MATSUYAMA, Japan - Three years after choking on pieces of apple at a nursery school in western Japan, 3-year-old Koshi Tamura remains unconscious and dependent on a ventilator, cared for around the clock by his parents.
His weight has more than doubled since he returned home from hospital, and his father says the family has settled into the demanding routine of caring for him. But worries remain, from rising prices to what would happen if a natural disaster cut off power to the equipment keeping him alive.
During a rehabilitation session in June, a physical therapist gently worked Koshi's stiffened body. His arms and legs move slightly when he feels pain.
"He just tensed up there," his father, Atsushi, said as he watched.
Physical therapist Ryo Utsunomiya called out, "Time to stand up!" before moving Koshi from the bed and securing him upright in a medical standing frame to put weight on his legs, hips and bones.
"It's hard work, but I hope he can enjoy it," Utsunomiya said.
Popular music played in the room as the 90-minute rehabilitation session continued.
Utsunomiya said the effects of Koshi's brain damage mean some parts of his body tense up while others do not. His ankles, in particular, are becoming twisted as he grows, and without treatment he could eventually require surgery, making rehabilitation tailored to his condition essential.
The accident occurred on May 16, 2023, at Niihama-Jobu Nozomi Nursery in Niihama, Ehime Prefecture. Koshi, then 8 months old, choked on pieces of raw apple served as baby food.
He went into cardiac arrest due to asphyxiation and was not revived in time to prevent severe brain damage.
Koshi was discharged from hospital in December 2023, and his parents have cared for him in shifts ever since.
To prevent phlegm from accumulating in one area of his lungs, they change his position every two hours and make hourly entries in a notebook recording details including his position.
"Things have been more settled lately, so there's less to write down that concerns us," his mother, Saki, said with a smile.
Atsushi takes a similarly matter-of-fact view of their life.
"Raising a child is hard work anyway. He just needs a little more care than most," he said.
Koshi weighed 8 kilograms when he left hospital. He now weighs more than 17 kg.
But the family faces new concerns.
In July this year, the amount of medical supplies they received from the hospital was reduced. Their monthly allocation of tubes used to suction phlegm fell from 10 boxes to one, which they suspect may be partly due to rising prices.
They worry that reusing the tubes could increase the risk of pneumonia from bacteria, but have little choice other than to disinfect them thoroughly with alcohol.
Natural disasters pose another risk. A power outage could leave Koshi's ventilator and suction equipment unusable, so the family keeps two long-lasting batteries on hand.
Evacuation had also been a concern, but a lift-equipped welfare vehicle ordered by the family arrived this year, allowing Koshi to be taken in and out while remaining in his special-needs buggy.
The vehicle has opened up new possibilities for the family.
"We'd like to go farther afield, maybe camping," Atsushi said.
Still, uncertainty remains a constant part of their lives.
"Honestly, the worry of not knowing how long he will live is always with us," Saki said.
A Niihama city review committee identified multiple problems at the nursery and concluded that the baby food served to Koshi did not comply with national guidelines.
Atsushi's anger toward the nursery has not disappeared, but he knows nothing he says can undo what happened.
"There's no point saying things that won't turn back the clock," he said.
Instead, he hopes the accident will not be forgotten.
"When you are entrusted with children, you have a responsibility," he said. "I want them to think about the lives in their care."
