The Incidence of Mental and Physical Handicaps in School-Age Children of Very Low Birth Weight

Fifty children of a total of 97 whose weight at birth was 3 lb (1,360 gm) or less, born in two Edinburgh hospitals between 1948 and 1960, have now passed their fifth birthday, the statutory age for school entrance. One case was not available for examination Recent data regarding type of schooling or other disposal, educational attainment behavior observed in school, and physical defect affecting education are presented for the 49 children examined. The findings are as follows: One-half of the total were ineducable in normal school, for reason of physical or mental handicap or both, one-quarter were dull children requiring special educational treatment within the normal school, and one-quarter were considered low average, average or superior in ability. Twenty-six children (53%) had one or more physical defects; 9 of these attended schools for the physically handicapped. Thirty-eight children (78%) were reported as having problems of behavior. Of 30 children with siblings for comparison, 2 were considered to be superior in ability, 6 approximately equal to at least one sibling and 22 obviously slower than all their siblings. In five of seven pairs of twins, the larger twin scored higher on intelligence tests than the smaller. A highly significant increase of severe handicap was found in children born between 1953 and 1954, as compared with those born in 1948 to 1950, and it is suggested that this is due to an increasing number of damaged children surviving, associated with an improved survival rate. There is a significantly higher proportion of males among those later born children, but there is no evidence of sex differential with regard to mental grade. A significantly higher incidence of handicap is found in children from the poorest homes. Twins show a lower average mental grade, but this is not statistically significant. In the period 1953 to 1954, 29% of mothers gave a history of relative infertility; all children born to these mothers were severely handicapped. Ten per cent of mothers in the period 1948 to 1952 gave a like history; all their children were considered average in mental ability.