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Influence of early childhood burns on school performance: an Australian population study
  1. Nadin Azzam1,
  2. Ju-Lee Oei2,3,
  3. Susan Adams3,4,
  4. Barbara Bajuk5,
  5. Lisa Hilder6,
  6. Abdel-Latif Mohamed7,
  7. Ian M R Wright8,
  8. Andrew J A Holland9,10
  1. 1 School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Royal Hospital for Women, Randwick, New South Wales, Australia
  3. 3 University of New South Wales, School of Women’s and Children’s Health, Randick, New South Wales, Australia
  4. 4 Sydney Children’s Hospital, Randwick, New South Wales, Australia
  5. 5 Pregnancy and Newborn Services Network, Sydney Children’s Hospitals Network, Westmead, New South Wales, Australia
  6. 6 National Perinatal Epidemiology and Statistics Unit, University of New South Wales School of Women’s and Children’s Health and Centre for Big Data Research in Health, Randwick, New South Wales, Australia
  7. 7 Department of Neonatology, Centenary Hospital for Women and Children, Canberra, ACT, Australia
  8. 8 Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
  9. 9 Department of Paediatric Surgery, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  10. 10 Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Andrew J A Holland, Department of Paediatric Surgery, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; andrew.holland{at}


Objectives To determine the influence of burn injuries on childhood performance in national standardised curriculum-based school tests.

Design Birth and health records of 977 children who were hospitalised with a burn injury between 2000 and 2006 in the state of New South Wales, Australia, were linked to performance scores in the National Assessment Program: Literacy and Numeracy test, a compulsory nationwide curriculum-based test (CBT) and compared with children who were not hospitalised for burns and who were matched for birth year, gender, gestation and socioeconomic status.

Main outcome measures Test scores in years 3 (ages 8–9), 5 (ages 10–11) and 7 (ages 13–14) in numeracy, writing, reading, spelling, grammar and punctuation.

Results Mean age at first burn injury was 28 months (median: 20, range: 0–140). Children with burns were significantly more likely to have younger mothers (28.5 vs 29.6 years) (P<0.001), be indigenous (OR 2.5 (95% CI 2.1 to 3.1)) (P<0.001) and have siblings (OR 1.2 (95% CI 1.1 to 1.4)) (P<0.001). They were also less likely to meet national minimum standards in most domains of testing until year 5, even after adjustment for parental education levels, parental smoking, maternal age and indigenous status. Each 10% increase in total body surface area burnt was associated with a decrease in year 5 scores by 37.0% in numeracy and 71.9% in writing.

Conclusions Most childhood burn injuries occur before the start of formal schooling. Children who are hospitalised for burns perform more poorly in CBT even after accounting for family and socioeconomic disadvantage. Rehabilitation of children with burn injuries must address school performance to decrease any long-term negative societal impact of burns.

  • paediatric burn injuries
  • academic outcomes
  • long-term outcomes
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  • Contributors The primary author of this article is NA, a final year medical student at the University of New South Wales. JLO was the primary supervisor over the research process, was responsible for developing the project idea, obtaining ethics approval and gaining access to the linked data sets. AJAH was the second main supervisor in the research, guiding the research question with his expertise in the field of paediatric burns and contributing to the development of the project idea and its aims. SA, BB and LH were involved in guidance over the statistical analysis of the data. IMRW and ALM provided valuable input in the synthesis of the data for the discussion, and all authors have been actively involved in the editing of the project.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained on February 13th 2013 from the NSW Population and Health Services Research Ethics Committee (2012/09/415), Aboriginal Health and Medical Research Council of NSW (1001/14), and all Australian educational sectors: the Board of Studies (for government schools), the Australian Independent Schools and the Catholic Education Commission (D2014/120797), with approval from all data custodians. Data were made available to researchers by December 2013. Ethics approval renewal enabled researchers continued access until 1 December 2015. Ethics Approval for NAPLAN analysis was granted on July 8th 2015, and data were made available to researchers by August 2015.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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