Educational Attainment of Children With Major Congenital Anomalies During Primary School in England: A Population Cohort Study

BACKGROUND: Major congenital anomalies (CA) affect 2.3% of livebirths and are associated with lower educational attainment. Understanding attainment trajectories throughout primary school would inform parents, schools and organisations and help plan support. OBJECTIVES: We compared school enrolment and attainment at ages 5, 7 and 11 in children with different CA and their peers in England using the Education and Child Health Insights using Linked Data database. METHODS: We included all singleton children born in NHS-funded hospitals from September 2003 to August 2008 who enrolled in state-funded schools at ages 4-5. CA were identified from hospital diagnoses, procedures or death records. We described school enrolment, school-readiness, the percentage who sat curriculum assessments and who achieved expected English and Maths attainment at three ages. We estimated risk ratios of children with CA achieving expected attainment compared with peers, adjusting for sociodemographic factors. RESULTS: Of 2,351,589 children enrolled at age 5, 78,847 (3.5%) had CA. At age 11, 88.7% of enrolled children with CA sat assessments versus 97.2% of peers. Proportionally fewer children with CA (45.7%) were school-ready at age 5 versus peers (57.0%). For English, 56.9%, 55.4% and 65.3% of children with CA achieved expected levels at ages 5, 7 and 11 respectively, consistently 11%-12% fewer than peers; similar gaps persisted for Maths. Children with CA were less likely than peers to achieve expected attainment (adjusted risk ratio [aRR], 0.86, 95% confidence interval [CI] 0.85, 0.86), but this varied substantially (aRR 0.01, 95% CI 0.01, 0.02 for Down syndrome; aRR 1.04, 95% CI 0.96, 1.12 for unilateral renal agenesis). CONCLUSIONS: Attainment gaps between children with CA 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.