Objectives Children with chronic liver disease (CLD) are at increased risk of neurodevelopmental difficulties compared with their healthy peers. However, current evidence is limited to studies of small, single centres focusing predominantly on children after liver transplantation. To address this evidence gap, we evaluated educational outcomes of children with CLD.

Methods We used ECHILD, which contains linked, longitudinal administrative health and education records for a national cohort of children born in England. Our study population included pupils born between September 2002 and August 2012 with developmental assessment recorded at age 5. CLD by age 5 was identified from ICD-10 diagnosis codes and OPCS procedure codes recorded since birth. Outcomes, including total point scores, up to seven main areas of child development, and achieving a ‘Good level of development’, were modelled using multivariable regression, adjusting for a range of confounders.

Results Of 5,084,585 pupils, 0.2% (N=9,937) developed CLD by age 5, ans 51.2% of children with CLD by age 5 did not achieve a good level of development, compared with 35.4% of those without CLD (risk difference: 15.8, 95% CI [14.7,17.0]; adjusted relative risk: 1.19; 95% CI [1.16,1.22]). Standardised total point scores were 0.35 lower (95% CI [0.41, 0.28]) in 2007/08–2010/11, and 0.19 lower (95% CI [0.21, 0.16]) in 2011/12–2016/17. Children with CLD performed worse than those without CLD in all areas of development. Effect sizes were strongest for the Physical Development domain.

Conclusions Children with CLD are at higher risk of poor cognitive development compared to the general population. Our data should be used to inform educational and health services policies of the urgent need for neuro-developmental assessment to be included in the routine care to ensure early detection and referral to specialist services. Further exploration of longitudinal educational outcomes and its relationship with specific liver disease related factors is needed.