What happens if I do not go to the U-examination?
In many countries, including most German states, special reporting requirements have been introduced to ensure that children regularly participate in the recommended U examinations. In these cases, pediatricians are obliged to report missed U-examinations to the State Institute for Health and Labor. If a follow-up examination is not carried out despite parents’ reminders of the missed U-examination date, this may even result in a report to the public youth welfare authorities.
Who bears the costs?
The U-examinations U1-U9 as well as the youth examination J1 are among the obligatory services of the health insurance companies and are therefore free of charge for all children from birth to 18 years of age. The additionally recommended examinations U10, U11 and J2 are not yet reimbursed by every health insurance company, but should still be performed for a comprehensive observation of the child’s development. In order to find out whether the health insurance company will cover the costs of the U examinations U10, U11 and J2, a telephone inquiry is usually sufficient. However, some carriers also reimburse the costs for the U10, U11 and J2, provided that participation in a bonus program of the health insurance company is granted.
The individual U-examinations at a glance
The U-examination U1 is usually performed directly after delivery or in the second to fourth hour of life. The most important goal of this examination is to detect acutely life-threatening diseases or malformations that require immediate treatment, as this is the only way to ensure the fastest possible therapy. First and foremost, it is important to determine whether the newborn baby has suffered injuries during birth.
Then the so-called vital functions are checked. In doing so, the pediatrician listens to the heart and lungs. The blood circulation, muscle tension and innate reflexes are also checked.
Within the framework of the U1, the so-called “APGAR score” is usually also collected. Another examination, which is part of the U1, is the collection of a small amount of umbilical cord blood, which is then tested for its oxygen content. This allows a statement about whether the child’s organs can be supplied with sufficient oxygen, which is of great importance for their function.
Another part of the U-examination U1 is the measurement and weighing of the newborn by the midwife.To support blood clotting, the child is also given drops containing vitamin K. The U2 examination should normally be carried out between the third and tenth day of life. Depending on how long the mother and child have to stay in hospital after delivery, the U2 is either carried out as an in-patient or by a pediatrician in private practice. An important component of U2 is the so-called extended newborn screening.
Here, the newborn is tested for important metabolic diseases or cystic fibrosis (a disease of the lungs that results in the production of excessively thick mucus). This examination should be carried out as early as possible, since metabolic diseases are diseases that should be treated early on in order to avoid permanent damage to the newborn’s health. In addition, a hearing screening is carried out, in which the child’s hearing is examined in detail.
Within the framework of U2, the newborn baby is also measured and weighed once more and examined from head to toe. In addition, this U-examination is also used to detect relevant malformations or the presence of jaundice and, if necessary, to initiate appropriate therapy. In the U2 examination, the newborn child receives another dose of vitamin K in order to prevent possible bleeding by increasing the formation of coagulation factors.
An important vitamin for bone formation and thus for the prevention of the bone deformation disease rickets is vitamin D, which is formed in adults under UV light radiation. Infants, on the other hand, cannot yet form vitamin D sufficiently, which is why they should be given one tablet of vitamin D daily. This is usually prescribed as part of U2 and should be taken for about 12-18 months.
The third important drug prescribed as part of U2 is fluoride. Between the fourth and fifth week of life the U3 should be taken. It is usually done by a pediatrician in private practice.
Here it is of particular importance that developmental disorders of the newborn are recognized and an appropriate therapy is initiated. The main component of the U3 examination, however, is the ultrasound examination (sonography) of the child’s hip joints. With this examination method, malpositions or malformations (also called hip dysplasia) of the hip can be detected very early on.
As a rule, the U3 also provides an initial clarification regarding the recommended vaccinations for babies, which may be given as early as the 6th week of life. If necessary, a first vaccination appointment can be arranged with the pediatrician. In addition, the U3 examination also offers room for possible questions from parents.
If there are any uncertainties regarding the new family member, the U-examination offers additional time for a consultation with the parents. The U-examination U4 usually takes place in the third or fourth month of life. The main focus of this examination is on the physical and mental development of the child.
Within this framework, the pediatrician pays attention to the child’s movements and reactions as well as the parent-child bond. In addition, the doctor palpates the small bone gap (also called fontanel) on the child’s head at U4 to check whether it is large enough to allow the skull to continue growing. With the U4, it is also possible to receive the recommended vaccinations if this has not yet been done.
A desired vaccination should, however, be agreed with the pediatrician in advance, so that the necessary vaccine is always in stock. The most frequently performed vaccinations within the U4 are the six-fold vaccination against diphtheria, tetanus (tetanus), Haemophilus influenzae (HiB), hepatitis B, polio (poliomyelitis), whooping cough (pertussis) and the vaccination against pneumococcus. If the child has already received the first vaccinations by the sixth week of life, there is the possibility of a repeat vaccination at U4.
The child’s vaccination card should be remembered. The U4 U-test, just like the other U-tests, offers parents the opportunity to talk about fears, worries, concerns or doubts regarding the family situation which is still new to most parents at the time of the U4. It is not necessary to be ashamed of questions or uncertainties.
At U5, the child is approximately six months old (sixth to seventh month of age).During the U5, the child’s state of physical development is closely examined once again. Here the pediatrician pays particular attention to whether the child shows delays in its development or whether the impression of a visual disorder is created. Height and weight are also determined once more in order to be able to compare it with children of the same age with the help of a so-called percentile curve.
However, it is not important that the child has approximately the same average values as other children. Rather, this curve is a way of assessing the child’s growth over time. A child who is very small for your age at the beginning can gain so much weight or height within a very short time that it even exceeds the age-typical average value.
Most pediatricians also offer an ultrasound examination of the child’s internal organs. However, this is only an additional, voluntary examination. The U5 also tests the support reflex and the foot grasping reflex, as well as the coordination of mouth and hand.
The U6 examination is usually performed between the tenth and twelfth month of life. The most important goal of this examination is to check the child’s already developed abilities and, in case of a developmental delay, to initiate the appropriate treatment as soon as possible. An initial examination of the eyes is often also performed as part of the U6.
Furthermore, this U-examination provides space for possible questions from parents, including questions regarding nutrition or accident prevention or daily oral hygiene of the milk teeth that often erupt at this time. In boys, the pediatrician also examines the testicles. During this examination it is checked whether the testicles are already in the scrotum or whether they are still in the inguinal canal.
Another important test in the U6 is related to fine motor skills. Here the doctor checks whether the child is able to perform the so-called tweezer grip. The gripping of objects with thumb and index finger is called tweezer grip.
In addition, the child’s vaccination book is also checked during this U-examination and the necessary booster vaccinations are carried out. Towards the end of the second year of life (21 to 24 months of age) the U-examination U7 should be performed. During this examination, the pediatrician pays special attention to the linguistic and mental development of the child.
At this age, children should already be able to form two-word sentences on their own and recognize and name simple objects. Often during a doctor’s appointment children do not dare to follow the pediatrician’s instructions. In this case, however, information from the parents about the extent to which the child can already articulate in familiar surroundings is sufficient.
As with all other U-examinations, the vaccination record is also checked during this precaution. As a rule, the second dose of the vaccination against measles, mumps, rubella and chickenpox is recommended at this age. At the age of three years (kindergarten age) another U-examination is offered: the U7a.
This is a physical examination, which this time also includes a sight and hearing test. In addition, the pediatrician checks the child’s linguistic development since the last U7 examination. The child should now be able to form simple three- to five-word sentences and be able to say his or her own name.
At U8, the child is almost four years old. This examination also controls the motor, linguistic and social development of the now almost pre-school child. In the event that no sight or hearing test has been performed during the U7 or U7a, this will be done during the U8.
Another important topic at U8 is the question of whether the child is already dry or whether he or she is still dependent on diapers. Furthermore, the child must provide a urine sample which is checked for blood components, sugar, proteins or bacteria. Next, the pediatrician tests the child’s gross and fine motor skills by, for example, testing the one-legged stand or having the child paint simple shapes and structures.
In a short conversation with the child, the doctor then tries to determine how far the child’s linguistic development has matured. In many pediatric practices, parents also receive a questionnaire regarding the social behavior of their child, which is to be answered to the best of their knowledge together with the kindergarten teachers.As a rule, there is no vaccination in the U8 U-test, unless missed vaccination dates of the last months have to be made up for. At the age of five years the U-examination U9 is due.
It serves as a preventive examination about one year before school enrolment and allows a first assessment of whether the child will be ready for school in one year. The child’s social and mental development is of particular importance for this. In the U-examination U9, all organ functions are again checked and the overall state of health is determined.
The function of the ears and eyes as well as the composition of the urine are also essential components of the U9. In addition, the pediatrician pays attention to whether the child’s speech development is age-appropriate and whether the pronunciation is intelligible or whether it may require logopedic treatment. The child’s fine and gross motor skills and posture are also thoroughly examined.
At the age of five years, it is also recommended to have a booster vaccination for tetanus (also known as tetanus), diphtheria and whooping cough (pertussis). The U-examination U10 is an additional preventive examination, which is recommended by the health insurance companies, but not yet covered by every insurance company. The costs usually amount to about 50€.
The U10 usually takes place at the age of seven to eight years and is therefore the first U-examination for school children. The aim of this screening is to detect developmental disorders that could negatively influence or complicate the child’s school attendance. These include primarily dyslexia and dyslexia-reading difficulties as well as attention deficit hyperactivity disorder (often abbreviated as ADHD).
Both developmental and behavioral disorders can be treated well by learning therapy, behavioral therapy and medication if diagnosed early. In many cases, an examination by means of an ECG (electrocardiogram) is also carried out as part of the U10, with which possible cardiac dysrhythmia can be detected. Furthermore, the pediatrician examines the dental status and can recommend orthodontic treatment with braces if necessary.
Since the U-examination U10 is not a regular check-up, it is not entered in the yellow check-up booklet, but in a green check-up booklet instead. The U-examination U11 should take place between nine and ten years, i.e. towards the end of primary school. Since children often develop school difficulties in this phase, this U-examination was introduced specifically to detect behavioral and school performance disorders.
In addition, the children receive detailed information about the dangers of addictive substances and about a health-promoting lifestyle. This includes advice on the topics of sport, nutrition, stress and media behavior. Even in this case, the costs are not always covered by the respective health insurance company.
Nevertheless, participation in the U11 is absolutely recommended and offers the chance to treat possible developmental disorders as quickly as possible, i.e. before the J1 examination between the ages of twelve and fourteen. Children or adolescents between the ages of twelve and fourteen should participate in the J1 (also called U12) youth examination. This is a very important preventive examination whose costs, in contrast to the U10 and U11, are completely covered by the respective health insurance companies.
The J1 includes a complete physical and mental examination of the adolescent, including the control of blood and urine values. The paediatrician or adolescent doctor will also provide information about puberty or, if puberty has already started, will check how far it has progressed. During the physical examination, the physician pays particular attention to the presence of scoliosis (lateral deviation of the spine) and the associated poor posture, which can be caused by a strong growth spurt, among other things.
Skin changes or the presence of eating disorders are also examined and discussed if necessary. If there are questions or uncertainties regarding contraception, sexuality or drug abuse, the J1 juvenile examination also offers room for this. J2 takes place at the age of 16 to 17 years.
This preventive examination is generally not covered by all health insurance companies. J2 is used to check health before entering adulthood.Important goals of the examination are the recognition of puberty and sexuality disorders, posture disorders, up to diabetes prevention. Counseling on social behavior, family and sexuality as well as career choice is provided. Within the framework of this preventive examination, the adolescent has the opportunity to have a confidential conversation with the attending physician without the presence of his parents.
