The number of children who were seriously injured in childcare facilities increased by over 50% last year.
According to Freedom of Information figures released to Newstalk, 271 children needed urgent medical treatment in 2019.
A serious injury to a child in an early years service is one that requires immediate medical treatment.
Tusla says this could include a child tripping, spilling tea over their arm or cutting their finger on a door.
The child and family agency says 180 children were seriously injured in pre-school services in 2018 - but this rose to 271 last year.
Kerri Smith is assistant director for children's services with Barnardos, and she says children do inevitably hurt themselves while playing.
She said: "One would expect that children will have some injuries.
"You're talking about children aged between two and five years of age. They're outside exploring, climbing, using climbing equipment, digging etc..."
Tusla says the increase last year is down to increased reporting, after an awareness campaign.
11 children also went missing in early years services in 2019.
Tusla says this could include a child being unaccounted for, but remaining on the premises.