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Study: Premature Babies May Benefit from School Delay

Premature babies more likely to under perform at school, study finds,” reports The Independent. Results from a new study have prompted calls that some children should be held back a year before starting school.

Previous research has found that premature babies have worse school performance than babies born at term. A new study has investigated whether this poor performance could be due to premature babies being compared with children born at term who, even if they were born at the same time, are effectively older than they are.

In addition, children who are born prematurely may be enrolled at school a year earlier than predicted by their expected due date. For example, a premature baby born in July could start school a year earlier than if they had been born at full term in September. So they would be enrolled in school effectively a year early, leaving the child constantly struggling to keep up.

The researchers looked at performance on “key stage one” tests – a UK test of reading, writing and maths skills. They also looked at whether children were judged as having special educational needs.

The researchers found that children born premature are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.

However, the risk was greatly reduced for preterm children who, if they had been born on their expected date of delivery, would still have been in the same school year as their actual birth date put them in.

While school performance for children born preterm may improve by delaying entry to school, the social implications of being perceived to be “held back” (to be in a school year with younger children) could have an adverse effect on the child. As the researchers conclude “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.

Premature birth – reducing the risk

Premature births can happen in any pregnancy, whatever the general health and lifestyle of the pregnant woman. However, there are steps you can take to reduce the risk of having a premature birth, including:

  • Avoiding potentially harmful substances such as alcohol, tobacco and drugs
  • Trying to achieve or maintain a healthy weight
  • Eating a healthy diet

For more information about health and wellbeing in pregnancy, visit the NHS Choices Pregnancy and baby guide.

Where did the story come from?

The study was carried out by researchers from the Neonatal Unit at North Bristol NHS Trust and the University of Bristol. No source of funding was reported.

The study was published in the peer-reviewed journal PLOS One. PLOS One is an open-access journal, which means that the article is available free of charge to read online or download.

The results of the study were well covered by the UK media. All three newspapers who reported on the study – The Independent, The Daily Telegraph and the Daily Mail – provide relevant commentary from independent childcare experts.

What kind of research was this?

This was a cohort study. Previous research has found that preterm babies have worse school performance than term babies. This study aimed to determine if some of this effect was due to preterm children being enrolled in school a year earlier than they would have been if they had been born at their expected due date. In the UK all children are offered a school placement based on their actual date of birth, rather than their expected due date.

To do this, they compared school performance in children born preterm who would have attended school in the same year if their expected date of delivery had been used rather than their actual date of delivery, to the school performance in children born at term.

A cohort study is the ideal study design to address this question.

What did the research involve?

The researchers analysed data from 11,990 children born in the Bristol area between April 1991 and December 1992 who were participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) – an ongoing cohort study.

Data on the gestational age at birth was extracted from clinical notes. The study included infants that were born between 23 and 42 weeks of gestation.

School performance was assessed using the results of key stage one (KS1) tests, which all children in mainstream education sit at the end of year two. In addition, teachers were sent a questionnaire that asked whether children had ever been recognised as having special educational needs.

The two primary outcomes were a low KS1 score (below 2, the expected standard in the “three Rs” of reading, writing and arithmetic), or having teacher-reported special educational needs.

The researchers looked to see if children who had been born preterm were at greater risk of low KS1 scores or having special educational needs, and whether this was due to them being placed in school a year earlier than if they had been born at term. To do this the researchers performed three analyses:

  • One where each preterm infant was matched with up to 10 term infants based on their date of birth, and the outcomes for term and preterm infants compared
  • One where each preterm infant was matched with 10 term infants based on their expected date of delivery, and the outcomes for term and preterm infants compared
  • One where each preterm infant was matched to term infants based on their expected date of delivery and year of school attendance, and the outcomes for term and preterm infants compared

In this final analysis, the researchers compared the risk of low KS1 scores and special education needs only in infants who would still have been in the same school year if they had been born at their expected date of delivery rather than their actual date of delivery.

The researchers adjusted their results for a range of factors (confounders) that could influence academic performance. These included:

  • Social factors (maternal age, socioeconomic group, education, car ownership, housing, crowding index [the number of household members per room] and ethnicity)
  • Antenatal factors (the number of times the mother had previously given birth, and gender, weight, length and head circumference at birth of the infant)
  • Factors during labour (mode of delivery, maternal high blood pressure and fever)

What were the basic results?

The study included 722 children who were born prematurely or “preterm” (at less than 37 weeks) and 11,268 children who were born at term (between 37 and 42 weeks).

Preterm infants were statistically more likely to have a low KS1 score and to receive special educational needs support.

Infants who were placed in the correct school year for their expected delivery date had higher KS1 scores than those children whose actual date of birth had put them in a different school year than their expected delivery date would have.

In children who had been born at full term, average KS1 scores were highest in the children oldest at the time of the test – i.e. children born in September. Average scores gradually decreased as the children entering the year were younger, with children born in August obtaining the lowest mean KS1 scores.

A similar pattern was seen for preterm infants, although the lowest mean KS1 scores were from children born in June.

Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of date of birth; to adjust for the fact that, on average, the oldest children did the best on the test (odds ratio (OR) for low KS1 score 1.57, 95% confidence interval (CI) 1.25 to 1.97; OR for special educational needs 1.57, 95% CI 1.19 to 2.07).

Children born preterm were at higher risk of low KS1 score and having special educational needs when children were matched on the basis of expected date of delivery rather than gestational age (to adjust for the fact that children born preterm are actually younger than their date of birth would suggest). The OR for low KS1 score was 1.53, 95% CI 1.21 to 1.94; the OR for special educational needs was 1.59, 95% CI 1.20 to 2.11.

However, children born preterm were not at significantly higher risk of low KS1 score or of having special educational needs when outcomes were compared only for children attending school in the correct year for their expected date of delivery, and children were matched based on their expected date of delivery (OR for low KS1 score 1.25, 95% CI 0.98 to 1.60; OR for special educational needs 1.13, 95% CI 0.81 to 1.56).

How did the researchers interpret the results?

The researchers concluded that “this study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their expected date of delivery) may increase their risk of learning difficulties with corresponding school failure”.


In the UK, all children are offered a school placement based on their actual date of birth, rather than their expected date of birth. This study has found evidence from a large UK cohort that children born preterm may benefit from school entry based on their expected date of delivery rather than their actual birth date.

The study found that children born preterm are at greater risk of having a low key stage one score, and of having special educational needs compared with children born at full term.

However, there was no significant increase in risk among preterm children who would still have attended the same school year even if they had been born on their expected date of delivery.

This arguably suggests that admission policies to schools should be based on a child’s expected date of delivery rather than actual birth date. However, as the researchers rightly point out, the issue of whether an older child would interact well with children who could be, or we perceived to be, younger than them also has to be considered.

As the researchers conclude: “whether a policy of holding infants born prematurely back to their corrected school year would have a beneficial impact is as yet unknown”.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.


“Premature babies more likely to underperform at school, study finds,” The Independent reports. Results from a new study have prompted calls that some children should be placed back a year before starting school.

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Video: How to Introduce Your Child to Sleeping in a Bed

In this brief video, NHS Health Visitor, Sara, discusses how to approach moving your young child from a cot (*crib) to a bed and gives some tips for success.

Editor’s Note: Video Highlights

  • child-moving-to-a-bedThere are no hard-and-fast rules for when to move your baby from a cot (*crib) to a bed – do it when it feels comfortable for your child and for you
  • From 18 months, you might find that your child is too big for a cot or is trying to climb out – that’s the time to move them into a bed
  • For some children, moving from a cot to a bed is really exciting and they accept it really well
  • For other children, they might feel a bit stressed about the change – so you might need to choose a calm time in their life
    • Challenging times for moving from a cot to a bed can be if you’re moving house, if you’ve gone back to work or if your child is not feeling well
  • You may need to move your child to a bed if you have another baby on the way – if so, do it about six to eight weeks before your new baby is born, to help keep your child from being unsettled with too much change
  • Once sleeping in a bed, your child might get up in the night and wander around, so be sure to childproof their room
    • Put a stair gate across the door
    • Check their room for any electrical appliances or wires they could trip over, any small toys or objects they can get hold of or any cord blinds that they could get tangled in
    • You might also want to put barrier next to the bed or put cushions on the floor in case they fall out
  • If your child doesn’t like the bed initially and they want to protest, just stay calm, reassure them, give them a cuddle, but put them back in the bed
    • You might find that you have to do it a few times, but if you’re consistent, they’ll soon get used to being in the bed
  • When your child has slept in the bed, or had some naps in the bed, praise them because it can make a big difference to their confidence and they’ll feel much more willing to sleep in the bed if you praise them for what they’ve done

Editor’s Note: *clarification provided for our US readers.


How to Cope with Teen Arguments, Aggression and Violence

Many parents find that when their child becomes a teenager, their behaviour becomes more challenging. But how do you cope if they become aggressive or even violent towards you?

If you’re experiencing aggression or violence from your teen, you’re not alone. A recent Parentline Plus survey found that 60% of calls (between October 2007 and June 2008) included verbal aggression from a teenager, and 30% involved physical aggression, much of it aimed at the parent themselves.

teen aggression and violenceIt is common to keep this kind of abuse behind closed doors and not confide in anyone. Many parents feel  that they have failed to control their child, or that they are responsible for the behaviour in some way – or they may not know where to turn.

However, any kind of aggression can be stressful, and can cause an atmosphere of tension and fear for the entire family, not to mention the possibility of physical harm if their teen becomes violent.

No parent should feel obliged to put up with an unruly teen, and as with any type of domestic abuse, help and support is available. You can find appropriate organisations and helpline numbers (*for the UK)  in “Help and Support” further below. There are also a number of techniques and tips that you might find helpful.

Defusing Heated Arguments

It’s useful to remember that your own behaviour can improve or worsen an aggressive situation, so it’s important to be a good role model for your teen.

Linda Blair, clinical psychologist working with families, advises: “Bear in mind that you are their principal role model. If you act aggressively but tell them not to, they won’t listen. It’s also helpful to remember that their anger is often based on fear – fear that they’re losing control.”

With that in mind, it is worth trying to maintain a calm and peaceful presence. You need to be strong without being threatening. Remember that your body language, as well as what you say and how you say it, should also reflect this.

Avoid staring them in the eye, and give them personal space. Allow them the opportunity to express their point of view, then respond in a reasoned way.

Breathing Exercises to Control Anger

If an argument becomes very heated, Linda suggests that you “stop for a moment”. Take a deep breath, hold it for a few seconds and then exhale. Repeat five times. This technique is very useful in intense situations.

If your teen is becoming aggressive during arguments, suggest this technique to them when they’re calm, so they too have a way of controlling their anger.

If an argument feels out of control, you can also try explaining to them that you are going to walk away, and that you’ll come back again in half an hour. Given the chance to reflect and calm down, you and your teen will both be more reasonable when you resume your discussion.

As with toddlers, if you give in to teenagers because their shouting and screaming intimidates or baffles you, you are in effect encouraging them to repeat the unreasonable behaviour as a way of getting what they want.

Counselling for Teenagers

Family Lives is a charity dedicated to helping families. They suggest that if very heated arguments happen frequently, it may be worth suggesting counselling to your teen. They’ll benefit from talking to someone new and unbiased, someone who isn’t in their family and who won’t judge them.

Read more about the benefits of talking treatments.

Remember they may not know how to handle their anger, and this can leave them frustrated and even frightened. Some guidance from an outsider can be very helpful.

Dealing with Violent Behaviour

Sometimes, teen aggression can turn into violence. If they lash out at you, or someone or something else, put safety first.

Let your teenager know that violence is unacceptable and you will walk away from them until they’ve calmed down. If leaving the room or house isn’t helping, call the police – after all, if you feel threatened or scared, then you have the right to protect yourself.

Family Lives offer this advice for coping with, and helping, a violent teen:

  • Give them space – once they have calmed down, you may want to talk to them about what has happened and suggest that they let you find them some help.
  • Be clear – teenagers need to know that you will stand by the boundaries you set. They need to know that any kind of violence is unacceptable.
  • Talk to their school and find out if their aggressive behaviour is happening there as well. Some schools offer counselling.
  • Arrange counselling – if your teen admits they have a problem and is willing to get help, book an appointment with a counsellor or psychologist as soon as possible. Speak to your GP (*pediatrician  or family doctor) or their school about what help is available.

Help and Support (*in the UK – see end for resources in other locations)

There are many organisations that offer emotional support and practical advice. Getting some support can help you and your child. At such an important development stage, it’s important that they learn how to communicate well and express anger in a healthy way.

  • You can call Family Lives’ Parentline on 0800 800 2222 any time, or email for a personalised reply within three days. They also offer i-parent modules to help you learn more about communicating better with your teen.
  • You can call the Samaritans on 08457 909090 any time to talk about any type of distress and to get confidential support and advice.
  • Youth Access has details about youth organisations and services offering teens counselling, advice and support.
  • Young Minds is a charitable organisation supporting children and young people with mental health issues, and their parents. They provide information to help young people with anger issues. If you discuss your child’s behaviour with them and they are open to getting help, you might like to direct them to the information on the Young Minds website.

Concerned about Mental Health Issues?

If you’re worried that your teen has a mental health problem such as depression, talk to your GP (*pediatrician  or family doctor). In the UK, he or she can refer them to the Child and Adolescent Mental Health Services, who in turn can refer all or some of you for Family Therapy. Or contact the Young Minds Parents’ Helpline on 0808 802 5544 for advice and support concerning mental health issues in young people.

If you are having trouble coping with your teenager, and you suspect you may have symptoms of depression or other mental health problems, discuss this with your GP (*pediatrician  or family doctor). He or she can then suggest suitable treatment. You may, for example, be referred for counselling, or directed to support groups or other services in your area.

Editor’s Note: *clarification provided for our US readers.

US Resources for Family and Teen Challenges:

Canadian Resources for Family and Teen Challenges:

Australian Resources for Teen Aggression:


How to Avoid Your Child’s Advertising-Fueled Nag Factor

I’ll admit it—the first brand name my son recognized was Starbucks. This probably says something about the coffee habits in our family. However, it also says something about the advertising and branded world we live in. At the time of this recognition my son was about 2 or 2.5 years old. It just goes to show how powerful branded messages and advertising are for even the youngest members of our society.

After reading this disturbing article that explained that the 0-3 year old age range is now the prime target for advertisers, I started to delve more into the research on advertising to children.

kids advertising and the nag factorWhat I found was not encouraging. It seems clear that advertisers focus a lot of their time and money on ads for food products targeted to kids, most of which are quite unhealthy. A study released by the Kaiser Family Foundation showed that advertising on children’s television (aimed at kids under age 12) had the highest proportion of food ads (50% of all ads) compared to all other genres of TV. What types of foods do these ads promote? Much like you might expect, these food ads targeted toward children primarily focus on candy and snacks (34%), cereal (28%), and fast food (10%).

Unfortunately, this type of advertising works. Studies show that children who watch more ads for food products on television are much more likely to prefer unhealthy foods when offered a choice.

So why is this advertising to children so effective? One factor, of course, is the advertisers are smart—they have harnessed the knowledge of psychology and marketing to be able to market products (especially food) to children in just the right way to make it very appealing to little minds.

Additionally, as we all know, children are relatively impressionable. Young children, in particular, have very little power to resist advertising when they see it. They do not yet have the skills to understand the advertisers’ persuasive tactics.

Lastly, and perhaps most disturbing, advertisers are aware of and have harnessed the power of “the nag factor.” We all know what that means. Kids nag their parents incessantly for products that they’ve seen advertised, usually on TV. One recent study looked at the “nag factor” and found that kids who are more familiar with commercial television characters are more likely to nag their parents for the products associated with those characters.

For me, one of the most problematic aspects of all this advertising to children is that the advertisers are really trying to indoctrinate kids into the idea that life should be all about purchasing and getting material things.

The good news is that parents are not helpless in this battle with advertisers for their children’s minds (and stomachs). Although advertising, particularly related to food items, is very persuasive to children, parents can be quite persuasive too as long as they promote a constant message of healthy food choices.

In a new study just published, several researchers considered the role of parents’ messages in the food choices made by children ages 3-5 just after watching advertising for food products. In one part of the study, children watched a commercial for French fries and were then given the option to choose French fries or a healthier food option for a snack. Parents looked on and one group was told to encourage their children to make the healthier choice, while the other group of parents was told to remain neutral about the food choice. When parents remained neutral, 71% of the children chose the French fries over the healthy option. However, when parents encouraged a healthier choice, the percentage of kids choosing French fries dropped to 55%. While this is not a dramatic drop, it does show that parental influence does have power, even in light of direct advertising for unhealthy products.

I think it’s unlikely that this type of marketing will end or even slow down, but this research offers encouragement that we as parents can influence good choices by our children, as long as we adhere to a clear, consistent message. It is obvious that advertising has a strong impact on children, so limiting children’s exposure to commercials will most likely make your children’s choices better in the long run and perhaps your life a little easier as a parent (e.g., less nagging).

Additionally, as children get older, I could see it being helpful to explain to them how advertisers play their game. If kids can understand why and how advertising is so persuasive, they might be more likely to resist it.

With my older son, I have begun explaining how some things we see on TV or the internet are a “trick.” The people making the product are trying to “trick” us into spending money on something that is either unhealthy or useless (like a junky toy). I have been reminding him of times when he bought a cheap toy and was bored with it after a day or two. These lessons are starting to sink in but it is an ongoing battle with advertising.

Here are some good resources available for helping kids learn media literacy:


Parents Share Their Tips for Helping Kids with Homework

Homework is an important part of your child’s education and as a parent you can take steps to help them to get the most from it.

Managing homework can be a source of tension. Three parents share the tips that helped them.

Turn Off the TV During Homework

helping with homework“The best thing I’ve ever done is ban all screen time on the TV and computer from Monday to Thursday,” says Patricia, 39, mum to two boys aged 8 and 12.

“Before I did this, my younger son would always be creeping off to watch cartoons. Now that’s not an option, it’s much easier to get homework done. Interestingly, his headmistress thinks that’s the best policy, too. She often sees a big improvement in overall mood and performance in children who have this partial ban.”

Don’t Help Your Children with Homework

“They’re not being marked on what you can do,” says Linda, 39, mum to twin eight-year-old girls. “I know people who virtually do their children’s homework for them, but what’s the point in that? It’s not a competition.”

Dr Susan Hallam of the Institute of Education also advises that you offer moral support, but only give help when your child asks for it.

Do Homework While Your Child’s Alert

“The golden rule with a seven-year-old is to get it done as soon as you get in from school, before tea (*dinner),” says Michael, who has a seven-year-old daughter. “The attention span deteriorates pretty quickly after tea for anything other than Barbie websites.”

Patricia agrees. “Some kids need a little downtime immediately after getting home from school, but if you leave it too late, they’ll be too tired to concentrate.”

Homework Tip: Use a Timer

“If you have one of those children who endlessly dawdle over homework, sharpening all their pencils, getting up and down or reading all their previous homework, it can sometimes help to set a timer,” says Patricia.

“If the school recommends 20 minutes a night, then set the timer for 20 minutes and say that’s the limit. This can sometimes backfire and result in hysteria though, so play it by ear.”

Let Children Know You’re on Their Side

“I find that if they’re complaining bitterly, it can help to sympathise with them,” says Patricia. “I do genuinely feel for them over homework and it does help them to know I’m on their side. But at the same time I feel I need to insist on it being done, so it’s a balancing act.”

Editor’s Note: *clarification provided for our US readers.

How to Reframe Your Child’s Negative, Anxious Self-Talk

Anxious-child-with-negative-thoughtsDo you have a child who is often emotional or moody – or prone to anxiety or depression? If so, you might be familiar with the negative self-talk that often contributes to these conditions. And, actually, any child – or adult – is subject to these thoughts on occasion.

Negative or anxious self-talk – sometimes also called “automatic negative thoughts” – is unhelpful, often skewed thinking that tends to drive negative emotions and behaviors. For example, your daughter might react to a friend who gets angry while playing and goes home, by thinking “I’m no fun to play with….nobody likes me” – and might avoid inviting any other kids to come over and play.

I learned about the concept of negative self-talk years ago through cognitive behavioral therapy while dealing with issues from my childhood. But I was surprised when I first began noticing examples of this thought pattern in my young son. When Elliott was in his first couple of years of elementary school, he would often come home at the end of the day and report that his day was “terrible”.

After digging a little I would often find out that one “bad” thing had happened each of these days – which then tainted the whole rest of the day. This overgeneralization / all-or-nothing thinking is an example of negative self-talk – and caused Elliott to have negative emotions about school and resist going in the mornings.

There are several different types of negative or anxious self-talk. A good reference book on anxiety for teens and kids – My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic (by Michael A. Tompkins, PhD and Katherine Martinez PhD) – gives an interesting classification for these unhelpful thoughts (a summary is listed at the end of this post). This book was recommended to me by a child and family psychologist and is well worth a read.

As the book title suggests, there are ways to deal with and manage such unhelpful thinking – and it’s useful to start early with kids who are prone to negative thoughts. At a minimum, it helps to start by identifying and unpacking the negative thought.

For example, with my son Elliott and his “terrible” days at school, I started asking him if anything good happened during the day. This got him to go over all the events of his time at school and put the “bad” experience into context – and I suggested that one or two bad experiences might not make a whole day terrible. Pretty soon, when I asked him how his day was, Elliott would outline how different parts of the day went (great, so-so, neutral, awful, etc) – and this pattern has persisted for more than five years! Even better, he has generally been much more positive about his school days ever since.

Additional exercises for recognizing and dealing with negative self-talk are provided in My Anxious Mind. Another practical book, with useful exercise to help teens cope with negative thoughts and other drivers of anxiety, is The Anxiety Workbook for Teens, by Lisa M. Schab, LCSW.

Types of Anxious Self-Talk  (from My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic)

Book Ends

This is anxious thinking that assumes there are only two possible outcomes of a situation – both at opposite extremes, with no possibilities in the middle. So, the child in the earlier example might be focused on how the play date with her friend needed to be perfect, and if that didn’t happen it would be a disaster.

Binocular Vision

In this unhelpful thought process, your child will “magnify” the effect of something bad – like failing a test – and assume that he won’t be able to go to college as a result. Or he might “shrink” the importance of something good, like all his excellent grades in other classes.

Fortune Telling

This type of self-talk involves your child thinking he or she can predict the future – usually thinking something bad will happen. For example, your child is engaging in fortune telling if she decides to audition for a part in the school play but spends the weeks leading up to the audition thinking “I’m not going to get the part”. Maybe she will, maybe she won’t – but she doesn’t know, and anxious self-talk won’t help the outcome either way.

Mind Reading

In the earlier example, the girl whose friend got angry and went home assumed that she could read her friend’s mind; that the friend thought she wasn’t fun and didn’t like her anymore. This is the mind reading track – and it’s important for the girl to know she isn’t a psychic and her friend will probably be back to play the next day.


With overgeneralization, similar to binocular vision, your child will focus on something small (usually bad) to make broad conclusions or sweeping statements – like, if one friend gets angry at me then no one likes me. Or if your son has one bad soccer game, assuming he’s no good and will get cut from the team.

End of the World

With this anxious track, your child is always expecting something terrible to happen. This could be at school or in relationships with friends, but it could also be thinking that every noise around the house is a burglar.

Should-y/Must-y Thinking

Too many thoughts with “shoulds” and “musts” can set the bar for performance and life experience way too high – and make your child anxious and less confident.

Mind Jumps

In this type of unhelpful thinking your child will jump to conclusions (usually negative) without all the facts – like when hearing that he isn’t invited to a party at a friend’s house, your son assumes his friend doesn’t like him. Getting the facts might tell him otherwise, especially if he finds out it’s a family-only affair (for example).


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