A Therapeutic Day Nursery*

The conference held on the occasion of the thirty fifth anniversary of the Leyden Child Guidance Clinic marked a stage in the evolution of the Child Guidance Clinic towards a comprehensive mental health service for children. It is gratifying that, after a long period when there was much groundwork to be done and resistance to be overcome, co-operation has now been extended by the various services such as the Municipal Departments of Education and Health, the Paediatric Department of the Leyden University Hospital and the Dutch Society of Psycho-Analysis.

Provisions to be made in Leyden as the centre of a region are specialised well-baby and child guidance clinics, a normal nursery school for training of staff, psychotherapeutic guidance of sick pre-school children in co-operation with the paediatric staff, inpatient treatment for seriously disturbed children, clinic for parent guidance and child psychotherapy, foster home service for homeless children, and day nurseries. In addition mental hygiene should be sufficiently represented in each local well-baby clinic, toddler clinic and nursery school. In such a comprehensive programme many child psychotherapists are needed. These specialists are almost entirely lacking in the Netherlands: we are therefore planning to set up an appropriate training for child psychotherapists.

In the decade following the second World War day nurseries in Holland came into being. Subsequently the needs of the handicapped children became apparent: those of the oligophrenic, physically handicapped and psychotic children. These children could not be accommodated in the existing day nurseries and nursery schools, and the situation became steadily more acute.

The increase in the number of handicapped children in need of care is both real and merely apparent. It is real in so far as improved care has led to a decrease in the mortality rate of children with severe congenital malformations. It is only apparent in so far as it results from an increase