Welfare Reforms: The impact of child-contingent cash benefits on the educational and health outcomes of vulnerable children
“This research could help to guide policy on offering early assistance to children who are at risk of experiencing poor outcomes during their school years.”
This study was completed in 2023. It was led by Nicolás Libuy (UCL) and funded by ADR UK.
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We wanted to find out what health conditions children who are born too early (preterm) are likely to have prior to school age, and how these children progress through primary school exams.
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We found that children born preterm (even those born just a few weeks too early) were less likely to do well at school than children born at full term. The earlier children are born, the more likely they are to have physical health problems affecting one or more bodily system (e.g. the lungs, brain or heart).
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Some children who are born preterm may need extra support when they start school, especially if they have physical health conditions. More research is needed to understand how best to support these children to ensure that they have the best start at school.
Find out more
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Why does being born early matter?
A typical pregnancy lasts about 9 months. We measure how far along a baby is using "gestational age", i.e. the number of weeks they've been growing in the womb. Most babies are born at 39-41 weeks, known as "full term." Babies born before 37 weeks are called "preterm," and these babies often face extra challenges with learning, health and behaviour as the grow up.
What did we want to find out?
We wanted to know how being born early, combined with physical health problems, affects children's progress in primary school. We also wanted to find out whether the exact number of weeks a baby was born early makes a difference to the support they need – for example, do children born at 28 weeks need different support to those born at 36 weeks? Until now, there hasn't been enough data on preterm babies to answer this.
Understanding these needs matters because it helps put the right support in place early on, giving children a better chance to succeed at school.
What we did
The study used ECHILD data on babies' health at birth, the physical health conditions they were diagnosed with or treated for as they grew up, their school test results, and whether they received extra help through special educational needs support.
What we found
School and learning: Children born preterm, even just a few weeks early, are less likely to do well at school than those born full term. The earlier a baby is born, the more likely they are to struggle with learning and need special educational support: children born at 36 weeks have more difficulties than those born at 40 weeks, and children born at 32 weeks have more difficulties still. Children born in autumn tended to do better at school than those born in summer, possibly because they were older when they started school.
Health: Preterm babies are more likely to have physical health problems affecting organs like the lungs, brain or heart. Again, the earlier the birth, the higher the likelihood of health problems.
Putting it together: Children born preterm with physical health problems are more likely to need special educational needs support than preterm children without health problems. Looking at all children who struggled at school or needed extra support, physical health problems appeared to play a bigger role than preterm birth alone.
What this means, and what's next
Some children born early or with physical health conditions may need extra support starting school. For some, this could mean starting school later; for others, earlier health and learning support, or better communication between health and education services, might help more. More research is needed to understand how factors like preterm birth and early health problems can be used to identify and support children before they start school.
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Introduction
We aimed to generate evidence about child development measured through school attainment and provision of special educational needs (SEN) across the spectrum of gestational age, including for children born early term and >41 weeks of gestation, with and without chronic health conditions.
Methods
We used a national linked dataset of hospital and education records of children born in England between 1 September 2004 and 31 August 2005. We evaluated school attainment at Key Stage 1 (KS1; age 7) and Key Stage 2 (KS2; age 11) and any SEN by age 11. We stratified analyses by chronic health conditions up to age 2, and size-for-gestation, and calculated population attributable fractions (PAF).
Results
Of 306 717 children, 5.8% were born <37 weeks gestation and 7.0% had a chronic condition. The percentage of children not achieving the expected level at KS1 increased from 7.6% at 41 weeks, to 50.0% at 24 weeks of gestation. A similar pattern was seen at KS2. SEN ranged from 29.0% at 41 weeks to 82.6% at 24 weeks. Children born early term (37–38 weeks of gestation) had poorer outcomes than those born at 40 weeks; 3.2% of children with SEN were attributable to having a chronic condition compared with 2.0% attributable to preterm birth.
Conclusions
Children born with early identified chronic conditions contribute more to the burden of poor school outcomes than preterm birth. Evaluation is needed of how early health characteristics can be used to improve preparation for education, before and at entry to school.
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