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Longitudinal educational attainment among children with isolated oral cleft: a cohort study
  1. Min Hae Park1,
  2. Kate J Fitzsimons2,
  3. Scott Deacon3,
  4. Jibby Medina2,
  5. Muhammad A H Wahedally2,
  6. Sophie Butterworth2,
  7. Craig Russell4,
  8. Jan H van der Meulen1,2
  1. 1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
  3. 3 South West Cleft Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  4. 4 Royal Hospital for Children, Queen Elizabeth University Hospital Campus, Glasgow, UK
  1. Correspondence to Dr Min Hae Park, Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK; MinHae.Park{at}


Objectives (1) To explore differences in educational attainment between children born with isolated clefts and the general population at ages 5, 7 and 11 years; (2) to describe longitudinal changes in attainment among children with cleft through primary education.

Design Analysis of Cleft Registry and Audit Network data linked to national educational outcomes.

Setting English state schools.

Patients 832 children born with isolated cleft, aged 5 years in 2006–2008.

Main outcome measures Difference in teacher-assessed attainment between children with a cleft and general population at each age, for all children and by cleft type. Percentage of children with low attainment at age 5 years who had low attainment at age 11 years, for all children and by cleft type.

Results Children with a cleft had lower attainment than the general population in all subject areas (Z-score range: −0.29 (95% CI −0.36 to −0.22) to −0.22 (95% CI −0.29 to −0.14)). This difference remained consistent in size at all ages, and was larger among children with a cleft affecting the palate (cleft palate/cleft lip and palate (CP/CLP)) than those with a cleft lip (CL). Of 216 children with low attainment in any subject at age 5 years, 54.2% had low attainment in at least one subject at age 11 years. Compared with children with CL, those with CP/CLP were more likely to have persistent low attainment.

Conclusions An educational attainment gap for children born with isolated clefts is evident throughout primary education. Almost half of children with low attainment at age 5 years achieve normal attainment at age 11 years.

  • child development
  • health services research
  • epidemiology

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  • Contributors MHP 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, and is guarantor of this work. KJF acquired and processed the data, interpreted the data and edited the manuscript. SD, SB and CR interpreted the data, contributed clinical aspects and edited the manuscript. JM and MAHW acquired and processed the data, and edited the manuscript. JHvdM conceptualised the study, interpreted the data and edited the manuscript. All authors read and approved the final manuscript.

  • Funding Hospital Episode Statistics data were made available by NHS Digital; National Pupil Database data were made available by the Department for Education. The CRANE database was funded by the National Specialised Commissioning Group for England and the Wales Specialised Health Services Committee, and is overseen by the UKNHS Cleft Development Group.

  • Disclaimer The funders did not have a role in in study design; in the collection, analysis and interpretation of data; in the writing of the report and in the decision to submit the paper for publication.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.