cardiopulmonary resuscitation along with pediatric advanced life support.

But they also have registered nurses who can give shots or administer other medicines the children need during the course of a day.

Stephanie Kane, a registered nurse from Egg Harbor Township, said she has worked in hospitals and most recently taught other nurses.

“But I love working with kids. We feel we’re making a difference in children’s lives,” Kane said.

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