Written evidence by Professor Samantha Johnson (Professor of Child Development at University of Leicester); Professor Camilla Gilmore (Professor of Mathematical Cognition at Loughborough University) (EYS0033)
Education Committee
Inquiry into Early Years: Improving support for children and parents
About the authors
Samantha Johnson is a Professor of Child Development in the School of Healthcare, University of Leicester. She is an expert in the study of the long-term impact of premature birth on children’s development and learning.
Camilla Gilmore is a Professor of Mathematical Cognition and an expert in developmental and educational psychology with a focus on learning and education in the early years. She leads the Economic and Social Research Council Centre for Early Mathematics Learning.
Professors Johnson and Gilmore led the development and evaluation of the free PRISM e-learning resource (www.pretermbirth.info) to improve the quality of education that children receive in schools, early years settings, childminders and reception classes.
Summary of submission
• We present evidence that preterm birth has adverse impacts on children’s learning and development, with negative consequences for their future life chances.
• We provide evidence that there is an urgent need to raise awareness of prematurity in the early years.
• We present three recommendations for enhancing early years support in order to reduce inequalities and improve quality and outcomes for preterm born children and their families.
Summary of recommendations
1) Early years settings and childminders should ask parents for, and record information about, a child’s birth history on admission.
2) Early years settings and childminders should instigate enhanced monitoring of children born preterm.
3) The early years workforce should be provided with access to high-quality evidence-based information and training about preterm birth and the opportunity to complete this during working hours.
This submission relates to two of the inquiry’s topics of interest around Quality and Outcomes
• Does early years provision currently provide sufficiently high-quality early education and care?
• Is there more that could be done to improve quality and the outcomes for children in early years settings which is missing from the Government’s Giving Every Child the Best Start in Life Strategy?
Evidence on the impact of preterm birth on children’s development in the early years
There is a large body of evidence on the long-term impact of preterm birth on children’s development and learning.[1] Babies born preterm, before 37 weeks of gestation, are at increased risk of a range of developmental problems and disorders later in life, especially cognitive and motor impairments, attention, social and emotional problems, ADHD and autism. The more preterm a baby is born, the greater the risk of these problems, such that babies born very preterm (before 32 weeks of gestation), and especially those born extremely preterm (before 28 weeks of gestation), are at greatest risk.
These problems are evident in the early years, during which preterm born children are more likely to have delayed development. As shown in Figure 1, in a study of children at 4 years of age, the proportion of children with developmental delay assessed using the Ages and Stages Questionnaires was highest among those born very preterm (<32 weeks of gestation). Moderate and late preterm children (born at 32-26 weeks of gestation) had higher rates of developmental delay than term-born children, but this was not as high as for very preterm children. For example, 3.5% of term-born children had delayed fine motor development compared with 8% of late and moderately preterm children and 12% of children born very preterm.[2] The pattern of results was the same in all areas assessed.
Figure 1: Percent of four-year-old children with developmental delay in relation to the degree of prematurity at birth.[2]
The same pattern is also observed in attainment in the early years Foundation Stage Profile, in which preterm-born children already fall behind their term-born peers at the end of reception class (Figure 2). For example, in the Millennium Cohort Study, 66% of very preterm children failed to reach the government’s target of a Good Level of Development compared with 51% of children born at full term (39-41 weeks of gestation). The rates for moderately and late preterm children were 63% and 59%, respectively.[3] As shown in Figure 2, the same patten was observed across all six areas of learning in the Foundation Stage Profile.
Figure 2: Percent of children without a good level of development in the Early Years Foundation Stage Profile Areas of Learning in relation to gestational age at birth.[3]
Difficulties experienced in the early years can persist across the lifespan and can have an adverse impact on a child’s performance at school. Our research has shown that children born preterm are at higher risk of special educational needs (SEN) than children born at term. In a recent study[4], we found that 27% of very preterm born children had SEN at age 11, three times the rate for children born full term (11%). We have also shown that 66% of children born at the lowest gestations, before 26 weeks of gestation, have SEN.[5] Preterm birth also impacts later academic achievement. For example, our research has shown that very preterm children have lower levels of achievement than their full term born peers, both at the end of primary school (Key Stage 2) and at GCSEs (Key Stage 4).[6] By CGSEs, 60% of very preterm born children failed to achieve five GCSE passes at Grades A-C, including in English and mathematics, compared with 44% of children born at term.[6]
The impacts of preterm birth don’t end at the end of schooling. Research shows that preterm born adults have lower IQ[7], are less likely to go on to higher education and have lower employment prospects and economic potential than adults who were born at term. [8] Our research has shown that these poorer outcomes are related to preterm children’s poorer attainment at school.[9] Thus it is essential that better support is provided in education, from the early years and throughout school to boost preterm children’s learning and improve their life chances. This will have benefits for individuals, society and the economy. To achieve this, early years settings and childminders need a good understanding of prematurity and how it can impact children and families. However, this is currently lacking.
Evidence on the need for increased understanding of prematurity in the early years
Our research has shown that education professionals, including early years practitioners, have poor knowledge of the impact of preterm birth on children’s development and learning and are ill prepared to support these vulnerable children and families.[10] This is also of major concern to parents. A recent survey by The Smallest Things Premature Baby Charity found that 78% of parents with preschool or primary aged children said they did not feel that staff understood the impact of their child’s preterm birth and 99% felt that more awareness of the developmental and educational needs of preterm children is needed.
In 2024, the House of Lords appointed a Committee to consider the incidence and impact of preterm birth. The Committee made 23 conclusions and recommendations, of which one stated that they “Enhancing understanding among education professionals has the potential to facilitate the transition to school for families, enable appropriate support to be provided during school and improve outcomes for children born prematurely.”[11] This recognises the lasting impact preterm birth can have on children’s outcomes and the need to raise awareness of prematurity throughout education, starting in the early years.
Summary of evidence:
Around 53,000 babies are born preterm, each year, in the UK. These children are more likely to have health and developmental problems, learning difficulties and special educational needs than children born at term. Preterm birth can have an adverse impact on parents’ mental health and wellbeing. At present, education practitioners lack awareness of prematurity and are ill prepared the meet the needs of these vulnerable children and families. A greater awareness of prematurity is needed to boost children’s learning and development, reduce inequalities, reduce long-term educational and healthcare costs, and give these children the best start in life. Despite the fact that 8% of children are born preterm in the UK, prematurity is not referred to once in the Government’s Giving Every Child the Best Start in Life Strategy. This needs to change.
Recommendations:
To improve quality and outcomes for children and families in the early years, we make the following three key recommendations.
Recommendation 1: Early years settings and childminders should ask parents for, and record information about, a child’s birth history on admission
Early years settings and childminders should routinely ask parents for information about their child’s birth history on the setting’s registration form so that it is available upon admission. This information should be recorded centrally and shared with all staff in the setting to ensure appropriate support for preterm children and families. It is important that staff are aware if a child is born preterm so that they can identify needs and provide appropriate support from the earliest opportunity. Asking parents about birth history will also facilitate them in sharing information about their child’s health and development and allow them to feel reassured that their child’s needs will be understood and met.
We recommend that the following two questions are added to registration forms:
1) Was your baby admitted to neonatal care?
2) If your baby was born prematurely (before 37 weeks), how many weeks were they when they were born?
Recommendation 2: Early years settings and childminders should instigate enhanced monitoring of children born preterm
Given the increased risk for developmental problems and disorders, early years settings and childminders should instigate enhanced monitoring of all preterm children on admission. To do this, early years settings and childminders should add preterm born children to their Vulnerable Children’s Register or other method for identifying children who require additional monitoring due to the presence of risk factors (e.g., looked after children; pupil premium students). This will ensure that additional support needs can be quickly identified and appropriate support put in place if developmental problems arise.
Recommendation 3: The early years workforce should be provided with access to high-quality evidence-based information and training about preterm birth and the opportunity to complete this during working hours
Commensurate with the House of Lords’ recommendation[11], the National Institute for Health and Care Excellence (NICE) recommend that education professionals should be aware that preterm birth may be a factor in learning or behavioural problems and that these problems can emerge at any point during a child’s education.[12] It is therefore crucial that high-quality, evidence-based training about the health and developmental needs of preterm born children is undertaken by childminders and staff in early years settings in order for them to better understand the long term impact of preterm birth, identify children with difficulties and provide support.
The PRISM e-learning resource (www.pretermbirth.info) provides free, evidence-based training about the long-term consequences of preterm birth and how to support preterm children’s learning and development. It takes around one hour to complete. Our research has shown that this training significantly improves education professionals’ knowledge of prematurity and their confidence in supporting preterm born children.[13] We recommend that all childminders and early years staff are provided with access to this training and the time needed to undertake it.
References
1. Wolke, D., Johnson, S., Mendonca, M., The life course consequences of very preterm birth. Annual Review of Developmental Psychology, 2019. 1: p. 69-92.
2. Kerstjens, J.M., et al., Developmental delay in moderately preterm-born children at school entry. J Pediatr, 2011. 159(1): p. 92-8.
3. Quigley, M.A., et al., Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study. Arch Dis Child Fetal Neonatal Ed, 2012. 97(3): p. F167-73.
4. Alterman, N., et al., Gestational age at birth and child special educational needs: a UK representative birth cohort study. Arch Dis Child, 2021. 106(9): p. 842-848.
5. Johnson, S., et al., Academic attainment and special educational needs in extremely preterm children at 11 years. The EPICure Study. Archives of Disease in Childhood Fetal and Neonatal Edition, 2009. 94: p. F283-F289.
6. Alterman, N., et al., Gestational age at birth and academic attainment in primary and secondary school in England: Evidence from a national cohort study. PLoS One, 2022. 17(8): p. e0271952.
7. Eves, R., et al., Association of very preterm birth or very low birth weight with intelligence in adulthood: an individual participant data meta-analysis. JAMA pediatrics, 2021. 175(8): p. e211058-e211058.
8. Bilgin, A., M. Mendonca, and D. Wolke, Preterm Birth/Low Birth Weight and Markers Reflective of Wealth in Adulthood: A Meta-analysis. Pediatrics, 2018. 142(1).
9. Basten, M., et al., Preterm Birth and Adult Wealth: Mathematics Skills Count. Psychol Sci, 2015. 26(10): p. 1608-19.
10. Johnson, S., et al., The long-term consequences of preterm birth: what do teachers know? Dev Med Child Neurol, 2015. 57(6): p. 571-7.
11. House of Lords, Preterm birth: reducing risks and improving lives. 2024: London, UK.
12. National Institue for Health and Care Excellence, Developmental follow-up of children and young people born preterm. Full Guideline. NG72. 2017.
13. Johnson, S., et al., Improving developmental and educational support for children born preterm: evaluation of an e-learning resource for education professionals. BMJ Open, 2019. 9(6): p. e029720.
November 2025
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