EYFS best practice in schools - Early days

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In the UK, around one in 13 babies is born before 37 weeks of pregnancy. ‘More children are born early because of medical advances, and more are surviving who would not have done ten years ago, even those born as early as 23 or 24 weeks,’ says Josie Anderson, senior policy and public affairs officer at premature baby charity Bliss.

Despite their growing numbers, it seems many schools are unaware of the possible needs of these children, and few are adapting their environment or teaching strategies to support them.

THE IMPACT OF PREMATURITY

While every child will develop differently, premature babies may take longer to reach milestones because they are not always assessed according to their due date rather than their earlier birth date. They may be small for their age, and may not be fully toilet trained on entering school, especially if their birth date puts them into a different year group than if they had been full-term.

Cognitive and behavioural problems

Preterm children have been found to experience some cognitive, behavioural and emotional problems. ‘Children born prematurely may be less attentive (on average) but not disruptive in their behaviour – they are often forgotten but easy-to-manage children,’ says Professor Dieter Wolke at the University of Warwick.

‘It is important to involve them in social activities to make friends, to provide assistance to monitor their attention and help with visual-spatial concepts and maths, language and reading. An important aspect for long-term happiness is to foster social relationships, as they have fewer friends and are at higher risk of being bullied.’

Ms Anderson explains, ‘While with some children there will not be any apparent issues, it is important to bear in mind that when they were born they were developing in an unnatural environment. They were exposed to light and sound they would not have been exposed to if they had remained in the womb, so their brain is wired a little differently.’

Academic attainment

While the vast majority of preterm children attend mainstream schools, research has found that these children have on average poorer academic attainment. A Bristol University study found that one third of children born before 37 weeks lag behind their peers academically at the age of seven. However, a recent report tracking 1.3 million children in Florida found that while there is a gap, for those born after 28 weeks, the differences in test scores were negligible, and even those born extremely prematurely had caught up with their peers by the age of 11.

ADMISSIONS POLICY

When a child’s birth date means that they will start school a year earlier than they would have done had they been full-term, parents are often keen to delay entry. Bristol’s study backed this approach, finding that children enrolled in school a year earlier than would be expected do worse than those who do not ‘skip’ a year.

On the other hand, a 2016 Nuffield Foundation report found a lack of evidence to justify delaying a premature child’s school start, and some evidence to suggest delayed school entry may place preterm children at further academic disadvantage. ‘We found that exposure to school and being supported helps them with social maturity,’ says Professor Wolke.

This confusion is reflected in policy and practice, with some schools allowing premature children to defer entry to Reception year and others refusing.

Kelvin Dawson’s daughter Charlotte will start Reception a year late according to her birthdate, but in the correct year for her due date. ‘Before we found the school we hoped to get a place at, we visited two others that absolutely refused to consider any of the research that shows premature children underperform,’ he says. ‘If Charlotte started at the “proper” time, I think she would be able to cope, but she would be coping rather than thriving.’ (See Etching Hill case study, above.)

IDENTIFYING PREMATURE CHILDREN

Some parents are reluctant to mention their child’s prematurity to school staff for fear of stigmatising them. ‘Parents and teachers have different attitudes: teachers want to know that a child was born preterm – as they think they can help them – but they need training,’ says Professor Wolke.

‘Parents are worried that if they tell the teacher, their child might be labelled as having problems. Both are realistic concerns: it is important for parents to be open but discuss frankly that many preterm-born children do well.’

Other parents, however, want teachers to know about their child’s background. Dr Carolyn Blackburn, senior research fellow at Birmingham City University, recently published a report on the experiences of parents of premature children in the early years. When starting school, only 15.6 per cent of parents said teachers or teaching assistants had asked about premature birth. While 61 per cent of parents felt their child needed additional support, only 34 per cent of schools adapted the environment or their teaching strategies to support preterm children.

‘Teachers don’t generally know who was born prematurely,’ says Ms Anderson. ‘They don’t get training on how it can affect learning and development, so even if they knew, they might not realise how to adjust their approach if that is a necessity for that child.’

TRAINING

‘Our research indicates teachers know very little about the special needs of preterm children,’ agrees Professor Wolke. ‘They may know about physical disabilities but not the major mental health issues such as attention problems, being socially withdrawn, more ASD symptoms, more maths problems and so on. But teachers really would like to know more.’

Dr Blackburn’s research found that parents would like pre-school and school staff to receive training about premature birth, particularly covering:

• the impact on learning and development
• the medical and health impact
• the psychological impact on parents of having a preterm child
• transition into pre-school and school
• supporting preterm children in building relationships.
  
  

ASSESSMENT AND APPROACH

Teachers may feel that if they have a strong early years approach, supporting the needs of each individual child, they do not need a specific policy for children born prematurely. However, some find it helpful to track the development of premature children as they do with those eligible for the Pupil Premium, while ensuring this does not lead to low expectations for that group.

‘If a child starts school and they have not shown any development issues, it doesn’t make much sense to be doing something proactively if it is not needed,’ says Ms Anderson. ‘But it can still be helpful to have an awareness, because some issues such as a difficulty with maths might not be noticeable until a child starts school, and others – such as speech and language issues – may become more pronounced over time.’

A premature child may be smaller than their peers – sometimes so small a parent cannot find a uniform to fit them – and a school should ensure all equipment is accessible. There may be behavioural and social issues which a child needs support with: for example, they could be given something to fidget with during carpet time.

Interventions should be available to encourage social interaction skills in premature children as many struggle making and maintaining friendships. ‘I think the focus, in particular in pre-school, should be on social integration – a major driver of well-being,’ says Professor Wolke. ‘Having friends is protective and assists with learning and working together.’

With improved survival rates for extremely preterm births and an increasing proportion of babies delivered at late preterm gestations (34–36 weeks), there will be more preterm children entering school in the coming years. ‘That is why it is increasingly important we are aware of the effects prematurity can have on learning,’ concludes Ms Anderson.

CASE STUDY: Etching Hill Primary School, Staffordshire

At Etching Hill, children born prematurely are front-of-mind for staff in nursery and Reception classes.

‘When children join our nursery, we ask to see their Red Book [Personal Child Health Record], so we are able to see if they were preterm, and gain an understanding of their health and development prior to starting with us. That puts them into a group where we pay especial attention to tracking their development,’ says deputy head Jamie McMullan. ‘We know children born early can face developmental delays, especially in their height, physical development, confidence, and listening and attention skills.’

The Multiple Factors That Affect group includes other children with potential additional support needs, such as looked-after children and summerborns. ‘We sit down and discuss all of the children in that group and talk about eight-week plans for them,’ says Ms McMullan. ‘Do we need to adapt the environment for them, or look at support with friendship groups?

‘We are able to have as many experts involved as possible to make sure we are progressing them as much as we can – of course, we are doing this with every child, but we might be looking at height, posture, attention skills, problem-solving through creative play.’

One example of enhancing the environment is bringing in height-adjustable equipment. ‘The water tray has two levels so children can access it whatever their height,’ says Ms McMullan. ‘We have got a teaching assistant role that is specifically focused on speech and language, we have Lego therapy for fine motor skills, and music therapy – it’s something we do as and when it is needed.’

The school uses a Focus Child system, where each week different children receive concentrated support, including taking home a questionnaire for parents, asking about any current family events or concerns, and for additional photos of family life. All pupils take their turns at being a focus child, but some take part more often, says Ms McMullan. ‘Pupil Premium, special needs and preterm children are a Focus Child every six weeks.’

There is a particular focus on transition from nursery to Reception: with nursery next door to Reception, teachers and the early years SENCO pop in and out, building relationships with the children. ‘We find parents of children with additional needs can have anxiety without realising it, so it is important to support them as well.’

Kelvin Dawson is dad to Charlotte (pictured), who will be four in August and was born at 25 weeks and two days, weighing just 1lb 13oz (820g). ‘We went to a number of schools and Etching Hill was the only one prepared to consider the Government guidelines on delaying admission for summerborn children,’ he says.

Charlotte is set to stay in nursery for another year and will start Reception when she has just turned five. ‘Delaying admission is never something we would instigate ourselves, but we are always open to discuss this with parents,’ says Ms McMullan. ‘We do not like to think of it as delaying, for us it is more about offering children who need it additional time in school to achieve their full potential.’

CASE STUDY: Braiswick Primary, Essex

Lauren Goddard’s five-year-old twins Harry and Finlay were born at 35 weeks and five days. Last September, the boys started at Braiswick Primary, where teachers hold a ten-minute consultation with every parent of a new starter.

‘At our first meeting, with them being twins, we did talk about whether they were premature,’ she says. ‘We talked about how long they were in hospital, whether they had had lung inflation – I was struck by the fact the school took that much interest in their first days.’

Nicola Whybrow, deputy head and early years teacher at Braiswick, says teachers would not necessarily ask parents directly whether a child was born preterm, but the consultation is an opportunity for parents to highlight any concerns they have. ‘We ask parents if children are meeting their milestones, and if they bring up the fact their child was born early, we ask if it has affected them,’ she explains.

‘As part of our transition process we visit all children in their nurseries and pre-schools, and have an informal chat to their key person about that child’s needs.’

A managed transition into Reception supports all children, but especially those with additional needs, as it gives staff a chance to build relationships. ‘If there are children who might find the transition to school tricky, there are special days when they can come and explore the classroom and meet our pastoral staff,’ says Ms Whybrow.

In September, Reception children start by attending only morning or afternoon sessions. As the boys are among the oldest in their year group, Ms Goddard says she has fewer concerns than she might have had. ‘If they had been July babies, I might have been more concerned,’ she says.

Ms Whybrow says the age range of classes can vary significantly from year to year, and the school adapts its approach accordingly.

Ms Goddard’s boys have been able to access additional speech and language support since starting school. ‘There are some sounds they are both unable to do, but I don’t know whether that’s because they were premature,’ she says. ‘I was happy the school suggested additional support.’

PREMATURE BABIES: FACTS AND FIGURES

Children born early are classified as:

• extremely preterm (less than 28 weeks)
• very preterm (28-32 weeks)
• moderate to late preterm (32-37 weeks)

In England and Wales in 2016, 3,184 babies born were extremely preterm, 5,627 were very preterm and 44,792 were moderately preterm.

Almost one in three children born prematurely has lower Key Stage 1 test results and more than a third have special educational needs. There is a major impact on a child’s development in about 10 per cent of cases and a more subtle impact in 50 per cent of cases.

Developmental effects

Almost two-thirds of children born extremely prematurely require additional support at school.

Up to 44 per cent of these children have a serious impairment in core subjects such as reading and maths, and 50 per cent have performance below the average expected range.

Extremely preterm children have a 13-fold increased risk of special educational needs requiring additional learning support and are 77 times more likely to have an educational statement at 11 years of age.

At the age of six, very preterm children reported four friends, compared with full-term children who had five friends. Very preterm children see their friends 15 per cent less than those born full-term.

At the age of four, 20 per cent of children born extremely or very prematurely have peer relationship problems, compared with 10 per cent of full-term children. Overall, 23 per cent have behavioural problems, compared with 11 per cent of full-term children.

Sources: Office for National Statistics – Preterm Birth, Age at School Entry and Educational Performance(2013); Nuffield Foundation; EpiCURE; The Champion Centre

MORE INFORMATION

‘All too soon’ and ‘Term times’, a two-part series on prematurity by Anne O’Connor, is at: www.nurseryworld.co.uk

The long-term consequences of preterm birth: what do teachers know? by Samantha Johnson and others, Developmental Medicine and Child Neurology, June 2014, https://bit.ly/2MCgZpx

‘A different kind of normal’: parents’ experiences of early care and education for young children born prematurely by Carolyn Blackburn and Merryl Harvey, Early Child Development and Care, May 2018, https://bit.ly/2K25ZTS

The Impact of Preterm Birth on Mathematics Achievement and Schooling by Dieter Wolke and others, Nuffield Foundation, 2016, https://bit.ly/2K270LG

Educational Performance of Children Born Prematurely by Craig Garfield and others, JAMA Pediatrics, August 2017, https://bit.ly/2t6M5O5

Preterm Birth, Age at School Entry and Long Term Educational Achievement by David Odd and others, PLoS One, May 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4871348