The U-examinations at a glance

What to Expect at Preventive Checkups U1 to U9: Key Screenings, Measurements, and Milestones

From infancy and toddlerhood to starting school, your child grows, learns, and changes especially quickly. To ensure their physical and social development stays age-appropriate, regular check-ups with the pediatrician are scheduled during the first years of life. We’ve put together an overview of what you and your child can expect during the so-called U-examinations and what is checked at each appointment for early detection.

What are the U-examinations?

From birth until approximately the fifth year of life, a total of ten early detection examinations take place at different intervals. During these check-ups, your child’s general health and physical development are assessed, as well as their social and emotional skills. On the one hand, regular visits to the pediatrician support disease early detection. This way, your little explorer can receive prompt help and appropriate treatment if there are any irregularities in physical development or signs of illness. On the other hand, important developmental milestones are monitored during these routine examinations.

Because some conditions or developmental delays need to be identified within a certain age range in order to be treated properly, it’s important to attend the examinations at the recommended times. This way, your child can receive early support and assistance if needed. Beyond the examination itself, each visit to the pediatrician is also an opportunity to discuss concerns, worries, or challenges in caring for your child—and to ask questions.

In this video, our pediatrician Ariane from LILLYDOO explains what you should know about your little explorer's U-examinations.

Although it is strongly recommended, participation in the U-examinations is not mandatory in all federal states. However, there is usually a so-called reporting obligation. This means that after each U-examination, the pediatrician sends a confirmation of participation to the state’s respective central authority. If an examination is missed, the local youth welfare office contacts the parents. Another reason to attend the U-examinations on time: as long as they are completed within the specified period, all ten early detection examinations are covered by statutory health insurance. This means the full costs are covered. However, if the appointments take place too late, you may have to cover the costs yourself. In addition to the legally mandated U-examinations, some health insurance providers also offer additional examinations as voluntary supplementary services. It’s best to check directly with your health insurance provider to see which additional preventive appointments they offer.

What is the yellow children's health record booklet?

The results of all U-examinations are recorded in the Child Examination Booklet , which every child receives immediately after birth during the initial examination, and in the vaccination record. In addition to its documentation purpose, the so-called Yellow notebook also serves as an Examination Certificate for third parties. For example, when registering at daycare, you must show that a medical vaccination consultation has taken place. Because the child examination booklet is a confidential document, participation in all examinations is noted on the separately extendable Participation Card . This way, you can provide proof without having to disclose your child's personal "medical record" to the daycare, school, or youth welfare office.

In the Yellow Booklet you will find detailed information about all examinations. This gives you the opportunity to inform yourself in advance or look back afterward, and to note down questions for the next doctor's visit. The Child Examination Booklet is therefore the central health document for your child, which you should keep in good condition. If you happen to lose it, your pediatrician's office can issue a new booklet for you.

What happens during the different U-examinations?

Even though all examinations focus on whether your little explorer is developing healthily and age-appropriately, different aspects take center stage at each visit. In the following section, you’ll learn exactly what happens during each U-examination.

In all examinations

  • Weighing, measuring, and listening to your child

  • Examination of the organs by palpation

  • Hearing and vision testing

  • Verification of vaccination status

  • Opportunity to clarify possible difficulties or questions with your pediatrician

  • If desired, you will receive information about regional support services (for example, parent-child assistance)

  • The doctor will observe how your baby interacts with you and responds to you

  • The first examination of your baby immediately after birth by the midwife or the doctor

  • Determination of the Apgar score after five and ten minutes: During this, your newborn's breathing, heartbeat, skin color, muscle tone, and reflexes are assessed through palpation and targeted observation. Using a scale from one to ten, these values help determine whether your child has coped well with the birth.

  • Detection of possible birth injuries or developmental abnormalities

  • Collection of umbilical cord blood: The pH value of the blood can indicate whether your baby experienced oxygen deprivation during birth, for example, because the umbilical cord was clamped.

  • Administration of vitamin K drops to prevent internal bleeding (in consultation with you and your partner)

  • Nutrition counseling (breastfeeding or infant formula)

  • If you and your baby are still in the hospital at the time of the U2, the examination will be carried out directly on site. If you are already back home or had a home birth, the U2 will take place at the pediatrician's office. In this case, you should schedule an appointment for the examination as soon as possible after the birth.

  • Monitoring of weight development: An initial weight loss after birth is normal, but it should not exceed ten percent of the birth weight by the tenth day of life

  • Blood tests for metabolic disorders or cystic fibrosis

  • Check for jaundice

  • Newborn Hearing Test

  • Special attention to your baby's skin, sensory organs, chest and abdominal organs, reproductive organs, and head

  • Examination of the musculoskeletal system and neonatal reflexes such as the Moro reflex (where your infant first extends their arms forward and then clenches their hands into fists when tilted backward from a supine position)

  • Re-administration of vitamin K drops for prophylaxis

  • Advice on nutrition and preventing sudden infant death

  • Recommendation for taking vitamin D for bone density and possibly fluoride for later tooth hardening

  • The doctor will ask you about your baby's drinking, digestion, and sleep habits and will advise you if there are any concerns

  • Listening to heart, lung, and bowel sounds

  • Ultrasound of the hip joint to detect and treat hip deformities or dislocations early

  • Possibly ultrasound of the kidneys to detect potential urinary tract infections early

  • Check for jaundice

  • Assessment of age-appropriate development of reflexes (such as the grasp reflex) and motor skills

  • Consultation for the first six-in-one vaccination (against tetanus, diphtheria, polio, Haemophilus influenzae type b, hepatitis B, and pneumococci), which can be administered from the eighth week. You can schedule an appointment before the next check-up, during which you will also receive your child's vaccination record.

  • If not already done, consultation on nutrition, prevention of sudden infant death syndrome, and accidents in general

  • Possibly a renewed recommendation for taking vitamin D for bone density and fluoride for later tooth hardening

  • Monitoring your baby's coordination and body posture (such as lifting the head from a prone position) and their age-appropriate development of mobility (for example, tracking a moving object with eyes and head from a back-lying position)

  • Examination of the internal organs, sensory organs, reproductive organs, and the skin

  • Checking whether the fontanel (the soft spot on the head) is large enough for your child's skull to continue growing without problems

  • The first vaccination, or even the booster vaccination, takes place by the U4 at the latest

  • Nutritional counseling: initial information on introducing complementary foods

  • Monitoring the age-appropriate development of your baby's mobility (including grasping and pushing up with the arms) and motor skills (such as hand-eye coordination) to detect potential developmental delays early

  • Testing your baby's reflexes

  • Information about dental health and oral hygiene

  • Consultation on recommended vaccinations; in some cases, the six-in-one vaccination is repeated

  • Nutritional counseling and answers to questions about complementary foods

  • The so-called "one-year examination" focuses on your child's developmental progress

  • Assessment of fine motor skills and body control (such as crawling, sitting, supporting oneself, and possibly first free steps)

  • Monitoring of language development (ability to communicate using sounds and syllable repetition like "da-da")

  • Examination of age-appropriate development: Checking whether your child understands simple instructions and questions and can perceive and recognize objects

  • Consultation on the recommended vaccination against chickenpox , rubella, measles and mumps

  • Consultation on caries prevention

  • Nutrition counseling from the first year of life

  • Examination of your child's motor skills (for example, their gait) and age-appropriate development of fine motor skills

  • Assessment of speech and hearing development (evaluating whether your child understands simple words and sentences)

  • Monitoring the development of social behavior: Your doctor may ask your child various questions to get an impression of their independence and ability to interact. They may also ask you how your child behaves in a group with peers.

  • Height, head circumference, and weight are still measured, but they are less central to the examination, as children develop much more individually from the first year of life onward.

  • Consultation on the recommended vaccination and, if necessary, a booster of the hexavalent vaccine (against tetanus, diphtheria, polio, Haemophilus influenzae type b, hepatitis B, and pneumococci) and/or against mumps, measles, rubella, and chickenpox

  • The U7a was reintroduced a few years ago (hence the suffix "a") to fill the gap between the preventive examinations U7 and U8.

  • Assessment of age-appropriate (language) development

  • Examination of the condition of the teeth and development of the jaw. Your doctor will refer you to the dental early detection examination for your child.

  • Information about the role of media use and ways to promote language development

  • The U8 is a particularly comprehensive examination in which your child, for example, may be asked to name pictures, answer questions, and do a few gymnastic exercises.

  • Examination of your child's linguistic, motor, and social development

  • Examination of the primary teeth if not performed by the dentist

  • Submission of a urine sample, which is tested for sugar, protein, bacteria, and blood components

  • Assessment of mobility (such as jumping forward with legs closed), coordination skills, and balance (can your child stand on one leg freehand for at least three seconds), reflexes, and muscle strength

  • Internal medical examination to rule out urinary tract infections, diabetes, heart defects, thyroid, and kidney dysfunctions

  • The U9 is the final and most comprehensive of the early detection examinations. Among other things, it assesses whether your child is ready for school. During this examination, your child can also show what they can do—for example, drawing shapes, walking on tiptoe, or counting to five.

  • Special assessment of hearing and vision, as well as language development (for example, pronunciation of vowels and consonants)

  • Examination of posture and foot position

  • The doctor may also ask you questions about your child's development, such as their ability to concentrate. They may also pay special attention to how you interact with each other in order to offer further suggestions for supporting your child.

  • Monitoring of blood pressure and urine

  • Possible booster vaccination

Especially in the first years of life, some parents feel uncertain about whether their child is developing well and age-appropriately. Usually, there is no reason to worry, as development during infancy and toddlerhood varies widely. Still, regular check-ups reassure many moms and dads—and they also give you a trusted contact who has known your child for a long time, possibly since birth, to discuss fears and questions. Of course, you can also speak with your pediatrician at any time outside of the check-ups if you notice anything unusual about your child.

And finally, here’s a little secret: The "U" simply stands for "Untersuchung" (examination)—so the term "U-Untersuchungen" (U-examinations) is actually redundant. ;)

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