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Health at birth and teen academic performance

Obstetrics & Gynecology,
July 2011

Health at birth and teen academic performance

Babies who get low scores on a test of heart, lung and brain function given just a few minutes after birth may be more likely to need special education as teenagers.

However, the chance of going to a special school is still low enough that parents shouldn't be concerned so long as their children with a low so-called ‘Apgar score’ do fine early in life. Apgar scores are measured one minute after birth and again five minutes after birth. They're rated on a scale of 0 to 10, with 10 meaning a baby is very pink and breathing well, has a fast enough heart rate and has good reflexes and muscle tone. It's simply a measure of how well the baby has transitioned from intrauterine life.

While a low Apgar score might mean that something went wrong during delivery - for example, the baby was deprived of oxygen at some point – Apgar score to some extent reflects the underlying condition of the baby and the baby's brain. A couple of things are known for sure about babies with very low Apgar scores like they have a higher risk of dying soon after birth, and they also are more likely to have cerebral palsy, a group of brain disorders that originate during development. Other than that only weak connections have been found between Apgar scores and how well a child does later on.

Researchers used data on 877,618 babies, born between 1973 and 1986 in Sweden, to link Apgar scores with children’s grades in school and their chances of being in a special-education school. Most of those children had a normal Apgar score of 9 or 10 at the five-minute test. Only about 1 percent had a score below 7 and one-third of those were below 4, indicating serious immediate problems. In total, about 23,000 of the children were going to a special-education school at age 16.

It was found that children with an Apgar score below 7 were about twice as likely to go on to special schools as children with high Apgar scores. Children who had scores as low as 2 or 3 were about three times more likely to need special education. Still only 1 in 44 babies with a score below 7 will go on to need special education because of whatever caused that low score at birth. That shows that the Apgar score really doesn't help predict which children will end up needing more help in school.

The vast majority of these children with Apgars of 7 or less are going to normal schools and they're getting good grades though on average, these children did slightly worse in normal schools than children who had scores of 9 or 10.

The findings don’t prove that low Apgar scores - or whatever made babies have trouble early on - caused more of them to need extra help in school as teens. But the reasons leading to a low Apgar score might have an impact on future brain function. However, children with low scores shouldn't be singled out. They should not be seen as a separate group, but each child should be treated individually, both medically and academically, based on its medical needs and academic capacity.

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