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The Impact of COVID-19 on the Educational Needs of Children Born Prematurely

by Catriona Ogilvy

Catriona is one of our specialist Paediatric Occupational Therapists, helping children with complex needs and life limiting conditions. She is also the founder of a premature baby charity, supporting families following neonatal intensive care.

Catriona Ogilvy It has been over a year since the COVID-19 pandemic forced the first closure of schools.

In that time, pupils have missed out on months of face-to-face education and while this has had a detrimental impact on learning and well-being for all pupils, Ofsted reports confirm what many of us who work in education already knew... Children with Special Educational Needs have been hit the hardest.

The Special Educational Needs of Children Born Prematurely

Every year 60,000 babies in the UK are born premature (prior to 37 weeks’ gestation), making up 7 percent of all births. That equates to 2 or 3 children in every average sized primary school class who may have been born prematurely.

Evidence tells us that children born preterm are at a higher risk of having Special Educational Needs (SEN) than children born at term, with much known about the long-term neurodevelopmental outcomes for children born prematurely, putting them at increased risk of a range of cognitive, learning, neuromotor and behavioural difficulties. Those born extremely preterm, before 28 weeks of gestation, are most likely to need extra support, but those born just a few weeks early may still face difficulties in school. Research has identified that teachers have limited training about the difficulties children born prematurely might face or how to support children born prematurely in school.

The Impact of COVID-19

A neonatal experience is always extremely hard and often traumatic for families following the premature birth of a baby, with high levels of parental mental health difficulties reported after neonatal intensive care. This last year has been extraordinarily difficult. Due to Coronavirus most neonatal units adopted restricted visiting times and many had to limit visitors to one parent only. Yet we know when parents provide hands-on care and prolonged periods of ‘skin-to-skin’ time babies have the absolute best long-term developmental outcomes. In addition to restricted visiting hours, parents have had to wear masks whilst on the units and babies wait weeks or months before going home and being able see their parents’ faces for the first time.

The Special Educational Needs of children born prematurely often go unrecognised, with limited teacher training and only a third of parents of children born prematurely believing that their child’s educational needs are met.

As a result of the pandemic, a cohort of children have missed out on support that has been available to other children with Special Educational Needs. They do not qualify alongside other ‘vulnerable’ children who have been able to attend school and access face-to-face support. When considered alongside the general detrimental impact that school closures have had upon children’s social, emotional, physical and cognitive development, children born prematurely are at a greater disadvantage and the impact on long-term outcomes is yet to be seen.

Training and Support

In June 2020, The Smallest Things, a premature baby charity dedicated to making the world a better place for premature babies and their families after neonatal intensive care, launched a ‘Prem Aware’ Award Scheme. The scheme aims to support teachers and schools to better understand how prematurity can affect development, to recognise additional learning needs in a timely manner and to support children born prematurely in education to achieve their potential.

The scheme promotes free online training, ‘Preterm Birth Information for Educational Professionals’, developed by the PRISM Study Team and funded by the charity Action Medical research, and asks schools to encourage parents at school registration stage to give details of birth history, including birth gestation. On becoming a ‘Prem Aware’ school, one deputy head teacher told the charity: “Completing the PRISM Awareness training has highlighted the need to gather as much information as possible about preterm births. This will enable us to identify early intervention that may be required to improve the life chances of those children born prematurely”.

The Role of the Occupational Therapist

Children’s Occupational Therapists have a unique role to play in recovery plans for children in a post-pandemic world. As natural advocates for children with Special Educational Needs, children with ‘hidden’ or ‘unrecognised’ needs should be at the forefront of their minds too.

There has been an increase in parental referrals, with families expressing concerns they have identified during lockdown learning, however, this is the tip of the iceberg. Parents from lower socioeconomic backgrounds are more likely to have a child born prematurely. They have been affected more adversely by the pandemic, struggled more to access online and remote learning and are less likely to self-refer to Occupational Therapy or identify special educational needs.

Children’s Occupational Therapists should consider the needs of children born prematurely when formulating service recovery plans and are well placed to work together with schools and teachers to raise awareness of the training and support that is available to them.

The long-term impact on children born prematurely during the pandemic remains to been seen, but one thing’s for certain, Children’s Occupational Therapists should be at the forefront of the recovery.

Further Reading

Ofsted COVID-19 series - GOV.UK

PRISM Training

Prem Aware Award — The Smallest Things

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