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Monday 23 November 2020

Child Development: how to improve educational outcomes of children born preterm?

 Child Development: How to Improve Educational Outcomes of Children Born Preterm?


In the UK, in an average sized classroom two to three children are likely to have been born preterm. Whilst the numbers of children born preterm are rising, there has been very little training available to education professionals: teachers, educational psychologists, nursery nurses or teaching assistants, with regard to the potential learning difficulties that these children can encounter in early years settings or schools.  For these reasons, it is particularly important that teacher training signposts to the evidence-based educational resources for children born prematurely - PRISM resources www.pretermbirth.info. These resources, aimed at education professionals, do not only raise the awareness of the impact of prematurity on learning, but they also highlight a range of strategies that can be used to improve educational experience of these children, ultimately leading to improving their life chances.  These high quality research-informed PRISM resources are available FREE on-line. 


Having worked in education and with a SEND background, I am keen to raise important understanding of the potential needs of these children to bridge the gap between healthcare and education.   Additionally, learning from my experience of developing NICE guidelines for the follow-up of children born preterm (https://www.nice.org.uk/guidance/qs169/resources/developmental-followup-of-children-and-young-people-born-preterm-pdf-75545608839109) and subsequently making a contribution to the development of PRISM resources, I feel that I am well placed to raise awareness among education professionals of the potential risk factors and learning needs of this cohort of children. Moreover, it is critical that any quality training for education professionals should include evidence-based information that is relevant to the career. This is particularly imperative when information applies to 8% of school population, especially that education professionals have very limited knowledge of this particular area of child development. Moreover, a national survey of teachers and educational psychologists (Johnson S. et al., 2015) reveals that education professionals’ poorest areas of knowledge related to the most frequent adverse outcomes following preterm birth.  This survey highlights some worrying gaps in knowledge.  For example, only 8% of teachers knew that mathematics difficulty is a particular deficit after preterm birth while 88% held a mistaken belief that most very preterm children experience developmental delays as a toddler; only 11% to 18% of teachers and EPs knew that very preterm children are likely to be inattentive or have poorer peer relationships than term-born children.Since children born preterm have a notable absence of an increased risk for hyperactivity or impulsivity and conduct disorders, it is crucial to recognise their difficulties early to ensure appropriate provision to meet their specific needs.


Research asserts that:


            …education professionals receive very little training about the impact of    preterm birth on children’s development and learning and have poor     knowledge of how to support preterm-born children in the classroom. In a             recent national survey, only 16% of teachers had received any training about      preterm birth and over 90% expressed the need for training. As teachers have       primary responsibility for supporting the learning and development of preterm born children in the long term, this represents a significant public            health concern.  (Johnson, S. et al., 2019).


To address this gap in knowledge and training, it is crucial that any new training or qualification for professionals working with children in education or early years settings, includes high quality evidence-based resources on how to improve the outcomes of children born preterm.  Furthermore, as “preterm birth places children at an increased risk for a range of developmental problems and disorders later in life” and “this disadvantage persists throughout the lifespan with fewer preterm-born adults having completed high school and undertaken higher education” (Johnson, S. et al., 2019), this issue is not only of concern to professionals working in primary school or early years settings. Clearly, awareness of prematurity and potential learning difficulties is applicable to all educational settings so appropriate teaching and learning strategies can be used for improved outcomes. 


As an experienced educator and an expert on learning, I cannot emphasise enough how fundamental it is for all staff working with children to have the right level of knowledge with regard to child development, including the impact of birth problems on subsequent cognitive, sensory or physical development. Free access PRISM e-resources provide valuable information for adults working with children on risk factors for child development and expected milestones. Despite significant improvements in neonatal care, to date there is no evidence of improved long-term outcomes for these young people.  Moreover, the experts highlight that:


            The continued increase in preterm birth rates for extremely preterm babies           [born <27 weeks gestation] means that there are increasing numbers of            preterm survivors entering societies year on year. This results in greater     demands being placed on education systems and their professionals to     identify difficulties and provide support for these children in the long          term.

            (Johnson, S. et al., 2019).


According to evidence, these particular areas may require additional support:

·      Difficulties with mathematics

·      Inattention

·      Working memory difficulties

·      Slow processing speed

·      Poor hand-eye co-ordination

·      Social and emotional problems

·      Sensory impairments

·      Poor fine and gross motor skills

However, as these children’s development is different to children born full term, it is important to understand that preterm children have different developmental mechanisms behind their difficulties than term born children. For example, inattention can be linked to poor working memory or visual impairment, rather than attention-deficit-hyperactivity disorder as known in term-born children.  It is also worth noting that the attainment of these children is often lower by comparison with peers and some may never attain at the same level as their peers born at term. 


For these reasons, and to minimise external interventions, it is important for any professionals working with children to engage with these interactive free e-learning resources, which are the only kind of resources available worldwide. An early evaluation of these resources indicates that they have “substantially improved teachers’ knowledge of preterm birth and their confidence in supporting preterm children in the classroom.” (Johnson, S. et al., 2019). This is why the access to these resources provides another important dimension to the study of child development as part of continuous teacher training and professional development.




Johnson S. et al. (2015) Developmental Medicine & Child Neurology. Vol. 57, Issue 6

Johnson S. et al. (2019) Improving developmental and educational support for children born preterm: evaluation of en e-learning resource for education professionals. BJM Open 2019; 9.

NICE Guidance: Developmental follow-up of children and young people born preterm, August 2017https://www.nice.org.uk/guidance/ng72

PRISM resources: Premature Infants’ Skills in Mathematics, University of Nottingham:http://www.pretermbirth.info




Dr Joanna Goodman, EdD, FCIEA is an independent Education Consultant. Her experience includes senior school leadership, inspecting education providers, teacher training, school improvement, curriculum and assessment development, leadership development and academic research.  She is published in educational and clinical journals. Joanna is an expert panel member for developing T Level qualification in Education and Childcare.


Dr Goodman provides training on the impact of prematurity on schooling and the use of PRISM resources.






Monday 30 March 2020

Covid-19: Homeschooling and what it means for education

We are living through what could be described as the biggest global experiment in education.  The new norm is teaching and learning which are not tied to space.  I have been discussing virtual learning and the application of AI in education before, but it has now become a sudden reality and an unintentional consequence of the current pandemic.  Around the world, schools are responding to this mammoth challenge in various ways and with various degrees of their on-line capabilities.  A huge consideration is the availability of technological resources by individual children as well as the adequate parental supervision, and the provision of the suitable environment for distance leaning in children’s own homes.  While some schools have been able to provide laptops for their students to learn from home, this has not been the case for every child.  Additionally, not every household around the world has access to the Internet from home.  These inequalities will, without doubt, have an impact on widening even further the gap in educational achievement between the disadvantaged and more privileged young people. 

However, I predict that this live experiment in providing education remotely on such a large scale will have some huge long-term benefits, including the rapid development, and implementation, of on-line learning solutions, leading to the expansion of virtual schools and virtual learning environments.   In practice, this has the potential to revolutionise traditional schooling.  Although the social aspect of school education plays a huge part in young people’s development, and learning is essentially a social activity, the potential for future gains cannot be denied.  Greater application of information technology into everyday learning, including virtual schools and AI technology, have the ability to provide a more personalised teaching and learning experience for a truly individualised learning that is well-matched to each student’s individual learning curve.  Thus learning according to age and ability, and modified to meet particular learning needs, could become more of a reality with the greater use of adaptable on-line/virtual learning solutions, including novel ways to tackle homework or to monitor pupils’ progress, or communicating with parents.  Moreover, adaptable on-line learning solutions capable of adjusting instruction accordingly, are conducive to the development of learning mastery, through increased intrinsic motivation, thus leading to greater learning independence.

The modes of curriculum delivery have a direct impact on student assessment, because assessment is an integral part of any curriculum.  This academic year, as the pandemic catastrophe deepens, public examinations, quite rightly, are being suspended.  The overriding factor in decision-making is that the young people due to sit public examinations, starting from early next term, cannot be disadvantaged by the circumstances beyond their control and must be treated fairly.  Although for the assessment professionals and examining bodies this comes as a shock too, the measures to be employed in awarding students’ results will include comprehensive assessment data kept on students by schools.  These data comprise students’ prior attainment, on-going teacher assessment and predicted grades, which, in combination with statistical analyses utilised by the awarding bodies, will determine students’ final results.  Looking ahead, I feel that more benefits may follow with regard to the nature of end assessment/public examinations, leading to a proper reflection on what is important in our assessment systems.  Re-examining situational learning as well as more flexible learning environments –learning not space dependent – should lead to more reflection about what is important in our qualifications and examinations systems and what are the best ways to evaluate young people’s achievements in preparation for their next stages.

Right now, there are some other pressing issues surrounding homeschooling and how to enable young people to make progress with their academic work… Primary school children, understandably, need more direction, encouragement and support with their learning at home.  However, all young people benefit from a set routine – something that schools are great at providing because of the way learning in schools is organised.  Although it would be difficult to emulate rigorous school routines at home, which give young people the security of knowing what to expect next, sticking to some routines is helpful to managing learning and time at home during this crisis.  As all academic learning involves reading, writing and mathematics, these should be seen as the cornerstones of all learning. 

To help with organisation and realistic aims of what is manageable in every household, at least three hours, with short breaks, should be set for the purpose of home learning.  Some parents may have to juggle working from home with looking after their children.  Under the circumstances, it is useful to consider a “week” as seven days, rather than a 5-day working week.  This will provide more flexibility with organising learning for any 5 days of the week.   Depending on the guidance from schools, it may be overwhelming for parents to know where to start.  Where available, guidance from schools should be used in the first instance.  Many quality resources, including curriculum on-line for different key stages in education, provide useful guidance for different ages in education.  Home environments are also conducive to engaging with creative and imaginative work.  A good example of engaging with written and creative work at any age is keeping a daily diary and, as the days in home isolation progress, young people can get more creative and imaginative with describing their feelings, changing moods and using interesting vocabulary in their descriptions.  Younger children can start with single words (nouns) and then adjectives to describe them, leading to some sentences and making illustrations to support their ideas.  Incidental learning at home can provide another dimension to formal academic learning and supplement it through family discussions, private reading, games or interactions with siblings, or friends via video calls; this also adds a social dimension to all the interactions.  Above all, do not succumb to 'death by worksheet' and use playtime or exercise outings with children as opportunities for learning and exploring, and extending different facets of thinking and creativity.  Covid-19 itself can be used as a starting point for learning, for example, with regard to geography, science, mathematics or ethics, where the scarcity of resources can be considered.  Grandparents can be involved with reading stories or singing/performing music via video calling apps.  Successful homeschooling is underpinned with careful planning.  Being able to stick to weekly plans negotiated with children regarding their academic activities and general routines, will assist not only with greater accomplishments, but also with calmer households.

Predicting academic and personal growth of young people by the end of this catastrophe, is difficult.  We are living through the biggest educational experiment of our times, if not ever, and only history will tell…  My personal view is that, if families are serious about the achievement of their children, we may have a reason to celebrate when they eventually return to school.