Preventive child examinations or early detection examinations U1 to U11 (also known as U examination) have been legally introduced in Germany since 1976 and serve the purpose of prevention (illness prevention). This is based on the early detection of disorders of physical, mental or social development in age-dependent developmental phases, so that they can be promoted or treated at an early stage if necessary. The examinations are carried out according to the “Children’s Guidelines”, which are laid down by the Joint Federal Committee.
The respective findings are documented in a yellow examination booklet for children. So far, the examinations have been offered on a voluntary basis, but there is a political discussion whether they should be introduced as a duty, since there has been an increasing number of neglect and violent crimes against children in recent years. Some states in Germany have already implemented this.
With the exception of the U1, early detection examinations are carried out by a pediatrician or general practitioner. Since the U1 (newborn initial examination) takes place immediately after birth, it is carried out by the delivering gynecologist, the midwife or a pediatrician consulted. The paediatrician is called in especially if the birth is premature or risky or if complications occur.
Implementation of the U1
This examination is performed according to the APGAR scheme, which is used to check the vital signs (breathing, heartbeat, etc.) of the newborn after birth. It is used to check whether the infant is allowed to stay with the mother or whether it is an emergency situation requiring quick action.
In the latter case, the infant is in a highly critical condition and may have to be resuscitated and/or ventilated directly or transferred to the intensive care unit. According to the APGAR scheme, points are awarded from 0-2 for each category/letter (APGAR score). In addition, there are further examinations that aim to identify acutely dangerous malformations.
If these are detected quickly or in time, some can prevent worse by immediate surgery. This includes probing the esophagus. During this, one looks to see if there is a continuous connection between the mouth and the stomach.
The first signs of a missing connection may be that the newborn baby does not want to drink. However, this is not a sufficient criterion, but an indication that a so-called esophageal atresia could be present. In addition to the esophagus, the nasal passages are also probed and thus checked for patency.
Furthermore, the rectal temperature is measured (thermometer is inserted into the anus) to rule out rectal atresia. Rectal atresia is the absence of the lower part of the rectum and thus the absence of a connection between the intestine and the outside world. As a result, the child cannot excrete anything, which is certainly an emergency that must be treated immediately.
Finally, the child is examined for gross malformations. These include cleft lip and palate, eye defects, neural tube defects (defects of the central nervous system) such as the open back (spina bifida), malformations of the extremities (e.g. clubfoot or dislocation/luxation of the hip), birth injuries and water retention (edema). In order to detect coarse heart and lung disorders at an early stage, the two organs are additionally monitored.
- In this scheme it stands for appearance and judges especially the skin color of the newborn. If the skin color is pale and blue, 0 points are given, for a rosy skin and mucous membranes 2 points are given. 2 points is the highest possible score in this score that the infant can achieve.
2 points in a category therefore means that everything is perfect.
- The abbreviation P stands for pulse. If there is no pulse, there are 0 points, for a pulse under 100 beats per minute there is 1 point and for over 100 beats per minute there are 2 points.
- The next test is that of facial movements (G). If the baby cries, everything is alright (2 points), but shows no reaction, the infant is not well (0 points).
- The next step is to check how active (A) the baby is or if and to what extent it is moving.
- The last thing to check is the respiration (R). For regular breathing, which occurs about 40 times per minute, the infant gets 2 points, if breathing is missing, no point is awarded.
