A new study published in JAMA Network Open reveals that more than half of children born very preterm—before 32 weeks of pregnancy—fail to meet school readiness benchmarks by age five. Research led by Professor James Boardman at the University of Edinburgh, which tracked nearly 16,000 children born in England between 2008 and 2012, indicates that these early developmental gaps often persist into primary school, with roughly half of the cohort trailing in writing and mathematics by age seven.
The Link Between Prematurity and Early School Performance
The research, which linked newborn hospital records with national school attainment databases, found that preterm birth acts as a significant hurdle for foundational learning. According to the study, just over half of children born before 32 weeks did not meet expected standards for school readiness at age five, leaving them 21 percentage points behind the national average for children that age.
The risk profile is heavily tied to the timing of birth. At the edge of survival—babies born at 23 weeks—close to nine in ten were not ready for school. Even after adjusting for other variables, children born at 23 or 24 weeks remained nearly three times as likely to lag behind their peers born at 31 weeks.
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The study found that children born in the summer who start school younger than their autumn-born peers face an even higher risk of missing developmental milestones. Researchers suggest that allowing these children to start school a year later or providing tailored support could help bridge this gap.
Social Disadvantage as a Primary Driver
Beyond clinical factors, social and economic conditions play a critical role in educational outcomes. Dr. Cheryl Battersby of Imperial College London noted that the impact of social disadvantage on academic attainment is comparable to the effect of severe brain injury. Children who qualified for free school meals—a marker of low household income—were nearly twice as likely to fall behind as those from more affluent backgrounds.
This “double burden” of prematurity and poverty creates a cumulative disadvantage. While some factors like sex and gestational age are fixed, the researchers identified specific, modifiable areas where intervention could improve outcomes.
Modifiable Factors to Improve Outcomes
The research team identified several variables that correlate with better school performance, offering potential targets for clinicians and policymakers:
- Breastfeeding: Babies fed breast milk during hospital care were less likely to fall behind than those fed exclusively with formula. Research from the Edinburgh group suggests breast milk may contribute to physical development in the brain’s outer layer.
- Prenatal Health: Smoking during pregnancy was identified as a factor that increases the risk of underachievement.
- Medical Management: While the causes are complex, the study noted that severe gut and lung conditions, as well as brain injuries common in preterm infants, were strongly associated with lower school readiness.
Early intervention is not just about the classroom. Because preterm birth is linked to long-term career outcomes, including lower earnings in adulthood, identifying these gaps at age four or five allows for support systems to be implemented before formal schooling begins.
Frequently Asked Questions
Are these academic gaps permanent for children born preterm?
Not necessarily. The study found that about one-third of the most premature children met every expected developmental milestone, proving that a difficult start does not predetermine a child’s entire future.
How does poverty compare to medical issues in affecting school readiness?
According to Dr. Cheryl Battersby, the impact of social disadvantage is comparable to the impact of severe brain injury in terms of its effect on primary school attainment.
Why is breastfeeding considered a factor in school readiness?
The University of Edinburgh research team found that preterm infants who received breast milk in their first weeks showed brain scans closer to those of full-term infants, suggesting a positive impact on neurodevelopment.
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