One hundred children with spina bifida were examined at home and reviewed at the schools they attended. The severity of the handicap had not been appreciated at the time of school entry. 27 of the 41 children who were over 10 years of age had become wheel-chair dependent; 39 of the 100 children had an IQ below 80, and incontinence remained a problem for 68 children. 64 had visual defects, including two who were totally blind, 27 had epilepsy, and 87 had suffered fractures, burns, scalds or pressure sores. Most of the children had started at an ordinary school. The teachers had to give a disproportionate amount of attention to the handicapped child, but were themselves often given inadequate information and support. Many children had learning difficulties. As they grew older their incontinence was less well tolerated. Wheelchair dependency precluded their admission to an ordinary secondary school with stairs, so the majority of older children attended special schools. Only very few will enter normal employment, and many will require a period of education and training beyond the usual school-leaving age. The education of such children should have realistic goals and aim at achieving the maximum degree of self-care.