The authors assessed 137 VLBW children and 162 controls for laterality by observation and questionnaire at 12 years of age. A significantly higher proportion of the VLBW children were either left-handed or mixed-handed. A number of motor cognitive and educational outcome variables were measured. Impaired manual dexterity was found to be significantly more common in VLBW non-right-handers. This group was also found to be more at risk of poor near vision. No cognitive or educational outcomes were associated with handedness. The results seem to support the theory that at least in a proportion of VLBW children, non-right-handedness has a pathological basis, but the relationship to perinatal events remains obscure.