Educational attainment of children with major congenital anomalies during primary school in England: a population cohort study using linked administrative data from ECHILD

BackgroundMajor congenital anomalies (CAs) occur in 2.3% of livebirths and are associated with lower educational attainment in affected children. Understanding how attainment changes throughout primary school would inform parents, schools and organisations and help plan support. ObjectivesWe compared school enrolment and attainment at ages 5, 7 and 11 in children with different CAs and their peers in England using linked administrative hospital and education data in the ECHILD database. MethodsWe included all singleton children born in NHS-funded hospitals from September 2003 to August 2008 who enrolled in state-funded schools at age 4-5. CAs were identified from hospital diagnoses, procedures or death records. We described school enrolment, school-readiness, the percentages of children who sat curriculum assessments and who achieved expected levels in English and Maths at three ages. We estimated risk ratios of children with CAs achieving expected levels compared with peers, adjusting for sociodemographic factors. ResultsOf 2,351,589 singleton children enrolled at age 5, 78,847 (3.5%) had CAs. At age 11, 88.7% of enrolled children with CAs sat assessments versus 97.2% of peers. Proportionally fewer children with CAs (45.7%) were school-ready at age 5 versus peers (57.0%). For English, 56.9%, 55.4% and 65.3% of children with CAs achieved expected levels at ages 5, 7 and 11 respectively, consistently 11%-12% fewer than peers; similar gaps persisted for Maths. Children with CAs were on average less likely than peers to achieve expected levels [adjusted risk ratio, aRR (95%CI): 0.86 (0.85,0.86)] but this varied substantially across CA subgroups [aRR (95%CI) range: 0.01 (0.01,0.02) to 1.04 (0.96,1.12)]. ConclusionThe attainment gap between children with CAs and peers remained unchanged across subjects and ages, with proportionally fewer sitting assessments at age 11. Better monitoring and support for these children from school entry could help optimise learning experiences and fulfil their academic potential. SYNOPSISO_ST_ABSStudy questionC_ST_ABSWhat are the patterns of educational attainment in children with major congenital anomalies (CAs) throughout primary school? What is already knownStudies of regional or registry-specific cohorts of children with CAs showed that proportionally fewer achieve expected attainment relative to peers at single stages of national assessments. There is limited evidence on childrens participation in assessments and how attainment gaps change throughout primary school at a population level. What the study addsLongitudinal analysis of whole-population cohorts from ages 4 to 11 found that attainment gaps between children with and without CAs remained largely constant across ages. Over half of children with CAs were assessed as not school-ready at age 5. Whilst almost all children with CAs remained enrolled in school at age 11, one in nine did not participate in assessments.