Health checks for children and adolescents

In all, children and adolescents are entitled to 11 preventive check-ups, known as U and J check-ups, the aim of which is to identify any illnesses or anomalies in their development so that they can be treated. This article explains what the check-ups focus on.

At a glance

  • U check-ups involve the doctor examining the child’s general health to ensure that they are developing normally.
  • It is important to have the check-ups done at the right time so that anything odd in terms of development or illness can be identified early on. This also applies to children and adolescents with disabilities or chronic illnesses.
  • The results of the U checks are documented in the child examination booklet.
  • Dental check-ups are also provided to identify any problems with the teeth, mouth or jaw and any caries.
  • These screening check-ups are obligatory in some federal states, or there is an obligation to invite the patient and submit a report.
Medical examinations for children and adolescents: small child sitting on a doctor’s couch playing with a stethoscope. A doctor is examining the child carefully.

Why is it important to attend appointments at the right time?

There are precise timescales for when health checks should take place.

There is a good reason for this. From birth to teenage years, every child goes through a large number of development steps. For example, when they are of kindergarten and pre-school age, they go through important developments linked to speaking, motor skills and relationships with peers. Any anomalies in terms of development, and any illnesses, can only be successfully treated or corrected if they are identified and treated early within a particular life stage.

Please attend the examinations at the right times: abnormalities can only be treated properly if they are detected within a specific life stage.

Parents should also keep to the normal check-up schedule even when their child has been born prematurely. Any differences in development are taken into account at these check-ups. 

Your health insurance provider will cover the costs of the 11 health checks defined by law if they are done according to schedule. Some health insurance providers also offer additional U and J check-ups as an option (U10, U11 and J2). Ask your health insurance provider about them in advance.

Timing and main focuses of health checks for children and adolescents

U1: immediately after birth

Monitors vital functions such as breathing and the cardiovascular system. The doctor checks skin color, breathing, muscular activity, heartbeat and reflexes.

The doctor also checks whether there are any heart defects, hormonal or metabolic disorders, deformities or hearing disorders.

U2: 3 to 10 days

Careful physical examination: doctors measure the weight and body length, and examine the skin, organs, sensory organs, head, skeletal system and reflexes.

U3: 4 to 5 weeks

In particular, doctors check that the child’s weight is developing normally, motor skills, reflexes and reactions, and the organs and hips. They ask about the child’s drinking, digestion and sleeping behavior.

U4: 3 to 4 months and
U5: 6 to 7 months

Doctors examine the organs, sensory organs, genital organs, skin, growth, motor skills, nervous system and movement.

U6: 10 to 12 months

Doctors monitor mental development, the sensory organs (such as sight) and the ability to move.

U7: 21 to 24 months

Doctors particularly test speech development, fine motor skills and body control.

U7a: 34 to 36 months

Doctors check whether the child has any sight disorders or other abnormalities, and whether speech development is normal.

U8: 46 to 48 months

Doctors do a close check on speech development, articulation and social behavior, motor skills, sight and hearing in order to be able to treat any illnesses or abnormalities before the child begins school.

U9: 60 to 64 months

Doctors check motor skills, speech development and sight, to be able to treat any illnesses or abnormalities before the child begins school.

J1: 12 to 13 years

Doctors check physical development, for example height and weight, organs and the skeletal system, pubertal development and vaccination status.

They also ask questions about mental and educational development, and find out whether there are any indications of behaviors that might endanger the child’s health, for example taking addictive substances.

The doctor advises the child on health issues, for example sexuality and contraception, weight problems and eating disorders, and can be the first point of contact if the child has any personal or psychological problems.

Interesting fact: The child examination booklet (yellow booklet) also has information about what the check-ups focus on.

Additional medical check-ups outside of the check-up program specified by the law. Not all of the health insurance providers pay for these.

U10: 7 to 8 years

Doctors check whether there are any developmental or behavioral disorders, which often only become clear after the child has started school. Treatment may be started.

U11: 9 to 10 years

Doctors check whether there are any disorders related to school performance, socialization or behavior, and whether there is any media behavior that could endanger the child’s health, or any problematic behavior with addictive substances. They also advise on exercise, sport and health-conscious behavior.

J2: 16 to 17 years

Doctors check whether the child has any disorders linked to sexuality or behavior. They also advise on prevention and issues related to behavior, socialization, the family, sexuality and choice of profession.

What happens in U check-ups?

In U and J check-ups, the doctor checks whether there are any indications of particular illnesses, and checks the child’s general health, and whether the child is developing normally. This way, any illnesses, disabilities or delayed development can be identified early on, and treatments and targeted support can start to be provided.

With this purpose the doctors check, for example, whether

  • the child’s body is developing normally.
  • certain illnesses are present.
  • the child’s mental development, speech development, and social and emotional skills have developed normally, and what the relationship between child and parents is like.
  • there are any particular problems or increased health risks. They also provide information about preventive measures and other help options. 
  • there are any anomalies in an adolescent’s health or educational development, or if there is any behavior that might endanger their health, for example smoking, and alcohol and drug consumption.

If the doctors identify any anomalies, they advise on the way forward, and might refer the adolescent on to specialists for further diagnosis and treatment. They also advise on vaccinations and check whether all vaccinations have been given.

Guardians can use the check-ups to ask questions about the child’s development and to address any problems, for example in relation to media consumption, diet or upbringing. The doctor might mediate contact with other advisory centers.

Are there any dental care checks?

Dental checks are also scheduled during the child’s first 6 years, in order to identify and treat any dental, oral and jaw disorders and caries at an early stage. 

Children are entitled to 6 check-ups during their first 6 years, which focus on examining the oral cavity, and giving the parents advice on diet and oral hygiene. During these, the enamel can be hardened, and caries-free fissures and pits in the molars can be sealed.

From the age of 6, the health insurance providers pay for dental check-ups every six months. From the age of 12 these check-ups are entered in a bonus booklet, and the grants increase if teeth need to be replaced later on.

Are the U check-ups also useful for children with a chronic illness or a disability?

Children with a chronic illness or a disability sometimes develop differently to healthy or non-disabled children. However, the scheduled check-ups are useful because the doctor checks how the child is developing and advises on any other treatments or supportive measures. For some disabilities, there are also other adjusted criteria for normal development.

What documentation is there?

Doctors enter the results of all the U check-ups into the child examination booklet, also known as the “yellow booklet”. Parents are given this after the child is born. 

The examination results entered into it is confidential information that is subject to specific data protection. Nobody, including any institution, such as a kindergarten, school or local authority, is permitted to look at the booklet if the parents do not give their consent.

In the new booklets that have been issued since 2017, there is a fold-out “attendance card” on which parents can confirm that they have attended the check-up.

The yellow booklet can also be saved in the electronic patient record (ePA).

The yellow booklet can also be saved in the electronic patient record (ePA).

Are the health check-ups an obligation for children and adolescents?

Every child and adolescent has a legal entitlement to the 11 check-ups specified by law, the U1 to U9 and J1. They are paid for by all of the health insurance providers, both statutory and private. However, the scheduled check-ups are only obligatory in some federal states.

In most federal states there is an obligation to issue invitations and to report. The children’s doctors report the fact that the check-up has been attended to the authorities. If no report is received, parents are asked to get in touch.

Further information

You can get more information about the check-ups from your child’s doctor and your health insurance provider.

Each child’s check-up schedule can be calculated at kindergesundheit-info.de – a Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung) website.

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