ArticleArchives of disease in childhood2026
School readiness in children with early-onset chronic liver disease: a population-based linked data cohort in England.
Article in Archives of disease in childhood, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChronic liver disease (CLD) affects 2-10 per 10 000 children. While prior evidence links CLD to lower cognitive ability, its impact on school readiness remains unclear.
objectiveTo study the association between early-onset chronic liver disease (CLD; <5 years) and school readiness at age 5.
designA population-based cohort study using linked health and education data from the Education and Child Health Insights from Linked Data project in England. Children born between 2002 and 2012 with teacher assessments at age 4-5 years (2007/2008-2016/2017) were included. CLD diagnoses were identified using the International Statistical Classification of Diseases and Related Health Problems, 10th revision and Operating Procedure Codes Supplement 4 hospital codes. Multivariable regression assessed standardised developmental outcomes in up to seven domains.
resultsOf 5 084 671 pupils, 0.1% (n=3672) were diagnosed with early-onset CLD by age 5. Of children in 2011/2012-2016/2017 with CLD, 55.8% did not achieve a good level of development, compared with 35.3% without CLD (adjusted relative risk: 1.40, 95% CI 1.34 to 1.46). Standardised total point scores were 0.69 lower (95% CI 0.58 to 0.81) in 2007/2008-2010/2011 and 0.41 lower (95% CI 0.36 to 0.46) in 2011/2012-2016/2017. Children with CLD performed worse than those without CLD in all areas of development, with the strongest effect sizes in the physical development domain. Larger effects were observed among girls, those with more severe disease and those from less deprived areas.
conclusionsChildren with early-onset CLD face greater cognitive risk than their peers affected by liver transplantation hospital stays. Further exploration of longitudinal educational outcomes and their relationship with specific liver disease-related factors is needed.
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