OCEANSIDE -- On the playground at the Together We Grow day care center in Oceanside, 8-year-old Ojani Masedo blows soapy bubbles through a wand with his friends and classmates. Nearby, Austin Laser, 4, enjoys pouring and serving pretend milkshakes.

The boys are bright-eyed and full of energy, though Ojani blows his bubbles from a prone position on the grass underneath a canopy. He is paralyzed from the waist down from the birth defect spina bifida.

The Explorers and Pirates group at the day care center is a mix of typical kids like Austin and special-needs kids like Ojani. Blending the two groups was the idea of Carlsbad resident Terry Racciato, who founded Together We Grow and opened the company's first day care center in Kearny Mesa in 1991.

Racciato opened the Oceanside center in 2001.

Roughly half the children at the center are what the state considers "medically fragile" --- children with chronic conditions such as diabetes, asthma or cerebral palsy. They are kids who require full-time nursing care but who, with help, can often be eventually mainstreamed into regular public schools.

Racciato said the children in her care -- whether typical or medically fragile -- are more alike than they are different.

"They are all happy, energetic kids, and some have these things on the side," said Racciato of her charges. "It's no different than if you -- or someone you know -- wears glasses (for poor eyesight). You learn to make accommodations for your disability, and then you and others learn to accept that accommodation."

A new way of looking at differences

Racciato said her two day care centers are the only ones of their kind in the state.

There are a handful of other pediatric health day care facilities in California, but Together We Grow is the only place with a nearly 50/50 split of typical to medically frail children, brought together in one environment, she said.

The Kearny Mesa and Oceanside centers both offer overnight stays or respite care to give parents a night or two off from the arduous task of caring for a medically fragile child.

Respite care has been particularly helpful to the Gough family, whose son William is 4 years old and severely disabled with an undiagnosed genetic disorder.

"That (respite care) has been really huge for us," said Mark Gough, who with his wife, Tina, has three other typical children.

"They do an outstanding job and we have seen a noticeable change with our son," Gough said. "He can watch the other (typical) kids do things."

Gough said his son recently learned how to reach out to grab toys -- something he didn't do before starting at the day care center five or six months ago.

Accommodating each child's health needs is part of everyday life at the school. Monitoring vital signs, regular blood checks and many treatments are carried out in plain sight of the other children.

"They (the medically fragile children) are not pulled away from the playground," said Janet Racciato, 35, director of the Oceanside center and Terry's daughter-in-law. "That way, it's not scary and they can just play and just be kids."

A registered nurse, Terry Racciato said she began her mission to improve pediatric care back in the 1980s when she lobbied the state legislature for MediCal to help families of medically frail children pay for day care and respite care.

When she formed her center in Kearny Mesa, the paperwork to license such a facility was onerous, she said.

"Back in the beginning of the process, they had no idea what to do with us," she said.

"In the early 90s, pediatric health care centers had the same regulations as a nursing home, so we had to provide a place for conjugal visits and a smoking area," she said, laughing. "I told them, 'only with the parents' permission.'"

Racciato said workers also had to fill out field-trip permission forms in order to move children from typical classrooms to those for the medically fragile.

Learning and playing together

Getting the kids together benefits everyone, she and her staff members said. The typical children learn acceptance, and all the children learn the social skills they will need in regular school -- how to get in line, sit quietly in circle time and share well with others.

The medically fragile kids also learn how to cope with the sometimes unkind treatment in the outside world.

Racciato said she likes to tell the story of a student named Mario who was missing an eye. She said that when he first came to the school, he was terribly shy and always wore a baseball cap low on his head.

For months, she said, he wouldn't participate in activities -- until he established a close friendship with another student named Sam. The friendship gave Mario confidence and helped him realize he was a regular kid.

"The class went to a field trip at the zoo, and another group of kids were laughing and teasing Mario, pointing at his eye," recalled Racciato. "And after they were gone, when we asked Mario if he was OK, he just said, 'They were weird.' "

Racciato said that months later, Sam's mother told her that on her Sam's first day of kindergarten, he was the first to help a fellow student -- who was blind -- to navigate the playground.

Empathy spreads

Kim Becker, a teacher at the Oceanside center, said that all of the typical children also learn the valuable lesson of acceptance.

"When Austin first came here, he was very timid with the kids with disabilities," Becker said. "But now he is the first to move a chair away to help someone through in a wheelchair, and he is one of our biggest helpers. … I think it is good for all of them to be exposed to all kinds of kids."

Austin's mother, Rebecca Laser, said she chose the day care center for many reasons, including the fact that it is near the Oceanside police station where her ex-husband works. She said she also likes that the center has a skilled nursing staff.

But mostly, she said, she chose the center because she hoped the experience would teach her son compassion. Now almost 5, Austin will leave the center in the fall to start kindergarten.

"If there was anything I could teach him, it is that people are different and those differences are not bad or good," said Laser. "My mom lives with me and she'll be 81 and uses a walker, and I think it (the experience) has helped him know how to deal with her. He is very attentive to her needs."

Another employee, Kim Cierzan, whose daughter, Natalie, is in Becker's class, said she thinks being at the center has been enriching for them both.

"I think our kids have a tendency to look at things differently," she said. "Instead of just seeing a kid in a wheelchair, they will comment on how cool it is to have wheels that light up."

Contact staff writer Ruth Marvin Webster at (760) 901-4074 or rwebster@nctimes.com.