Health checks for children and adolescents

U and J check-ups involve doctors examining children’s general health to ensure that they are developing normally. The doctors also check for signs of neglect and/or abuse.

This makes it possible to detect illnesses or developmental disorders so as to initiate treatment and targeted support at an early stage.

During the check-ups, the doctor will check several things, including whether:

• the child’s body is developing normally
• chronic illnesses are present
• there are any indications of visual or hearing disorders
• the child’s mental development, speech development, and social and emotional skills are normal for their age
• there are any abnormalities in the relationship between the child and parents
• any anomalies detected during previous check-ups have improved
• there are any particular problems or increased health risks 
• there are any anomalies in an adolescent’s health or educational development, or any behavior that might endanger their health, for example smoking, alcohol consumption, or drug consumption

They also provide information about preventive measures and other help services.

In the event of anomalies, doctors provide advice on how to proceed. If necessary, they also provide a referral to specialist practices for further diagnostics and treatment. They also advise on vaccinations and check whether any vaccinations have been missed.

Parents or other carers can use the check-up appointments to ask questions about the child’s development and discuss any difficulties, for example with regard to media consumption, diet, or upbringing. The doctor may mediate contact with advisory centers. 

There are precise timescales for when health checks should take place. There is good reason for this. From birth to teenage years, every child goes through a large number of development steps. For example, when children are of kindergarten and pre-school age, they go through important developments linked to speaking, motor skills and relationships with peers. Some developmental anomalies or even illnesses can only be optimally treated within a specific life stage.

Parents should adhere to the normal check-up schedule even if their child was born prematurely. The dates are calculated from the actual date of birth. However, the pediatrician will consider any differences in development. 

Health insurance providers cover the costs of the newborn screening and the eleven U and J check-ups defined by law if they are done according to the specified 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. These check-ups are documented separately rather than in the yellow child examination booklet (U-Heft). 

Timescales and focus areas of the health checks

U1: immediately after birth

The doctor checks vital functions such as breathing and the cardiovascular system by looking at aspects such as skin color, breathing, muscular activity, heartbeat, and reflexes. The child is also examined for birth defects, birth injuries, jaundice, and water retention as well as measured and weighed. Vitamin K is administered to prevent dangerous bleeding.

Special health checks

Between U1 and U2, the oxygen content of the blood is checked with a sensor to eliminate certain heart defects.

A blood test is also performed to detect certain rare hormonal and metabolic disorders as well as serious immune disorders. This is known as newborn screening. The child’s hearing is also tested. These three checks are recommended by doctors and free of charge.

U2: 3 to 10 days

A careful physical examination is performed: the weight and body length are measured and the skin, organs, sensory organs, head, skeletal system, and reflexes are checked. The doctor pays particular attention to any birth defects and birth-related consequences. The child is given another dose of vitamin K. The parents are told about the benefits of giving the child fluoride and vitamin D to promote healthy teeth and bones.

U3: 4 to 5 weeks

During U3, the doctor talks to the family about how things are going with the newborn: is the child breastfed and does the mother need any support with this, for example in the form of breastfeeding advice? Is the child drinking enough? Is the child’s digestion normal? How much does the child sleep? Does the child cry a lot? Is the mother showing any signs of postpartum depression? The doctor also checks that the child’s weight, motor skills, reflexes, reactions, organs, and hip joints are developing normally. An ultrasound scan is taken of the baby’s hips to enable the early detection and treatment of any misalignments. The infant is given vitamin K drops for the last time. The parents are given information about the recommended vaccinations.

U4: 3 to 4 months

This check-up once again focuses on potential anomalies in relation to sleeping, breastfeeding, drinking, digestion, or any other elements of the baby’s behavior. The doctor also checks whether the child’s body is developing normally and examines the child’s motor skills and nervous system.

U5: 6 to 7 months

The child is given a further physical examination. In the case of boys, this particularly includes checking for an undescended testicle. The doctor advises the parents to gradually transition from breast milk or formula to solid food. The switch from fluoride tablets to fluoride toothpaste is also discussed, as are the topics of sun protection and vaccination.

U6: 10 to 12 months

During the check-up, the doctor pays particular attention to the child’s level of mobility and body control. An eye test is also performed to detect any visual impairments. The child’s speech and interaction skills are also checked for the first time. The upcoming transition from a diet of milk and pureed food to standard family food is discussed. The doctor provides advice on the recommended vaccinations and on promoting speech development. The administration of vitamin D can stop after the second early summer that the child experiences, i.e. after 1–1.5 years depending when the child was born.

U7: 21 to 24 months

This check-up particularly focuses on the child’s ability to run around and whether the child is starting to learn to climb stairs as well as the fine motor skills, speech, and interest in other children. If the child has not yet received all the recommended vaccinations, this can be rectified. The doctor also checks for any visual impairments.

U7a: 34 to 36 months

At this age, the clarity of vision is determined and the spatial vision is tested. The check-up also focuses on coordination and balance, which are tested by asking the child to hop and climb stairs. The child’s fine motor skills and social behavior are also checked. At this stage, the doctor provides advice on media consumption for the first time. The doctor also rechecks that the child’s speech is developing normally.

U8: 46 to 48 months

A hearing test is performed to detect rare hearing disorders that occur during development. The clarity of vision and spatial vision are retested. The doctor checks the child’s speech development, coordination, mobility, and dental status. The parents are given further advice on language development, media consumption, diet, and sufficient exercise. A urine test is performed to check for chronic kidney diseases.

U9: 60 to 64 months

The doctor checks the child’s motor skills, speech development, and sight to be able to treat any illnesses or anomalies before the child begins school. The child’s color vision is also checked for the first time. 

A date calculator for U1 to U9 can be found on kindergesundheit-info.de, a website provided by the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA).

J1: 12 to 13 years

This check-up focuses on the early detection of mental and social risk factors, such as problems at school, smoking, or alcohol consumption. The doctor also advises the adolescent on health matters, for example sexuality and contraception, weight problems, or eating disorders, and can be the first point of contact for any mental health problems. 

The doctor measures the blood pressure and performs a physical examination, paying particular attention to pubertal development and posture as well as thyroid, spinal column, and hip disorders.

Additional medical check-ups outside of the check-up program specified by law

Not all health insurance providers cover the costs of the additional check-ups U10, U11, and J2. However, many providers offer these check-ups to insurance holders as an additional benefit.

U10: 7 to 8 years

The physical, mental, and educational development are checked. The child’s hearing and sight are also retested. The doctor also asks about media consumption and whether the child gets enough exercise.

U11: 9 to 10 years

During this check-up, the doctor checks whether there are any problems at school or in the social environment. The doctor also inquires whether there is any problematic use of media or addictive substances. U11 check-ups furthermore include advice on sport and exercise as well as health-conscious behavior. Attention is also paid to the early stages of pubertal development and potential puberty issues.

J2: 16 to 17 years

The physical, mental, and social development are rechecked at the end of puberty. Problems with educational or professional development as well as behavior that poses a risk to health should be detected so as to be addressed before adulthood. The doctor also checks for any visual or hearing disorders.

Adolescents are also able to talk to their doctor about any problems with friends, family, or their own sexuality. The check-up can occur with or without parental supervision.

Newborn screening occurs 36 to 72 hours after birth, sometimes at the same time as the U2 check-up. It involves taking a few drops of blood from the newborn’s veins or heel and sending it to a special laboratory for testing.

The screening is used to detect a number of congenital disorders and instigate treatment at an early stage. Although most of the disorders that are tested for have no cure, they can often be successfully treated so as to mitigate or even avoid their effects.

Further information about newborn screening and the various disorders that it can detect can be found in an online brochure published by the Joint Federal Committee (G-BA) (in German only).  

Parents can receive dental care for their children from an age of six months in order to enable the early detection and treatment of any problems with the teeth, mouth, or jaw, such as caries. Three dental examinations are recommended between the 6th and 33rd months of life. The pediatrician also checks the teeth within the scope of the U check-ups and advises the parents on dental health.

Three dental appointments are also recommended between the age of four and six. Appointments should occur every 12 months. In addition to examining the mouth, the examinations focus on providing parents with information and advice on diet and oral hygiene. If necessary, the enamel can also be hardened and caries-free fissures and pits in the molars can be sealed.

From the age of 6, health insurance providers pay for dental check-ups every six months. From the age of 12, these check-ups are recorded in a(n) (electronic) bonus booklet. People who can prove that they have had all preventive check-ups receive higher subsidies if they later require dentures.

Children with a chronic illness or disability sometimes develop differently to healthy or non-disabled children. The scheduled check-ups are therefore useful because the doctor checks how the child is developing and advises on any other treatments or supportive measures. In the case of some disabilities, such as Down’s syndrome, there are adjusted criteria for normal development.

The doctor records the results of all U check-ups in the (electronic) child examination booklet, also known as the “yellow booklet” or “U-Heft”. Parents are given this shortly after the child is born.

In addition to the yellow booklet, pediatricians can also give parents a white and green “PaedPlus” booklet. This booklet is used to document the additional U10, U11, and J2 check-ups as well as the J1 adolescent check-up.

The examination results entered are classed as confidential information subject to specific data protection. Nobody, including institutions such as kindergartens, schools, or local authorities, is permitted to look at the booklet without the parents’ consent. In the newer child examination booklets that have been issued since 2017, there is a fold-out “attendance card” that parents can use to prove that their child has had the check-ups.

The yellow booklet can also be saved in the electronic patient record (ePA). Clear information about how the electronic patient record (ePA) can accompany and support children throughout their lives can be found on the ePA topic page.

Every child and adolescent is entitled to receive the eleven check-ups specified by law (U1 to U9 and J1). They are paid for by all health insurance providers, both statutory and private.

In most German states, the check-ups are not obligatory – with the exception of Baden-Württemberg, Bavaria, and Hesse. In the other German states, however, there is an obligation to issue invitations and report attendance in relation to several check-ups. Pediatricians or parents (depending on the federal state) report the participation in the medical check-ups to the authorities. If the participation in the medical check-ups is not reported, the authorities will make an inquiry with the parents. If the parents/pediatricians have simply forgotten to report a check-up, this can be easily rectified. If a check-up has actually not taken place, the health authority or youth welfare service will usually visit the family to ensure that the child is being well cared for.

You can obtain further information about the U and J check-ups from your pediatrician and your health insurance provider.

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

The German Association of Child and Adolescent Physicians (BVKJ) offers a reminder service. People can enter their details to receive vaccination and check-up reminders by e-mail.