“Premature babies more likely to under perform at school, study finds,” reports The Independent. Results 
from a new study have prompted calls that some children should be held back a year before starting school.
Previous research has found that premature babies have worse school performance than babies born at term. A new study has investigated whether this poor performance could be due to premature babies being compared with children born at term who, even if they were born at the same time, are effectively older than they are.
In addition, children who are born prematurely may be enrolled at school a year earlier than predicted by their expected due date. For example, a premature baby born in July could start school a year earlier than if they had been born at full term in September. So they would be enrolled in school effectively a year early, leaving the child constantly struggling to keep up.
The researchers looked at performance on “key stage one” tests – a UK test of reading, writing and maths skills. They also looked at whether children were judged as having special educational needs.
The researchers found that children born premature are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.
However, the risk was greatly reduced for preterm children who, if they had been born on their expected date of delivery, would still have been in the same school year as their actual birth date put them in.
While school performance for children born preterm may improve by delaying entry to school, the social implications of being perceived to be “held back” (to be in a school year with younger children) could have an adverse effect on the child. As the researchers conclude “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.
Premature birth – reducing the risk
Premature births can happen in any pregnancy, whatever the general health and lifestyle of the pregnant woman. However, there are steps you can take to reduce the risk of having a premature birth, including:
- Avoiding potentially harmful substances such as alcohol, tobacco and drugs
- Trying to achieve or maintain a healthy weight
- Eating a healthy diet
For more information about health and wellbeing in pregnancy, visit the NHS Choices Pregnancy and baby guide.
Where did the story come from?
The study was carried out by researchers from the Neonatal Unit at North Bristol NHS Trust and the University of Bristol. No source of funding was reported.
The study was published in the peer-reviewed journal PLOS One. PLOS One is an open-access journal, which means that the article is available free of charge to read online or download.
The results of the study were well covered by the UK media. All three newspapers who reported on the study – The Independent, The Daily Telegraph and the Daily Mail – provide relevant commentary from independent childcare experts.
What kind of research was this?
This was a cohort study. Previous research has found that preterm babies have worse school performance than term babies. This study aimed to determine if some of this effect was due to preterm children being enrolled in school a year earlier than they would have been if they had been born at their expected due date. In the UK all children are offered a school placement based on their actual date of birth, rather than their expected due date.
To do this, they compared school performance in children born preterm who would have attended school in the same year if their expected date of delivery had been used rather than their actual date of delivery, to the school performance in children born at term.
A cohort study is the ideal study design to address this question.
What did the research involve?
The researchers analysed data from 11,990 children born in the Bristol area between April 1991 and December 1992 who were participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) – an ongoing cohort study.
Data on the gestational age at birth was extracted from clinical notes. The study included infants that were born between 23 and 42 weeks of gestation.
School performance was assessed using the results of key stage one (KS1) tests, which all children in mainstream education sit at the end of year two. In addition, teachers were sent a questionnaire that asked whether children had ever been recognised as having special educational needs.
The two primary outcomes were a low KS1 score (below 2, the expected standard in the “three Rs” of reading, writing and arithmetic), or having teacher-reported special educational needs.
The researchers looked to see if children who had been born preterm were at greater risk of low KS1 scores or having special educational needs, and whether this was due to them being placed in school a year earlier than if they had been born at term. To do this the researchers performed three analyses:
- One where each preterm infant was matched with up to 10 term infants based on their date of birth, and the outcomes for term and preterm infants compared
- One where each preterm infant was matched with 10 term infants based on their expected date of delivery, and the outcomes for term and preterm infants compared
- One where each preterm infant was matched to term infants based on their expected date of delivery and year of school attendance, and the outcomes for term and preterm infants compared
In this final analysis, the researchers compared the risk of low KS1 scores and special education needs only in infants who would still have been in the same school year if they had been born at their expected date of delivery rather than their actual date of delivery.
The researchers adjusted their results for a range of factors (confounders) that could influence academic performance. These included:
- Social factors (maternal age, socioeconomic group, education, car ownership, housing, crowding index [the number of household members per room] and ethnicity)
- Antenatal factors (the number of times the mother had previously given birth, and gender, weight, length and head circumference at birth of the infant)
- Factors during labour (mode of delivery, maternal high blood pressure and fever)
What were the basic results?
The study included 722 children who were born prematurely or “preterm” (at less than 37 weeks) and 11,268 children who were born at term (between 37 and 42 weeks).
Preterm infants were statistically more likely to have a low KS1 score and to receive special educational needs support.
Infants who were placed in the correct school year for their expected delivery date had higher KS1 scores than those children whose actual date of birth had put them in a different school year than their expected delivery date would have.
In children who had been born at full term, average KS1 scores were highest in the children oldest at the time of the test – i.e. children born in September. Average scores gradually decreased as the children entering the year were younger, with children born in August obtaining the lowest mean KS1 scores.
A similar pattern was seen for preterm infants, although the lowest mean KS1 scores were from children born in June.
Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of date of birth; to adjust for the fact that, on average, the oldest children did the best on the test (odds ratio (OR) for low KS1 score 1.57, 95% confidence interval (CI) 1.25 to 1.97; OR for special educational needs 1.57, 95% CI 1.19 to 2.07).
Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of expected date of delivery rather than gestational age (to adjust for the fact that children born preterm are actually younger than their date of birth would suggest). The OR for low KS1 score was 1.53, 95% CI 1.21 to 1.94; the OR for special educational needs was 1.59, 95% CI 1.20 to 2.11.
However, children born preterm were not at significantly higher risk of low KS1 score or of having special educational needs when outcomes were compared only for children attending school in the correct year for their expected date of delivery, and children were matched based on their expected date of delivery (OR for low KS1 score 1.25, 95% CI 0.98 to 1.60; OR for special educational needs 1.13, 95% CI 0.81 to 1.56).
How did the researchers interpret the results?
The researchers concluded that “this study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their expected date of delivery) may increase their risk of learning difficulties with corresponding school failure”.
Conclusion
In the UK, all children are offered a school placement based on their actual date of birth, rather than their expected date of birth. This study has found evidence from a large UK cohort that children born preterm may benefit from school entry based on their expected date of delivery rather than their actual birth date.
The study found that children born preterm are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.
However, there was no significant increase in risk among preterm children who would still have attended the same school year even if they had been born on their expected date of delivery.
This arguably suggests that admission policies to schools should be based on a child’s expected date of delivery rather than actual birth date. However, as the researchers rightly point out, the issue of whether an older child would interact well with children who could be, or we perceived to be, younger than them also has to be considered.
As the researchers conclude: “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.
Summary
“Premature babies more likely to underperform at school, study finds,” The Independent reports. Results from a new study have prompted calls that some children should be placed back a year before starting school.
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In this week’s Child Safety News: Kids Who Are Too Friendly With Strangers May Have This Disorder https://t.co/XQvXqB2iu8
Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use social media to communicate relevant and timely health and safety information to the parents, medical professionals and caregivers who follow us. Occasionally we overlook something, but overall we think we’re doing a pretty good job of keeping you informed. Still, quite a bit happens every day – so to make sure you don’t miss anything, we offer you a recap of this week’s top 20 events & stories.
Graco Just Recalled Over 25,000 Child Car Seat Restraints https://t.co/ACZSiXe9kr
I’ve been reflecting this week on the value of making mistakes. We hear that mistakes are learning opportunities. Without making mistakes, we don’t know that we need to revise our strategy or approach.
Yet, it has occurred to me, how do we talk with children about the benefit of making mistakes in a manner that improves their cognition? How do we help children become empowered thinkers, learners and revisionists of their previous actions? How do we calm the brain, reduce the anxiety and bring out the joy when the learning is so tedious and difficult for these children? Musical Thinking Cueing is a kind start.
My thinking was inspired by a sweet child with whom I work.
This child was practicing her writing skills and was bothered that she wasn’t touching the writing guidelines perfectly with each swoop of her pencil. She was quite focused on her pencil grip and letter formation.
I then thought about how many words I have written and typed in my years and told her, “In your life you are going to write letters millions of times. This moment, right now, is just one time. Let’s embrace this moment, have fun in this moment and know that all the moments together will add up to beautiful writing. It will happen as all your writing moments combine with one another over time.” “You will be a beautiful writer one day, for now, it’s important to enjoy the writing, make it your friend.” Not an easy concept for a 9-year-old right? But she got it. Her eyes brightened and she smiled.
Then I moved to the Motivation Cueing questions we use in Musical Thinking and I asked her things like.
“How can we look at making just one letter more creatively?”- “Could we make it bigger or smaller?”
- “Could we carry it two centimeters below the line?”
- “How would we know what two centimeters look like?”
- “Would we measure them out?”
- “Would we draw another line below the line, perhaps in a different color?”
- “Once we did that, could we write an entire word two centimeters below the line?”
- “That would be just one way we could enjoy the creativity in this moment and play with our writing instead of struggling with it.”
- “Let’s think of other creative ways we could write our letters in and around the guidelines.”
“When we become friends with the writing process and struggle against it less, we allow what we thought were mistakes to be opportunities to create more interesting letters. All that practice adds up, so fear not about perfectly drawn letters, let’s just keep writing them, they will grow into letters you love over time.”
Executive function training has many parts.
The first part is to reduce the child’s anxiety so that they will engage in the process. That’s why the relationship matters so much. The next part is to teach the child how to think, problem solve and approach a challenge in a new way. This is how we build better planning, previewing, initiation and cognitive flexibility skills.
Sometimes Executive Function training is about bringing joy and creativity to a table that is often wrought with frustration and shame. Make the moments engaging, thought-provoking and fun.
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Millions of children face challenges with inattention, impulsivity, cognitive inflexibility and disorganization, yet strategies and solutions to address them are elusive. We expect kids to alter their behavior when we say things like, “Just slow down,” “Think it out,” or “Use your creative problem-solving skills,” only to see the children look up bewilderingly. We often get caught in the trap of telling them what to do without telling them how to do it. This results in children who become disorganized thinkers, using trial and error to try to meet the expectations of teachers, parents and those whom they love. Musical Thinking, 5 Simple Steps To Teaching Children How They Think – The Quick Start Manual, is Dr. Lynne Kenney’s creative response to empowering children to take charge of their learning and behavior by teaching children HOW their brains work, not simply what to think. Musical Thinking is available at amazon.com
AMC Entertainment (AMC) and the Autism Society have teamed up to bring families affected by autism and other special needs “Sensory Friendly Films” every month – a wonderful opportunity to enjoy fun new films in a safe and accepting environment.
The movie auditoriums will have their lights turned up and the sound turned down. Families will be able to bring in snacks to match their child’s dietary needs (i.e. gluten-free, casein-free, etc.), there are no advertisements or previews before the movie and it’s totally acceptable to get up and dance, walk, shout, talk to each other…and even sing – in other words, AMC’s “Silence is Golden®” policy will not be enforced during movie screenings unless the safety of the audience is questioned.
Does it make a difference? Absolutely! Imagine …no need to shhhhh your child. No angry stares from other movie goers. Many parents think twice before bringing a child to a movie theater. Add to that your child’s special needs and it can easily become cause for parental panic. But on this one day a month, for this one screening, everyone is there to relax and have a good time, everyone expects to be surrounded by kids – with and without special needs – and the movie theater policy becomes “Tolerance is Golden“.
Families affected by autism or other special needs can view a sensory friendly screening of Diary of a Wimpy Kid: The Long Haul on Saturday, May 27th at 10am (local time). Tickets are $4 to $6 depending on the location. To find a theatre near you, here is a list of AMC theatres nationwide participating in this fabulous program (note: to access full list, please scroll to the bottom of the page).
Coming in June: Captain Underpants (Sat, 6/10), Wonder Woman (Tues, 6/13), Cars 3 (Sat, 6/24) and Transformers: The Last Knight (Tues, 6/27)
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Editor’s note: Although Diary of a Wimpy Kid: The Long Haul has been chosen by the AMC and the Autism Society as this month’s Sensory Friendly Film, we do want parents to know that it is rated PG by the Motion Picture Association of America for some rude humor. As always, please check the IMDB Parents Guide for a more detailed description of this film to determine if it is right for you and your child.
Sharon has a teenage daughter who is transgender. She describes how Nicki was born in a male body but felt from a very young age that she should have been a girl.
“When my child Nick was about two, I realised that he wasn’t playing with toys that I expected a boy to play with. He was interested in dolls and girly dressing-up clothes. At that age, it doesn’t really matter. You just think they’re trying lots of different things, so I never made a fuss about it.
“But when he was four years old, Nick told me that God had made a mistake, and he should have been a girl.
“I asked my GP what I should do. He told me to wait and see, and that it might just be a phase and go away. But it didn’t. It got stronger.
“One day when Nick was six, we were in the car, and he asked me when he could have the operation to cut off his ‘willy’ and give him a ‘fanny’ (*vagina). His older cousin had told him about these things.
“I spoke to a friend who’s a psychiatrist. He said I should contact the Tavistock Clinic [now The Tavistock and Portman service for children and young people with gender identity issues].
“He also told me that the medical term is ‘gender dysphoria’. When I looked it up online, I found Mermaids, a charity that helps children with gender identity issues and their families.
“I also spoke to my GP again, who referred us to the local mental health unit. The person at the unit had worked at the Tavistock and knew about gender identity issues.
“He was brilliant. It was such a relief to talk to somebody who understood what was going on. I’d blamed myself, but he reassured me that it wasn’t my fault. We were then referred to the Tavistock Clinic.
“The team from the Tavistock came to Nick’s school and talked to the teachers. They helped the teachers to understand that Nick wasn’t being difficult, and that this may or may not be a phase. When a child is this young, you just don’t know.”
From Nick to Nicki
“Nicki desperately wanted to be female all the time. When she was 10, we feminised her name from Nick to Nicki at home. The following year, Nicki started secondary school as a girl.
“The school was very supportive, but because she moved up to secondary school with her peer group, everybody knew.
“In the first week, she was called a ‘tranny’ and a ‘man-beast’. She was spat on and attacked in the corridors. Within her first six months of being at that school, she took four overdoses.
“We then pulled her out of school, but after a few months she decided to go back.
“Each year, the bullying and isolation got worse, and Nicki started harming herself. At the beginning of year nine, I transferred her to another secondary school, but unfortunately the kids there found out.
“At that point, I withdrew her from school completely, and the education welfare office found her a place at a Specialist Inclusive Learning Centre, which is a unit for children who can’t cope with mainstream schooling for various health reasons.”
Going Through Puberty
“When Nicki started puberty, I wanted her to get the type of treatment that’s offered in the Netherlands, where puberty is blocked before major physical changes take place.
“I felt that if she was going to change her mind about being a girl, she would have done so by now.
“The Tavistock Clinic wouldn’t give her hormone blockers. [The Tavistock and Portman follows British guidelines, which at the time suggested not introducing hormone blockers until the latter stages of puberty. Since January 2011, the age at which hormonal treatment may be offered has been lowered from 16 to 12, under a research study that is being carried out by the Tavistock and Portman into the effects of hormone blockers earlier in puberty.]
“In the end, we went to a doctor in the US. I found him through the WPATH network (The World Professional Association for Transgender Health). Nicki was 13 when she started taking hormone blockers. It’s put her male puberty on hold, and given her time to think.
“If she hadn’t been given blockers, she would have suffered the psychological agony of going through male puberty. She told me she would have killed herself. Nowadays, you’d never guess that she was born male.
“If at any point Nicki were to tell me that she wasn’t sure that this was the right thing for her, we’d simply stop the injections and male puberty would go ahead.
“For Nicki, the next step is starting hormones and surgery as soon as she can.
“During the first few years of secondary school, I was constantly in fear for Nicki’s life. It was so distressing to watch her go through all of this.
“Now it’s a million times better. She’s a typical teenage girl, and it’s a blessing. She leaves a mess, she borrows my clothes, my make-up and my perfume. I never thought she’d reach this stage. She still has to face many more hurdles but she’s looking forward to adulthood.”
*The names in this article have been changed.
Where to Get Help
Sharon, who tells her story above, says that the most helpful thing was speaking to other families who’ve been through the same thing. The charity Mermaids provides family support for children and teenagers with gender identity issues, and can put you in touch with other parents with similar experiences.
Editor’s Note: *clarification provided for our US readers.
In this week’s Child Safety News: Senators Seek Improved In-Flight Child Safety – critical care gap you may not know about
Welcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use social media to communicate relevant and timely health and safety information to the parents, medical professionals and caregivers who follow us. Occasionally we overlook something, but overall we think we’re doing a pretty good job of keeping you informed. Still, quite a bit happens every day – so to make sure you don’t miss anything, we offer you a recap of this week’s top 20 events & stories.
Child Drowning myths vs. reality https://t.co/PlT2cqx6h0
