The neurodevelopmental, health, and growth outcomes for 28 six-year-old extremely low birth weight (ELBW) (birth weight less than 1001 gm) children were compared with those of 26 control children born at term. The two groups did not differ in mean weight or height, but the ELBW group had smaller head circumferences (p = 0.015). Kaufman mental processing scores correlated with head circumference (p = 0.0003). Significantly more of the ELBW children (61%) had mild or moderate to severe neurologic problems compared with control children (23%) (p = 0.003). Three ELBW children had mild spastic diplegia; one was blind. Eighteen (64%) of the ELBW children had required rehospitalization versus five (20%) of the comparison group. The mean Kaufman Mental Processing Composite was lower for the ELBW group, but when the data were analyzed by maternal education, only those children whose mothers had a twelfth-grade education had significantly lower scores (p = 0.0001). A similar pattern of group differences was seen for scores on visual-motor function (p = 0.0045), visual-perceptual abilities (p = 0.003), and attention span (p = 0.0001). No group differences were seen regarding hyperactivity or parental stress. Overall functional disability among the ELBW children was considered absent in 46%, mild in 36%, and moderate to severe in 18%. There was a significant association (p = 0.029) between classification of handicap at 12 to 34 months and classification at 6 years. No neonatal factors correlated with 6-year outcome. A significant proportion of ELBW children had no severe disabilities, but many had dysfunctions likely to affect learning and behavior in school.