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The relationship between low birth weight babies and school readiness — June 2017


What does the research say about the relationship between low birth weight babies and school readiness or other child outcomes?


Following an established REL West research protocol, we conducted a search for research reports as well as descriptive study articles on relationship between low birth weight and school readiness, as well as other child outcomes. The sources included ERIC and other federally funded databases and organizations, research institutions, academic research databases, and general Internet search engines. (For details, please see the methods section at the end of this memo.)

We have not evaluated the quality of references and the resources provided in this response. We offer them only for your reference. Also, we searched for references through the most commonly used sources of research, but the list is not comprehensive and other relevant references and resources may exist.

Research References

Dilworth-Bart, J. E., Poehlmann, J. A., Miller, K. E., & Hilgendorf, A. E. (2011). Do mothers’ play behaviors moderate the associations between socioeconomic status and 24-month neurocognitive outcomes of toddlers born preterm or with low birth weight? Journal Of Pediatric Psychology, 36(3), 289-300. Retrieved from

From the abstract: “We examined whether neonatal risks and maternal scaffolding (i.e., task changes and flexibility) during a 16-month post-term play interaction moderated the association between socioeconomic status (SES), visual-spatial processing and emerging working memory assessed at 24 months post-term among 75 toddlers born preterm or low birth weight. SES and neonatal risk data were collected at hospital discharge and mother–child play interactions were observed at 16-month post-term. General cognitive abilities, verbal/nonverbal working memory and visual-spatial processing data were collected at 24 months. Neonatal risks did not moderate the associations between SES and 24-month outcomes. However, lower mother-initiated task changes were related to better 24-month visual-spatial processing among children living in higher SES homes. Mothers’ flexible responses to child initiated task changes similarly moderated the impact of SES on 24-month visual-spatial processing. Our results suggest that mothers’ play behaviors differentially relate to child outcomes depending on household SES.”

Espy, K. A., Fang, H., Charak, D., Minich, N., & Taylor, H. G. (2009). Growth mixture modeling of academic achievement in children of varying birth weight risk. Neuropsychology, 23(4), 460–474. Retrieved from

From the abstract: “The extremes of birth weight and preterm birth are known to result in a host of adverse outcomes, yet studies to date largely have used cross-sectional designs and variable-centered methods to understand long-term sequelae. Growth mixture modeling (GMM) that utilizes an integrated person- and variable-centered approach was applied to identify latent classes of achievement from a cohort of school-age children born at varying birth weights. GMM analyses revealed 2 latent achievement classes for calculation, problem-solving, and decoding abilities. The classes differed substantively and persistently in proficiency and in growth trajectories. Birth weight was a robust predictor of class membership for the 2 mathematics achievement outcomes and a marginal predictor of class membership for decoding. Neither visuospatial-motor skills nor environmental risk at study entry added to class prediction for any of the achievement skills. Among children born preterm, neonatal medical variables predicted class membership uniquely beyond birth weight. More generally, GMM is useful in revealing coherence in the developmental patterns of academic achievement in children of varying weight at birth and is well suited to investigations of sources of heterogeneity.”

Goddeeris, J. H., Saigal, S., Boyle, M. H., Paneth, N., Streiner, D. L., & Stoskopf, B. (2010). Economic outcomes in young adulthood for extremely low birth weight survivors. Pediatrics, 126(5), 1102-1108. Retrieved from

From the abstract: “The goal was to compare educational attainment and labor market outcomes in young adulthood (21-26 years of age) for a Canadian, population-based cohort of 149 extremely low birth weight (ELBW) (<1000 g) survivors and a normal birth weight (NBW) cohort of 133 young adults from the same geographic area who were matched to the ELBW cohort in childhood. We estimated the effects of ELBW status, according to gender, on continuous outcomes through least-squares regression and those on binary outcomes through logistic regression. We controlled for family background and considered neurosensory impairment and IQ as mediating variables. Controlling for family background, ELBW male subjects were less likely to complete high school or to attend a university than were their NBW counterparts, and their educational attainment was reduced by >1 year. Among subjects who were working, weekly earnings were ∼27% lower. ELBW female effects on education were not significant, but ELBW female subjects were less likely than NBW subjects to be employed or in school and they also seemed to experience lower earnings. Our findings suggested that ELBW survivors are somewhat less productive as adults, on average, than are subjects born NBW and that effects are not confined to subjects with severe neurosensory impairments. In accord with other studies, however, we found that productivity deficits for most ELBW subjects were not large.”

Goosby, B. J., & Cheadle, J. E. (2009). Birth weight, math and reading achievement growth: A multilevel between-sibling, between-families approach. Social Forces, 87(3), 1291–1320. Retrieved from

From the abstract: “We used multilevel covariance structure analysis to study the relationship between birth weight, family context and youth math and reading comprehension growth from approximately ages 5 through 14 within and between families. Using data from the National Longitudinal Survey of Youth Child Sample, we examined the relationship between birth weight and subsequent academic achievement growth disparities, distinguishing between birth weight and other contextual social confounders. We found that smaller birth weight is associated with lower math and reading scores at age 5. Additional findings indicated that the home environment has important developmental consequences from early childhood and into adolescence. Overall, the pattern of findings painted a complex picture of disadvantage, beginning in the womb and extending through a variety of mechanisms into adolescence.”

Hack, M., Taylor, H. G., Schluchter, M., Andreias, L., Drotar, D., & Klein, N. (2009). Behavioral outcomes of extremely low birth weight children at age 8 years. Journal of Developmental and Behavorial Pediatrics, 30(2), 122–130. Retrieved from

From the abstract: “To describe the prevalence of behavioral problems and symptomatology suggestive of Autism and Asperger’s disorders at age 8 years among extremely low birth weight (ELBW, <1 kg) children, born 1992 through 1995. Parent reports of the behavior of 219 ELBW (mean birth weight, 810 g; gestational age 26 weeks) were compared with 176 normal birth weight children of similar maternal sociodemographic status, sex, and age. Behavior was assessed via the Child Symptom Inventory that includes both Symptom Severity Scores and scores meeting DSM-IV criteria for disorders. ELBW compared with normal birth weight children had significantly higher mean Symptom Severity Scores for the inattentive, hyperactive, and combined types of attention-deficit hyperactivity disorder (all p < .001) as well as higher scores for Generalized Anxiety (p < .01) and Autistic (p < .001) and Asperger’s (p < .01) disorders. When DSM-IV criteria were considered, ELBW children also had significantly higher rates of attention-deficit hyperactivity disorder of the inattentive (10% vs 3%, p < .01) and combined (5% vs 0.6%, p < .05) types. Attention-deficit hyperactivity disorder, mainly the inattentive type is prevalent among ELBW children. Our findings of an increase in symptoms pertaining to Autistic and Asperger’s disorders at school age agree with recent reports of others during early childhood. Early identification and intervention for these problems might improve child functioning and ameliorate parent and child distress.”

Isaacs, J. B. (2012). Starting school at a disadvantage: The school readiness of poor children. Washington, DC: Center on Children and Families, Brookings Institution. Retrieved from

From the abstract: “Poor children in the United States start school at a disadvantage in terms of their early skills, behaviors, and health. Fewer than half (48 percent) of poor children are ready for school at age five, compared to 75 percent of children from families with moderate and high income, a 27 percentage point gap. This paper examines the reasons why poor children are less ready for school and evaluates three interventions for improving their school readiness. Poverty is one of several risk factors facing poor children. Mothers living in poverty are often unmarried and poorly educated, they have higher rates of depression and poor health than more affluent mothers, and they demonstrate lower parenting skills in certain dimensions. In fact, the gap in school readiness shrinks from 27 percentage points to 7 percentage points after adjusting for demographic, health, and behavioral differences between poor and moderate- and higher-income families. Even so, poverty remains an important influence on school readiness, partly through its influence on many of the observed differences between poor and more affluent families. Higher levels of depression and a more punitive parenting style, for example, may result from economic stress and so models controlling for these factors may understate the full effects of poverty on school readiness. In addition to poverty, key influences on school readiness include preschool attendance, parenting behaviors, parents’ education, maternal depression, prenatal exposure to tobacco, and low birth weight. For example, the likelihood of being school ready is 9 percentage points higher for children attending preschool, controlling for other family characteristics, and is 10 percentage points lower for children whose mothers smoke during pregnancy and also 10 percentage points lower for children whose mothers score low in supportiveness during parent-child interactions. These findings suggest a diverse set of policy interventions that might improve children’s school readiness, ranging from smoking cessation programs for pregnant women to parenting programs, treatments for maternal depression, income support programs and expansion of preschool programs. Preschool programs offer the most promise for increasing children’s school readiness, according to a simple simulation that models the effects of three different interventions. Expanding preschool programs for four-year-olds has more direct effects on school readiness at age five than either smoking cessation programs during pregnancy or nurse home visiting programs to pregnant women and infants, the two other alternatives considered.”

Kull, M. A., & Coley, R. L. (2015). Early physical health conditions and school readiness skills in a prospective birth cohort of U.S. children. Social Science and Medicine, 142, 145–153. Retrieved from

From the abstract: “Rationale: Extant research identifies associations between early physical health disparities and impaired functioning in adulthood, but limited research examines the emergence of these associations in the early years of children’s lives. This study draws on data from the Early Childhood Longitudinal Study Birth Cohort (ECLS-B; N = 5900) to assess whether a host of early health indicators measured from birth to age five are associated with children’s cognitive and behavioral skills at age five. Results: After adjusting for child and family characteristics, results revealed that children’s neonatal risks (prematurity or low birth weight) and reports of poor health and hospitalizations were associated with lower cognitive skills, and neonatal risks and poor health predicted lower behavioral functioning at age five. Some of the association between neonatal risks and school readiness skills were indirect, functioning through children’s poor health and hospitalization. Analyses further found that associations between early physical health and children’s school readiness skills were consistent across subgroups defined by family income and child race/ethnicity, suggesting generalizability of results. Conclusions: Findings emphasize the need for more interdisciplinary research, practice, and policy related to optimizing child well-being across domains of physical health and development in the early years of life.”

Molloy, C. S., Wilson-Ching, M., Doyle, L. W., Anderson, V. A., & Anderson, P. J. (2014). Visual memory and learning in extremely low-birth-weight/extremely preterm adolescents compared with controls: A geographic study. Journal of Pediatric Psychology, 39(3), 316–331. Retrieved from

From the abstract: “Contemporary data on visual memory and learning in survivors born extremely preterm (EP; <28 weeks gestation) or with extremely low birth weight (ELBW; <1,000 g) are lacking. Geographically determined cohort study of 298 consecutive EP/ELBW survivors born in 1991 and 1992, and 262 randomly selected normal-birth-weight controls. Visual learning and memory data were available for 221 (74.2%) EP/ELBW subjects and 159 (60.7%) controls. EP/ELBW adolescents exhibited significantly poorer performance across visual memory and learning variables compared with controls. Visual learning and delayed visual memory were particularly problematic and remained so after controlling for visual–motor integration and visual perception and excluding adolescents with neurosensory disability, and/or IQ <70. Male EP/ELBW adolescents or those treated with corticosteroids had poorer outcomes. EP/ELBW adolescents have poorer visual memory and learning outcomes compared with controls, which cannot be entirely explained by poor visual perceptual or visual constructional skills or intellectual impairment.”

Reichman, N. E. (2005). Low birth weight and school readiness. Future of Children, 15(1), 91–116. Retrieved from :

From the abstract: “In the United States black women have for decades been twice as likely as white women to give birth to babies of low birth weight who are at elevated risk for developmental disabilities. Does the black-white disparity in low birth weight contribute to the racial disparity in readiness? The author summarizes the cognitive and behavioral problems that beset many low birth weight children and notes that not only are the problems greatest for the smallest babies, but black babies are two to three times as likely as whites to be very small. Nevertheless, the racial disparities in low birth weight cannot explain much of the ‘aggregate’ gap in readiness because the most serious birth weight-related disabilities affect a very small share of children. The author estimates that low birth weight explains at most 3–4 percent of the racial gap in IQ scores. The author applauds the post-1980 expansions of Medicaid for increasing rates of prenatal care use among poor pregnant women but stresses that standard prenatal medical care cannot improve aggregate birth outcomes substantially. Smoking cessation and nutrition are two prenatal interventions that show promise. Several early intervention programs have been shown to improve cognitive skills of low birth weight children. But even the most promising programs can narrow the readiness gap only a little because their benefits are greatest for heavier low birth weight children and because low birth weight explains only a small share of the gap. The author stresses the importance of reducing rates of low birth weight generally and of extending to all children who need them the interventions that have improved cognitive outcomes among low birth weight children. But because black infants are more likely to be born at the lowest birth weights, ‘preventing’ low birth weight—when researchers learn how to—is likely to be more effective than early intervention in narrowing birth weight-related racial gaps in school readiness.”

Rose-Jacobs, R., Black, M. M., Casey, P. H., Cook, J. T., Cutts, D. B., Chilton, M., & Frank, D. A. (2008). Household food insecurity: Associations with at-risk infant and toddler development. Pediatrics, 121(1), 65–72. Retrieved from :

From the abstract: “In this study, we evaluated the relationship between household food security status and developmental risk in young children, after controlling for potential confounding variables. The Children’s Sentinel Nutritional Assessment Program interviewed (in English, Spanish, or Somali) 2010 caregivers from low-income households with children 4 to 36 months of age, at 5 pediatric clinic/emergency department sites (in Arkansas, Massachusetts, Maryland, Minnesota, and Pennsylvania). Interviews included demographic questions, the US Food Security Scale, and the Parents’ Evaluations of Developmental Status. The target child from each household was weighed, and weight-for-age z score was calculated. Overall, 21% of the children lived in food-insecure households and 14% were developmentally ‘at risk’ in the Parents’ Evaluations of Developmental Status assessment. In logistic analyses controlling for interview site, child variables (gender, age, low birth weight, weight-for-age z score, and history of previous hospitalizations), and caregiver variables (age, US birth, education, employment, and depressive symptoms), caregivers in food-insecure households were two thirds more likely than caregivers in food-secure households to report that their children were at developmental risk. Controlling for established correlates of child development, 4- to 36-month-old children from low-income households with food insecurity are more likely than those from low-income households with food security to be at developmental risk. Public policies that ameliorate household food insecurity also may improve early child development and later school readiness.”

Temple, J. A., Reynolds, A. J., & Arteaga, I. (2010). Low birth weight, preschool education, and school remediation. Education & Urban Society, 42(6), 705-729. Retrieved from :

From the abstract: “Studies have documented a strong relationship between low birth-weight status and adverse child outcomes such as poor school performance and need for special education services. Following a cohort of more than 1,300 low-income and predominately African American children in the Chicago Longitudinal Study, the authors investigate whether birth weight and family socioeconomic risk measured at the time of the child’s birth predicts placement into special education classes or grade retention in elementary school. Contrary to previous research, the authors find that low birth weight (<5.5 pounds) does not predict special education placement. Rather, these children (especially boys) are more likely to be retained in grade as an alternative approach in addressing poor school performance. Family socioeconomic risk at birth is a significant predictor of the need for remedial services. The authors also assess whether a high-quality preschool program offered at the ages between 3 and 4 can reduce the negative effects of low family socioeconomic status and birth weight on the need for special education and grade retention. Preschool participation in the Child Parent Centers is found to reduce the likelihood of school remediation. The effects of preschool are greater for children from families with higher levels of socioeconomic disadvantage. The beneficial effects of preschool on special education placement are also larger for boys than for girls.”

Other Resources

Aarnoudse-Moens, C. H., Weisgias-Kuperus, N., Van Goudoever, J. B., & Oosterlaan, J. (2009). Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics, 124(2), 717–728. Retrieved from :

From the abstract: “Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (?33 weeks’ gestation) and/or very low birth weight (VLBW) (?1500 g) children. Great variability in the published results, however, hinders the field in studying underlying dysfunctions and developing intervention strategies. We conducted a quantitative meta-analysis of studies published between 1998 and 2008 on academic achievement, behavioral functioning, and EF with the aim of providing aggregated measures of effect size for these outcome domains. METHODS: Suitable for inclusion were 14 studies on academic achievement, 9 studies on behavioral problems, and 12 studies on EF, which compared a total of 4125 very preterm and/or VLBW children with 3197 term-born controls. Combined effect sizes for the 3 outcome domains were calculated in terms of Cohen’s d. Q-test statistics were performed to test homogeneity among the obtained effect sizes. Pearson’s correlation coefficients were calculated to examine the impact of mean birth weight and mean gestational age, as well as the influence of mean age at assessment on the effect sizes for academic achievement, behavioral problems, and EF. RESULTS: Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. Of all behavioral problems stacked, attention problems were most pronounced in very preterm and/or VLBW children, with teacher and parent ratings being 0.43 to 0.59 SD higher than for controls, respectively. Combined effect sizes for parent and teacher ratings of internalizing behavior problems were small (<0.28) and for externalizing behavior problems negligible (<0.09) and not significant. Combined effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. Mathematics and reading performance, parent ratings of internalizing problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age (all r values > 0.51). CONCLUSIONS: Very preterm and/or VLBW children have moderate-to-severe deficits in academic achievement, attention problems, and internalizing behavioral problems and poor EF, which are adverse outcomes that were strongly correlated to their immaturity at birth. During transition to young adulthood these children continue to lag behind term-born peers.”

Boyce, L. K., Cook, G. A., Simonsmeier, V., & Hendershot, S. M. (2015). Academic outcomes of very low birth weight infants: The influence of mother-child relationships. Infant Mental Health Journal, 36(2), 156–166. Retrieved from

From the abstract: “It is commonly accepted that parent-child interactions are bidirectional and complex and are influenced by many different factors. The current study examined the academic and behavioral skills in the early elementary years of preterm infants and the influence of their early mother-child interactions on these skills. Using a sample of 21 premature infants and their mothers, this study found that positive early interactions during feeding were related to later mutual enjoyment during a teaching task at school age, but early maternal depression was not. Early risk factors of premature infants, specifically the number of days spent on a ventilator, were positively related to maternal perceptions of hassle associated with feeding and negatively related to maternal sensitivity during feeding. Finally, mutual enjoyment was strongly associated with language, cognitive, and behavioral skills at school age. These results suggest that it is not only the infant risk factors following a premature birth that influence later development but also the parent-child relationship and emphasize the importance of understanding and promoting these early positive parent-child interactions for premature infants.”

Fletcher, J. M. (2011). The medium term schooling and health effects of low birth weight: Evidence from siblings. Economics of Education Review, 30(3), 517–527. Abstract retrieved from

From the abstract: “Research has shown that low birth weight is linked to infant mortality as well as longer term outcomes. This paper examines the medium term outcomes that may link low birth weight to adult disadvantage using a national longitudinal sample with a large sample of siblings (Add Health). Results show strong effects on several educational outcomes, including early grade repetition, receipt of special education services, and reports of a learning disability. Results for longer term outcomes are suggestive, though less robust and small in magnitude. Overall, the results suggest that medium term educational disadvantages associated with low birth weight are not driven by family level unobservables and do not accumulate into large long-term disadvantage.”

Gillion, L. (2016). Birth weight as destiny? The changing influence of childhood health and social environment on cognitive ability (Conference Paper). Washington, DC: American Sociological Association. Retrieved from

From the abstract: “Through numerous studies, scholars have come to view birth weight as having a lasting impact on educational outcomes with lower birth weight associated with less educational attainment. However, much of the literature views this relationship in a time-free space, where health equally impacts a child’s academic performance throughout their lifetime. This approach overlooks varying levels of parental investment in early childhood and the growing saliences of school environments. Using panel data from Fragile Families Child Well Being, investigate the mechanisms by which birth weight influences cognitive development. The results show that while birth weight has a significant direct effect on cognitive development, parents and school and mediate the effects of birth weight. These mediating factors actually reinforce birth weight differences and play role in the lingering cognitive gap exhibited later in childhood.”

Gillion, L. (2017). Birth weight as destiny: How parental investment reinforces the birth weight educational gap. Journal of Social, Behavioral and Health Sciences 11(1), 80-95. Retrieved from

From the abstract: Through numerous studies, scholars have come to view birth weight as having a lasting impact on educational outcomes. Normal birth weight is associated with greater educational attainment; however, much of the literature ignores the role of parental investment. Using data from the Fragile Families Child Well-Being Study, it was found that birth endowments alone do not produce varying levels of cognitive development, but these birth endowments do lead parents to make different choices for their children, choices that potentially exacerbate the educational divide. Children with normal birth weight receive more parental investment from birth to age 3 than children with abnormal birth weight. The increased parental investment from birth to age 3 directly increases cognitive scores and the role of parental investment on cognitive scores is amplified indirectly through birth weight. Parents may actually reinforce birth weight differences and, thus, it plays a role in the lingering cognitive gap exhibited later in life.

Koenen, K. C., Lincoln, A., & Appleton, A. (2006). Women's status and child well-being: A state-level analysis. Social Science & Medicine, 63(12), 2999-3012. Retrieved from

From the abstract: “We conducted an ecologic analysis of the relation between women's status and child well-being in the 50 United States. State-level women's status was assessed via four composite indices: women's political participation, economic autonomy, employment and earnings, and reproductive rights. Child well-being was measured via five outcomes: percentage of low birthweight babies, infant mortality, teen mortality, high school dropout rate, and teen birth rate. Higher state-level women's status on all indicators was associated with significantly better state-level child well-being in unadjusted analyses. Several associations remained significant after adjusting for income inequality and state racial composition. Women's political participation was associated with a significantly lower percentage of low birthweight babies (p<.001) and lower teen birth rates (p<.05). Women's employment and earnings was associated with lower infant mortality (p<.05) and teen birth rates (p<.05). More economic and social autonomy for women was associated with better child outcomes on all measures (p<.01 all). Greater reproductive rights were associated with significantly lower infant mortality (p<.01). We conclude that child well-being is worse in states where women have lower political, economic, and social status. Women's status is an important aspect of children's social context which may impact their well-being. Multi-level analyses of the association between state-level women's status and child well-being are needed.”


The following keywords and search strings were used to search the reference databases and other sources:

“Low birth weight” AND (“school readiness” OR “child outcomes” OR “developmental outcomes” OR “academic achievement” OR “graduation rate” OR “school success” OR “school failure”)

Databases and Resources

We searched ERIC for relevant resources. ERIC is a free online library of over 1.6 million citations of education research sponsored by the Institute of Education Sciences. Additionally, we searched Google Scholar and PsychInfo.

Reference Search and Selection Criteria

When we were searching and reviewing resources, we considered the following criteria:

  • Date of the Publication: References and resources published for the last 15 years, from 2001 to present, were included in the search and review.
  • Search Priorities of Reference Sources: Search priority is given to study reports, briefs, and other documents that are published and/or reviewed by IES and other federal or federally funded organizations and academic databases, including ERIC, EBSCO databases, JSTOR database, PsychInfo, PsychArticle, and Google Scholar.
  • Methodology: Following methodological priorities/considerations were given in the review and selection of the references: (a) study types – randomized controlled trials, quasi-experiments, surveys, descriptive data analyses, literature reviews, policy briefs, etc., generally in this order; (b) target population, samples (representativeness of the target population, sample size, volunteered or randomly selected, etc.), study duration, etc.; and (c) limitations, generalizability of the findings and conclusions, etc.

This memorandum is one in a series of quick-turnaround responses to specific questions posed by educational stakeholders in the West Region (Arizona, California, Nevada, Utah), which is served by the Regional Educational Laboratory West at WestEd. This memorandum was prepared by REL West under a contract with the U.S. Department of Education’s Institute of Education Sciences (IES), Contract ED-IES-17-C-00014524, administered by WestEd. Its content does not necessarily reflect the views or policies of IES or the U.S. Department of Education nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.