All nursery school staff should undergo paediatric first aid training, a coroner has said.
The plea came after an inquest jury concluded a nine-month-old girl died of misadventure when she choked on shepherd's pie on her third full day at a nursery in Cheadle Hulme, Greater Manchester.
Millie Thompson started coughing and crying in a high chair during her mashed lunchtime feed from a supervisor at Ramillies Hall private school before her lips turned blue.
The nursery supervisor - whose basic first aid certificate had expired - shouted for help and passed her on to a colleague who did have paediatric first aid training and proceeded to give her back slaps.
Millie's condition fluctuated and then deteriorated as an ambulance arrived 10 minutes after staff dialled 999 on October 23 last year.
There were no signs of life as she was taken to Stepping Hill Hospital and she was pronounced dead soon after arrival.
It emerged during the hearing at Oldham Magistrates' Court that Millie suffered a rare complication as a result of the choking in which air was able to get into her partially blocked airway but not out.
The trapped air placed pressure on her heart which led to a fatal cardiac arrest.
An expert witness in paediatrics told the inquest that the condition was uncommon.
The only effective treatment would have been a medical procedure where a needle is inserted to the chest to release the air pressure.
Paramedics are trained to carry out such a procedure but it would have been difficult to make the correct diagnosis in such a young child.
Nursery staff could also not be criticised for not recognising its nature. The jury agreed it was "a difficult to diagnose complication" and that in the circumstances they "did not believe that the outcome for Millie could have been different".
Ramillies Hall did fulfil its legal requirements in ensuring at least one staff member with a paediatric first aid training certificate was on the premises at any given time.
It emerged that all nursery employees had to undergo paediatric first aid training in the wake of Millie's death.
Following the verdict, South Manchester Coroner John Pollard said he would write to the Secretary of State for Education Michael Gove to ask that all nursery staff have such training.
He said sending the letter "as a matter of national importance".