In every classroom, there are likely to be at least three children who were born preterm. And according to Professor Samantha Johnson, those children may be missing out on vital support due to a dearth of knowledge in schools about the challenges these pupils might face and a lack of identification of the children who may be affected.

Speaking on the latest episode of Tes Podagogy, the University of Leicester developmental psychologist explains that we now know much more than we once did about the potential impact of preterm birth on a child. 

“We know that, overall, the rates of preterm birth are increasing and that survival rates of extremely preterm babies are increasing,” she reveals. “A preterm baby is one who is born before 37 weeks of gestation. In the UK, that is around 8 per cent of all babies born. 

“Among those, most will be born just a few weeks early, at 32-36 weeks of gestation. We refer to them as being late or moderately preterm. A smaller subgroup of babies are born very preterm, so before 32 weeks. That is 1-2 per cent of all births. And finally you have children born extremely preterm, before 28 weeks of gestation. 

“Evidence has been accumulating in the past few years, so we now know so much more about these babies and the risks they have as they get older. We know what kinds of difficulties they might have [and] what we need to look out for.”

Learning difficulties?

The most common difficulties, she explains, are associated with mathematical ability, social and emotional skills, and attention. 

“On average, children are likely to have cognitive difficulties, so poor working memory, deficits in visuospatial ability, processing speed and executive function,” she says.

“We also know that children born preterm are at greater risk of attention difficulties, social and emotional difficulties - difficulties interacting with peers and maintaining friendships - and being shy, anxious or withdrawn. These children will often have a number of these difficulties that co-occur. 

“But what we tend to see is that there is not a greater risk of these groups having an increased risk of conduct problems or defiance. So in the classroom, these children tend to have cognitive difficulties - they will tend to be the child that is more withdrawn, they may struggle to focus, but they do not tend to be the children who are disruptive or aggressive. As a result, these children may not be coming to the teacher’s attention as being in need of support.”

Lack of knowledge

In a survey she conducted with colleagues in 2015, Johnson found that neither teachers nor educational psychologists had a good knowledge of these potential issues. She also found that only 16 per cent of those surveyed had received any training on the educational outcomes of, and potential challenges experienced by, children born preterm. 

This lack of knowledge and training has been one of the reasons why parents have been reluctant to tell schools about a child’s birth history; without knowing what the potential difficulties of a child born preterm might be, there is little use in telling a school that information.

But with more information now available, Johnson feels it is a useful piece of data for teachers to know. 

“Among these children there is a very small proportion who have difficulties severe enough to have a diagnosis (and the vast majority attend mainstream schools). Usually, it is subtle difficulties in a number of areas, but combined, they can have a big impact on learning.

“If a teacher is not aware of the kinds of difficulties the child may have, and is not aware of the birth history, these children may not be picked up as having difficulties. Their attainment could be within average range, but with these issues addressed, they could be achieving much more.

“Up until now, I think the information around preterm birth has not been communicated to teachers, certainly not to the level of what we now know in the research - once we start to communicate that, it might be more useful to tell teachers of the child’s birth history.”

Shifting expectations

However, there is a risk that if a teacher did know of the birth history of a child, then that teacher’s expectations of the child might shift, perhaps to the detriment of that child in some cases. Johnson says this is why the nature of the evidence needs to be clearly communicated.  

“Every child is different, born preterm or not,” she says. “Every child will have their own strengths and weaknesses. It is important to say that the risks we associate with preterm babies are cohort studies and averages - some children will have very different outcomes - but that is not to say we have not identified particular patterns of outcomes for these children. Prematurity is a risk factor, not a diagnosis, for difficulties later in life.”

To ensure the right information is getting into schools, Johnson and her colleagues have developed an e-resource for teachers. 

“It represents about 1 hour of learning,” she explains. “It focuses on providing information, based on current research, about what preterm birth is, what educational outcomes are like for these children, social and emotional difficulties that are likely, and there is a section at the end detailing strategies teachers can use if the difficulties are identified. The strategies will be just as useful for children with the same difficulties who were not born preterm.”

In the podcast, she talks more extensively about the risk factors involved, why they occur, and goes into more detail on the developmental assessments required to spot potential difficulties.

You can listen by searching for “Tes - the education podcast” on your podcast platform (including Spotify) or via the player above. 

The funder for the resource is Action Medical Research. The resource was created with Loughborough University (Camilla Gilmore), University of Nottingham (Lucy Cragg and Heather Wharrad), University College London (Neil Marlow) and Ulster University (Vic Simms)