child school

Children born with heart defects face learning challenges and inadequate special education assistance in elementary school, according to a new study.

Using North Carolina education records, birth defect registries and birth certificates, researchers examined whether congenital heart defects were associated with low scores on standard reading and math tests at the end of third grade. The study included 2,807 children born with heart defects and 6,355 without who completed third grade in public school in 2006-12.

Children with a congenital heart defect, regardless of how severe their condition, had 24 percent higher odds of not meeting standards in reading or math, compared to children without congenital heart defects, researchers said.

Those with critical defects were 46 percent more likely to get special education support compared to those with less severe defects.

The study is the largest of its kind to examine the impact of potential brain deficits in U.S. children with heart defects.

It’s unclear why children with heart defects struggle in school.

“Most theories relate to factors that are most important in children with severe defects, namely surgical factors, prenatal brain development, time in an intensive care unit, or degree of hypoxia,” said Matthew E. Oster, M.D., M.P.H., pediatric cardiologist at Children’s Healthcare of Atlanta in Georgia.

“Children with milder congenital heart defects do not typically share those risk factors; however, both groups of children with congenital heart defects may share a genetic vulnerability to problems with brain development.”

Children with less severe defects are less likely to receive special education services because of a “lack of recognition of such heart defects as a risk factor for neurocognitive challenges,” Oster said.

Doctors should be aware that all children with heart defects are at risk for such problems. They should also ask parents how children are doing in school.

“Doctors should consider formal neurocognitive evaluations when appropriate,” he said. “Schools should be aware that children with heart defects can have learning difficulties, even many years after their heart defect is supposedly ‘fixed’.”

Oster said that further research should follow children as they grow to detect similar academic problems beyond third grade; explore if special education can help improve their outcomes; and pinpoint the factors that affect how these children fare.

The study is published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.