An inquest into the death of a 4-year-old boy who was found unresponsive by crèche staff after he was left to sleep for almost three hours, has returned a verdict of death by natural causes.

The jury at the inquest into the death of Cillian O'Driscoll, from Parkgate, in Frankfield in Cork city recommended that in future all crèche staff should be made aware of policies and procedures in place and are regularly updated on any changes to them.

The 4-year-old died at Cork University Hospital on 14 December, 2018 after he was found unresponsive by crèche staff at Kindercare Childcare in Ballincollig.

The child, who had autism and was non-verbal, had been left asleep on cushions in a tree house in the pre-schooler room for more than two and a half hours.

Dr Margot Bolster told Cork City Coroner's Court that it was a very complex case, but it was her finding that that Cillian died of cardiorespiratory arrest due to myocarditis with a floral bronchitis pneumonia.

She said she believed the infection had been there for a couple of days, but that it might not have been apparent.

Cillian's father, John Paul, gave evidence of dropping Cillian and his brother at the Kindercare Childcare crèche in Ballincollig on the morning of 14 December 2018.

He said he was in good form and appeared well. Cillian had been attending the crèche since January and his mum would collect him in the afternoon.

But he got a call from the crèche at 2.30pm to say his son was unconscious and to come immediately.

His wife rang the crèche a number of times and the last time she called, a paramedic said Cillian was very ill and they were taking him to Cork University Hospital.

Mr O'Driscoll said they could tell how grave his condition was by the looks on the faces of staff.

Cillian was put on life support when he arrived at the hospital.

"Our little boy was no longer there - his body was listless, as were his eyes", Mr O'Driscoll said.

The couple hoped to donate Cillian's organs, but they started to fail and "we held his hand until his heart stopped beating", Mr O'Driscoll said in his statement to the court. 

Deirdre O'Driscoll described her eldest son as a lively boy, who loved the outdoors.

She said he had been diagnosed as autistic in June 2018 and she had secured a special needs assistant for him.

She told the court they loved to read his daily diary written up by his assistant to tell them how he was progressing.

She said Cillian had tonsillitis in November 2018 and the crèche had contacted them straight away, but they did not receive any text on 14 December.

Cillian's special needs assistant, Christine Murray, told the inquest that Cillian was playing in his comfort zone - a tree house in the pre-school room - when he fell asleep.

He was still asleep when she went off duty at 12.15pm.

Ciara O'Connor, one of two childcare workers in the pre-school room said they kept an eye on him through the bars of the tree house and saw him moving at around 1.15pm, but the alarm was raised at 2pm when he was found unresponsive.

She began CPR while waiting on the ambulance. She agreed with Senior Counsel Pearse Shreenan that no one was assigned to specially keep an eye on Cillian once his special needs assistant was gone.

Coroner Philip Comyn offered his deepest sympathies to his parents John Paul and Deirdre. He said he could not think of anything worse than losing a beloved child. 

He also addressed the crèche staff saying how difficult it is for them too losing a special child like Cillian.

But speaking this afternoon, Cillian's parents, in a statement read out by their solicitor Amy Connelly, said they could not understand how Tusla had allowed the crèche to operate without a sleep monitoring policy for toddlers.

"For the last two hours of his life, he was not checked at all. If Cillian had been checked, it is clear his evolving viral infection would have been spotted, and action taken and he would be with us today."