Child screening examinations are used for the early detection of diseases and developmental disorders in newborns, infants, children and adolescents. There are different regulations for their mandatory nature in the individual federal states. However, Section 26 of the Fifth Book of the German Social Code (SGB) (§ 26 SGB V) is the general legal basis for pediatric screening.
What are the preventive medical checkups for children?
Pediatric checkups are used for the early detection of diseases and developmental disorders in newborns, infants, children and adolescents. Pediatric screenings are preventive measures to detect any diseases, defects or developmental disorders of newborns, children and adolescents as early as possible. On their basis, appropriate therapies can then be initiated. In addition to the early detection of diseases, a special focus of preventive examinations is the diagnosis of child abuse and sexual abuse. The examinations are carried out by pediatricians, adolescents or family doctors. For children, there are 12 examinations (from U1 to U11), the performance of which depends on age. From the age of 13, there are two more examinations for adolescents (J1 – J2). The preventive examinations for newborns and infants are compulsory services provided by the health insurance funds. Thus, the services for the examinations U1 to U9 are fully covered. More and more health insurers are also covering the costs of the U10 and U11 examinations. According to the guidelines of the Joint Federal Committee of Physicians and Health Insurers, the medical measures for the early detection of diseases are specified for children up to the age of 6. These examinations from U1 to U9 are documented in a “yellow booklet”. The other preventive examinations for children and adolescents from U10 to J2 can be recorded in an additional “Green Booklet”.
Function, effect, and goals
Child screening examinations begin with the birth of the child. From minute one to minute ten, assessments are performed according to the so-called Apgar score. This includes measuring and weighing the newborn and examining the cord blood. This first examination is referred to as APGAR. From the second to the fourth hour of life, the U1 is performed. The purpose of the U1 is to detect any defects of vital functions that affect motor function, posture and muscle tone, in order to be able to act quickly. For this purpose, the body is examined, listened to and palpated. With U2, screening for possible congenital metabolic diseases or hormonal disorders takes place from the third to the tenth day of life. These two examinations are still performed in the clinic. From U3 onwards, the pediatrician or family doctor is responsible for the examinations. In the fourth and fifth week of life, the doctor examines the nervous system and the various sensory organs as part of the U3. There is also an ultrasound examination of the hips. This appointment also includes an assessment of the kidneys and urinary bladder, as well as vaccination counseling. The examinations U4 to U7 are carried out in the period from the third to the 24th month of life. These examinations are mainly concerned with the child’s physical development. The doctor’s main focus is on any motor disorders that are cerebral in origin. The necessary vaccinations should also be carried out during this period. In 2008, another examination, U7a, was inserted between U7 and U8 as a benefit of the statutory health insurance. U7a, which is performed between the 34th and 36th month of life, is mainly concerned with examining dental status, behavior, speech development and identifying any visual defects. U8 in the 46th to 48th month of life is used to determine coordination skills, pronunciation and dental status. In the 60th to 64th month of life, U9 is performed one year before school enrollment to examine gross and fine motor skills, speech comprehension, and vision and hearing. Between the seventh and tenth year of life, the U10 and U11 examinations take place. They focus mainly on examining the child’s physical and mental development. This refers to the detection of possible behavioral disorders, literacy and numeracy disorders, motor disorders or addictive behavior. Health-conscious behavior should be supported.From the age of 13, the adolescent health examination begins with the J1, which is completed in the 17th year of life with the J2. Both examinations once again assess the general health situation, social behavior, pubertal development, sexual behavior and motor development. Among other things, the last preventive examination J2 also serves as an accompanying counseling for career choices.
Risks, side effects and dangers
Child screening is regulated differently in the various federal states, despite a uniform legal basis. The legal basis for preventive medical examinations is § 26 SGB V.
This legal basis merely states that children up to the age of six have a legal right to general examinations and up to the end of their tenth year to an examination for the early detection of serious diseases that impair their development. However, there is no obligation for these preventive examinations. In the German states of Bavaria and Baden-Württemberg, the examinations have been made mandatory until the start of school since 2008 and 2009, respectively. The background to this is probably to put a stop to child abuse and sexual abuse of children by making screening compulsory. In other federal states, there is no obligation to participate in preventive medical checkups for children. However, in some states, pediatricians are required to report when children have participated. This is intended to centrally identify children who have not attended. The parents of these children receive a reminder, if necessary, to have the examination performed. If no screening then takes place within four weeks, the responsible youth welfare office is informed, which decides on the further course of action.
