The U-examinations at a glance
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From infancy and toddlerhood to starting school, your child grows, learns, and changes particularly rapidly. To ensure that their physical and social development progresses age-appropriately, regular check-ups with the pediatrician are scheduled during the first years of life. We have put together an overview of what you and your child can expect during the so-called U-examinations and what is specifically checked during 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. In these check-ups, not only the general health status and physical development of your child are examined, but also their social and emotional skills. On one hand, the regular visits to the pediatrician serve the purpose of disease early detection. This way, your little explorer can receive prompt help and the appropriate treatment if there are any irregularities in physical development or suspicion of illness. On the other hand, important developmental milestones are monitored during these regular examinations.
Since some conditions or developmental delays need to be identified within a certain age range in order to be properly treated, it is important to attend the examinations at the recommended time. This way, your child can receive early support and assistance if necessary. Beyond the examination, visiting the pediatrician always provides an opportunity to discuss concerns, worries, or difficulties 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 the pediatrician sends a participation confirmation to the respective central authority of the state after each U-examination. 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. They therefore cover the full costs. However, if the appointments take place too late, you may have to bear 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 which additional preventive appointments they offer.
What is the yellow children's health record booklet?
The results of all U-examinations are stored in the Child Examination Booklet , which every child receives immediately after birth during the initial examination, and recorded in the vaccination record. Besides the documentation purpose, the so-called Yellow notebook fulfills, it also serves as Examination Certificate towards third parties: For example, during the initial registration at the daycare, it must be demonstrated that a medical vaccination consultation has taken place. Since the child examination booklet is a confidential document, participation in all examinations is indicated on the separately expandable Participation Card Noted. 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 way, you always have the opportunity to inform yourself beforehand or retrospectively about the examinations and to note down questions for the next doctor's visit. The Child Examination Booklet is therefore the central health document Your child's, which you should keep in good condition accordingly. 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 are about whether your little explorer is developing healthily and age-appropriately and certain things are checked each time, different aspects are the focus of attention during each doctor's visit. In the following section, you will 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 determine 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
Check whether the fontanel (the soft spot on the head) is large enough so that your child's skull can continue to grow without problems
The first vaccination or even the booster vaccination takes place at the latest during the U4
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 answering questions about the 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: Checks 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 (evaluation of 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 questions about how your child behaves in a group with peers.
Height, head circumference, and weight are still measured, but are less central to the investigation, as children develop much more individually from the first year of life onward.
Consultation on the recommended vaccination and, if necessary, 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 usage and ways to promote language development
The U8 is a particularly comprehensive examination in which your child, for example, should name pictures, answer questions, and perform some 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 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, during which, among other things, it is assessed whether your child has achieved school readiness. For this examination, it is also allowed to show what it can do, for example, draw shapes, walk on tiptoe, or count 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 concentration ability. They may also pay special attention to how you interact with each other in order to provide you with 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 when it comes to whether their child is developing well and age-appropriately. Usually, there is no reason to worry, as individual development during infancy and toddlerhood is so diverse. Nevertheless, regular check-ups provide many moms and dads with reassurance – including the opportunity to have a contact person who has known their child for a long time, possibly since birth, to address 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, we reveal a little secret: The "U" simply stands for "Untersuchung" (examination) – the term "U-Untersuchungen" (U-examinations) is actually redundant. ;)