Children born before 37 weeks of pregnancy face a higher risk of developing mental health challenges. Despite advances in medical care, their mental health outcomes have not improved in recent decades. Researchers from Germany and the UK studied over 1,500 preterm-born children to identify which factors help them cope and thrive emotionally. This study looked at children aged 7-8 years and examined influences ranging from personal skills to family and community environments. The findings showed that certain skills and relationships can make a big difference in mental health resilience, regardless of the level of early adversity. Supporting self-regulation, fostering strong family bonds, and preventing bullying emerged as key strategies for helping these children lead emotionally healthier lives.

Children born preterm often experience unique developmental challenges. Alongside medical issues, they are more likely to encounter social and emotional difficulties, which can persist into later childhood and adolescence. While much research has focused on the risks, fewer studies have explored how some children still manage to thrive despite these challenges. Understanding what supports their mental health could help families and professionals take more effective action.

To learn more, researchers followed two large groups of preterm-born children in Germany and the UK. They studied a range of possible protective influences – from a child’s ability to regulate emotions, to the quality of relationships within their family, to the safety and friendliness of their neighborhood. The goal was to find which factors most strongly predicted better-than-expected mental health.

Key Skills and Relationships Make the Difference

The study found that children with strong self-regulation skills – the ability to manage emotions and behavior – tended to have better mental health. Good parent-child relationships, especially between mothers and children, were also linked to higher resilience. A positive home environment, healthy relationships between parents, and protection from bullying further supported mental well-being. These findings were consistent in both the German and UK groups, suggesting that these factors are important regardless of cultural context.

Beyond these core elements, other helpful influences included attention skills, a stimulating family climate, supportive sibling relationships, and high-quality neighborhoods. Even so, self-regulation stood out as the single most important factor, with effects independent of other influences.

Why This Matters for Families and Care Providers

Practical steps can be taken to strengthen these resilience factors. Parents and caregivers can help children develop self-regulation by providing structure, encouraging independence, and responding warmly to emotional needs. Maintaining a supportive, respectful relationship between parents benefits the child’s emotional security. Addressing bullying early – both among peers and siblings – can protect mental health. For families living in challenging circumstances, improvements to the home environment and strengthening close relationships may help buffer against stress.

While some risks, like being born preterm, cannot be changed, this research shows that the right support can make a meaningful difference. Healthcare providers, educators, and community workers can work together with families to identify and build these protective elements.

Paper available at: Fostering positive mental health outcomes in vulnerable children: Pathways to resilience after preterm birth - Twilhaar - Journal of Child Psychology and Psychiatry - Wiley Online Library

Full list of authors: Twilhaar, E.S.; Wolke, D.

DOI: https://doi.org/10.1111/jcpp.70002