Chronic illnesses such as otitis media, respiratory disease, and epilepsy increase the likelihood that children will be developmentally at risk for difficulties at school entry, a study showed.

The authors’ findings indicated “that chronically poor health in early childhood is a risk for school readiness, over and above the disadvantage conferred by socioeconomic factors,” Megan F. Bell of the University of Western Australia in Perth and her associates reported online (Pediatrics. 2016 April 13. doi: 10.1542/peds.2015-2475). “This increased risk was particularly evident for social and emotional capacities.”

The researchers analyzed developmental school readiness among 22,890 children (average age, 5 years), within the context of having chronic illness. The children were born in Western Australia in 2003-2004, underwent an early development assessment for school readiness in 2009, and did not have special needs, cerebral palsy, or a diagnosed developmental disorder. The assessments’ five domains included physical health and well-being, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Children were designated “developmentally vulnerable” if they scored in the bottom 10% of a domain and “at risk” if they scored in the bottom 10%-25%. The top 75% were classified as “on track.”

Among 2,879 children with chronic illness, involving 13% of the overall sample, 93% of these children had one chronic illness diagnosis, and 7% had at least two. The most common illnesses were chronic otitis media (71%), chronic respiratory disease (27%), and epilepsy (3%).

Using health and demographic data for 19,227 mothers and 19,030 fathers of the children, the researchers accounted for sociodemographic characteristics of each child, their community, and their parents, including parental chronic illness. After these adjustments, children with a chronic illness were approximately 20%-35% more likely to fall within the vulnerable or at-risk categories in all five developmental domains, compared with their healthier peers. Children with multiple diagnoses, however, were not significantly more likely to be less developmentally ready for school in any of the five domains than their peers with one diagnosis, suggesting that “just one chronic illness is enough to increase a child’s risk for lower school readiness,” the authors wrote.

A 15%-35% increase in the risk of developmental vulnerability was seen in all domains for 1,859 children with a single diagnosis of otitis media and a 24%-45% increase was seen for 618 children with a single diagnosis of respiratory disease. However, there was no significant increase in risk for the 63 children with a diagnosis of epilepsy; all probability values were greater than .05.

“School-based programs targeted at enhancing social and emotional abilities have been shown to lead to improvements in behavioral, social, and academic outcomes,” the authors wrote. “This may therefore be an important focus of intervention for chronically ill children.

“Our findings suggest there is a need to broaden the scope of health conditions eligible for additional support at school entry. For instance, the most prevalent diagnosis was chronic otitis media, a common childhood condition that is associated with delayed language development, reading and spelling difficulties, and auditory processing deficits. Although recurrent ear infections may not be associated with significant limitations in daily activities, our study demonstrated that children with this condition are at increased risk of poor school readiness, even without having a more severe comorbid condition,” Ms. Bell and her associates wrote.

The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.


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