Prolonged Hospitalization

What makes it difficult to learn in a hospital?

By March 12, 2018 No Comments

The ideal preschool environment is one where children can focus their attention; and process and retain the information that is being shared with them. The hospital environment inadvertently makes this state extremely difficult to achieve: there are doctors’ multiple ward rounds; frequent and routine blood tests; the prospect of claustrophobic scanners; and the menu of essential, often life-saving in-hospital care which can disorientate and distract.

This, of course, is by no means an exhaustive list.

Childhood illness prevents children from actively playing and exploring, which may impede key developmental processes – like the refinement of gross and fine motor coordination. Hospital treatment can make this even worse this by enforcing immobility (through intravenous therapies and other treatments, like haemodialysis).

It follows then, that being admitted to a hospital can have a detrimental effect on a young child’s education. This hypothesis has been confirmed and extended with work conducted by the Department of Child Health at the University of Bristol, which investigated the impact of preschool hospitalisation.

The 1970 British Births Cohort was used to select 2,900 hospitalised and 11,000 non-hospitalised preschool children for the purposes of comparing their long-term educational attainment. Their vocabulary was assessed at age 5, and later at age 10, they completed a range of tests which covered mathematics, reading and general cognitive ability [1].

The proportion of children with vocabulary, reading and mathematics scores in the lowest 15% at age 10 increased with the length of hospital stay before the age of 5. A preschool hospital stay of greater than 3 weeks produced vocabulary, reading and mathematics scores approximately one-fifth of a standard deviation below those of children admitted for less than 1 week when assessed at age 10 [1].

Children admitted both before and after the age of 2 displayed this reduced performance on the vocabulary test at age 5. Those who were admitted for less than 1 week did not differ in their educational attainment when compared to children who had never been admitted. In addition, no link was found between the number of hospital admissions and educational achievement.

These findings suggest that preschool hospitalisation can have lasting and significant effects on educational achievement, even when it occurs before the age of 2-years-old. The length of hospital stay beyond 1 week also appeared to influence the extent to which a child’s educational achievement would be impaired. Short or repeated admissions were not found to impact on long-term educational performance.

Analysis of data from the 1946 National Survey of Health and Development (which concerned preschool hospitalisation from 1946 to 1951) revealed a similar association between admission exceeding 1 week in duration and both educational and behavioural difficulties at 13, 15 and 17 years of age [2]. Later studies replicated this finding upon an assessment of data derived from the Isle of Wight and Inner London Borough Studies [3].

It’s startling that a single 3-week hospital admission before the age of 5 can have such far-reaching consequences — and it serves to focus our attention on the population of children who are unfortunate to have prolonged stays. This cohort clearly requires intensive educational support to prevent them from falling behind.



  1. Haslum MN. Length of preschool hospitalization, multiple admissions and later educational attainment and behaviour. Child Care Health Dev. 1988; 14(4):275-291
  2. Douglas JW. Early hospital admissions and later disturbances of behaviour and learning. Dev Med Child Neurol. 1975; 17(4):456-480.
  3. Quinton D, Rutter M. Early hospital admissions and later disturbances of behaviour: an attempted replication of Douglas’ findings. Dev Med Child Neurol. 1976; 18(4):447-459.