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School absence and achievement in children with isolated orofacial clefts
  1. Kate J Fitzsimons1,
  2. Scott A Deacon1,2,
  3. Lynn P Copley1,
  4. Min Hae Park1,
  5. Jibby Medina1,
  6. Jan H van der Meulen1,3
  1. 1 Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
  2. 2 Bristol Dental Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3 Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Kate J Fitzsimons, Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK; kfitzsimons{at}


Objectives To examine school absence and academic achievement among 7-year-old children with isolated orofacial clefts in England.

Design Analysis of educational data linked to national cleft registry and administrative hospital data.

Setting English state schools.

Patients 3523 children with isolated clefts aged 7 years between 2006 and 2014.

Main outcome measures Annual school absence and reaching the national ‘expected level’ according to teacher-assessed academic achievement.

Results Children with isolated clefts had higher mean annual school absence (10.5 days) than their peers in the national population (8.9 days). Total absence was higher in children with a cleft lip and palate (CLP; 11.3 days) or with a cleft palate only (CPO; 10.5 days) than in children with a cleft lip only (CLO; 9.5 days). The percentage reaching the expected academic level decreased with increasing school absence (from 77.4% (923/1192) with annual school absence ≤5 days to 43.4% (193/445) with annual school absence >20 days). However, differences in school absence did not explain that children with CPO (65.9% reaching expected level) or CLP (66.1% reaching expected level) had poorer levels of academic achievement than children with CLO (73.5% reaching expected level). Children with a cleft were twice as often recognised as having special education needs (40.5%) than their peers (21.6%).

Conclusions School absence and cleft type are both independently associated with school attainment at 7 years. Children with an isolated cleft, especially when the palate is involved, and those with high levels of school absence may benefit from increased support addressing their educational needs.

  • congenital abnorm
  • outcomes research
  • school health

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  • Contributors KJF conceptualised and designed the study, carried out the analyses and interpretation of data, drafted the initial manuscript and revised and finalised the manuscript for submission. JHvdM and SAD conceptualised and designed the study, interpreted the data and reviewed and edited the manuscript. LPC coordinated and managed the data collection from the three datasets and processed the Hospital Episodes Statistics data. MHP and JM conceptualised and designed the study, reviewed and edited the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This work was funded by the National Specialised Commissioning Group for England and the Wales Specialised Health Services Committee and was carried out by the team of the CRANE database (the Cleft Registry and Audit Network of England, Wales, and Northern Ireland), which is overseen by the Cleft Development Group.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Summary school absence data from the general population were obtained from Under our data agreements with NHS digital and the Department for Education, we are unable to share the data used for these analyses directly with others. Information on how to request Hospital Episode Statistics data can be obtained from Information on how to access National Pupil Database data can be obtained from Craniofacial Registry and Audit Network (CRANE) database data are available on reasonable request, which must be approved by the Cleft Development Group on behalf of NHS England (the data controller). Please see