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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.