Children born very prematurely face significant school challenges: a 2026 cohort study of 15,857 extremely premature babies in England found that 56.6% didn’t meet school readiness standards by age 5, and about half struggled with writing and math by ages 6-7. However, Gram Research analysis shows that specific factors—breastfeeding, maternal nonsmoking, proper medical care, and reducing poverty—can substantially improve outcomes. The earliest-born children (23-24 weeks) had nearly 3 times higher risk of falling behind, but even less-premature babies showed disadvantages.
A major study of over 15,000 children born very early found that premature babies face real challenges when starting school. More than half didn’t meet reading and writing goals by age 6-7. The good news? Researchers identified specific things that make a difference—like breastfeeding, avoiding smoking during pregnancy, and getting proper medical care. According to Gram Research analysis, poverty and neighborhood disadvantage also played a role, suggesting that supporting families matters just as much as medical treatment for helping premature babies succeed in school.
Key Statistics
A 2026 cohort study of 15,857 children born before 32 weeks of pregnancy in England found that 56.6% did not meet school readiness standards by age 5, with 51.8% struggling with writing and 48.1% struggling with math by ages 6-7.
Children born at 23-24 weeks of pregnancy had 2.86 times higher odds of not meeting school readiness compared to those born at 31 weeks, according to the 2026 study of over 15,000 very premature children.
In a 2026 analysis of 15,857 premature children, those living in the most deprived neighborhoods had 27% higher risk of not meeting school readiness standards compared to children in the least deprived areas.
Exclusively formula-fed premature babies had 51% higher risk of school readiness problems compared to breastfed babies in a 2026 study of 15,857 children born before 32 weeks of pregnancy.
The Quick Take
- What they studied: How children born very early (before 32 weeks of pregnancy) perform in school and what factors help or hurt their chances of success.
- Who participated: 15,857 babies born very prematurely in England who survived neonatal care, tracked from birth through ages 6-7 when they took school readiness tests.
- Key finding: More than half of very premature babies didn’t meet expected school readiness levels by age 5, and about half struggled with writing and math by ages 6-7. Children born earliest (23-24 weeks) had nearly 3 times higher risk of falling behind.
- What it means for you: If your child was born very early, expect they may need extra support in school—but specific interventions like breastfeeding, avoiding smoking, and proper medical care can significantly improve outcomes. Talk with your pediatrician about your child’s individual needs.
The Research Details
Researchers looked back at medical records for all babies born before 32 weeks of pregnancy in England who received neonatal intensive care. They connected this information with school test scores from when these children were 5-7 years old. This allowed them to see which babies struggled in school and identify what factors—from how early they were born to their family’s income level—predicted better or worse outcomes.
The study examined many different factors: how premature the babies were, whether they had complications like brain injuries or lung disease, whether their mothers smoked during pregnancy, how they were fed as newborns, and whether they lived in poor or wealthy neighborhoods. Researchers used statistical methods to figure out which factors independently predicted school success, accounting for multiple influences at once.
This approach is powerful because it follows real children over many years and uses actual school test results rather than predictions. The researchers could see long-term effects that might not show up until children start formal education.
Understanding which factors predict school problems helps doctors, parents, and teachers know who needs extra help early. By identifying modifiable factors—things that can actually be changed—the study points to practical interventions that could improve outcomes for thousands of children.
This study is strong because it included nearly all eligible children in England (not just a sample), used official school assessment data rather than parent reports, and adjusted for many competing factors. The large sample size (15,857 children) provides reliable results. Published in a top medical journal (JAMA Network Open), it represents current data from 2024-2025. Limitations include that results may apply mainly to England’s healthcare system and that some factors couldn’t be measured perfectly from medical records.
What the Results Show
The study found that premature birth creates a substantial and lasting disadvantage in school. At age 5, 56.6% of very premature children didn’t meet school readiness standards, compared to typical expectations. By ages 6-7, about half still struggled with writing (51.8%) and math (48.1%), while fewer had trouble with reading (41.9%) or science (36.0%).
The earliest-born children faced the steepest challenges. Those born at 23-24 weeks had nearly 3 times the risk of not meeting school readiness compared to those born at 31 weeks. However, even children born at 27-31 weeks showed significant disadvantages.
Socioeconomic factors mattered enormously. Children living in the poorest neighborhoods had 27% higher risk of not meeting school readiness standards compared to those in wealthy areas. This gap persisted across all academic subjects. The combination of being born very early AND living in poverty created the worst outcomes.
Several medical complications during newborn care predicted worse school performance: brain injuries (particularly a condition called periventricular leukomalacia, which tripled risk), fluid on the brain (hydrocephalus), lung disease, intestinal disease, and eye disease all independently increased the likelihood of school struggles.
Several surprising factors also mattered. Boys had nearly twice the risk of girls of not meeting school readiness standards. The season a baby was born affected outcomes—babies born in certain seasons had 2.6 times higher risk, possibly related to school entry timing. Maternal smoking during pregnancy increased risk across all subjects (19-31% higher risk depending on the subject). How premature babies were fed made a difference: exclusively formula-fed babies had 51% higher risk of school readiness problems compared to breastfed babies, while mixed feeding increased risk by 19%. Exposure to certain steroids used to treat lung disease in newborns was associated with higher risk.
This research confirms what smaller studies suggested: premature birth affects not just immediate health but long-term learning. However, this is the first large study to connect actual neonatal medical data with official school test results in such a large population. Previous research relied on parent reports or smaller samples. The finding that socioeconomic factors amplify premature birth’s effects aligns with broader research showing that poverty creates additional barriers to learning for all children, but especially vulnerable ones.
The study only included children who survived neonatal care, so results don’t apply to babies who died. Some medical information came from hospital records and might not be perfectly complete. The study was conducted in England, so results may differ in countries with different healthcare systems or school structures. Researchers couldn’t measure all possible factors affecting school success, like parental education or home learning environment. The study shows associations but can’t prove that one factor directly caused another—for example, smoking might be a marker for other family stressors rather than the direct cause of school problems.
The Bottom Line
High confidence: If your child was born very prematurely, expect they may need school support and work with teachers to monitor progress. Moderate-to-high confidence: Breastfeeding (if possible), avoiding smoking during pregnancy, and appropriate medical care during neonatal hospitalization all appear protective. Moderate confidence: Consider whether your child might benefit from starting school later or receiving targeted academic support, especially if born in certain seasons. Discuss with your pediatrician and school about individualized assessment and support plans.
Parents of children born before 32 weeks of pregnancy should pay close attention to these findings. Teachers and school administrators should understand that very premature children often need extra support. Healthcare providers caring for pregnant women and newborns should use this evidence to counsel families about modifiable risk factors. Policymakers should consider how to reduce socioeconomic inequalities that amplify premature birth’s effects. Children born at 27-31 weeks should also receive attention, as they showed significant disadvantages even though they’re less extremely premature.
School readiness challenges appear by age 5 and persist through ages 6-7. Early intervention during preschool years (ages 3-5) may help prevent or reduce these gaps. Benefits from interventions like breastfeeding or smoking cessation would likely appear gradually over the first few years of life, with measurable school performance differences visible by kindergarten and first grade.
Frequently Asked Questions
Will my child born prematurely struggle in school?
Many do—56.6% of very premature children didn’t meet school readiness by age 5 in a major 2026 study. However, outcomes vary widely. Early intervention, breastfeeding, avoiding smoking, and proper medical care significantly improve chances. Talk with your pediatrician about your child’s individual risk factors and support options.
What can I do now to help my premature baby succeed in school?
If still pregnant, avoid smoking—it increased school problems by 19-31% in a 2026 study of 15,857 children. If breastfeeding, continue as long as possible (formula feeding increased risk 51%). Ensure proper nutrition and medical care during infancy. Later, provide early literacy and math activities starting in preschool.
Does poverty make premature birth worse for school?
Yes. A 2026 study found children in the poorest neighborhoods had 27% higher risk of school readiness problems than those in wealthy areas. This gap persisted across all subjects. Poverty appears to amplify premature birth’s effects, suggesting that family support and resources matter significantly.
Should my premature child start school later?
Possibly. The 2026 study found birth season affected outcomes, with some children having 2.6 times higher risk. Discuss with your pediatrician and school whether delaying entry or providing targeted academic support would help your specific child based on their development.
What medical complications during newborn care predict school problems?
Brain injuries (tripled risk), fluid on the brain, lung disease, intestinal disease, and eye disease all independently increased school struggles in a 2026 study. Proper medical management and monitoring of these conditions during infancy may help prevent or reduce long-term educational effects.
Want to Apply This Research?
- Track monthly developmental milestones and school readiness skills (letter recognition, counting, following instructions) starting at age 3. Compare progress to age-appropriate benchmarks and share results with pediatrician and teachers.
- Set a specific goal: if breastfeeding, aim to continue as long as possible; if formula feeding, ensure proper nutrition. If pregnant, use the app to track smoking cessation progress with daily check-ins and support resources. For school-age children, log weekly reading practice and math activities to monitor academic progress.
- Create a long-term dashboard tracking school readiness scores at age 5, then academic performance in reading, writing, and math at ages 6-7. Compare your child’s progress to the study’s benchmarks. Set alerts for concerning patterns and share data with your child’s school and pediatrician quarterly to adjust support strategies.
This research describes associations between premature birth and school outcomes but cannot prove direct causation. Results apply primarily to children born in England and may differ in other healthcare systems. Every child is unique—individual outcomes depend on many factors not captured in this study. Consult your pediatrician, child’s school, and educational specialists for personalized assessment and recommendations. This information is educational and should not replace professional medical or educational advice. If you have concerns about your child’s development or school readiness, seek evaluation from qualified healthcare and education professionals.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.