Standard check-ups for children and teenagers in Germany

At each check-up, the child is measured and weighed, and the doctor gives them a thorough physical examination. Some of the check-ups include eye and hearing tests. The child’s parents are also asked whether they’ve noticed anything unusual or whether there are any problems at home. In addition, the doctor always checks how the child and the parents interact.

Depending on how old the child is, these check-ups include advice for parents on subjects such as:

• breastfeeding and diet,
• preventing accidents and sudden infant death syndrome (“cot death”),
• vaccinations,
• vitamin D (to prevent bone disease),
• fluoride (to prevent tooth decay), dental hygiene and dental check-ups,
• mental health and language development, and
• media consumption.

Equally importantly, each check-up is an opportunity to ask for advice and to get information on local services such as parent-child classes, advice centers and “family midwifes” (who provide support for the baby, mother and family through pregnancy and the child’s first year at home).

The check-up results are recorded in a special booklet, which in Germany is referred to as the gelbe Heft or “yellow booklet” because of its color.

If your child gets anxious about the check-ups, you can prepare them for what will happen and try to stop them from feeling frightened. For example, you can explain what tests will be done or find fun ways of preparing, like trying out headphones if there’s going to be a hearing test.

Within 30 minutes of birth:

• The baby’s heartbeat, complexion, reflexes, muscle tension and breathing are checked.
• The baby is checked for external deformities and any injuries possibly due to the delivery process.
• Blood is taken from the umbilical cord. The pH level is checked to determine whether there’s enough oxygen in the baby’s blood.
• With the parents’ consent, the baby is given a vitamin K shot to prevent bleeding. Babies are born with low levels of vitamin K, which is important for blood to clot.

This check-up can also be done by a midwife.

Between the third and tenth day after birth:

• A physical examination is done, mostly to identify any diseases or deformities.
• The doctor asks about how well feeding the baby is going: Is breastfeeding or bottle feeding the baby working out? Is the baby having any trouble drinking or swallowing?
• The baby’s hip is examined. If the doctor notices any risk factors that increase the likelihood of a hip deformity, another more specialized examination is recommended.
• With the parents' consent, the baby is given a second dose of vitamin K.
• Expanded screening tests are offered. The baby’s blood is tested for metabolic disorders, hormone imbalances, and some other diseases. Typically a few drops of blood are taken from the baby’s heel.
• The same blood sample can be used to test for mucoviscidosis, if the parents would like.
• A special hearing test is carried out so that any hearing problems can be detected at an early stage.
• A test method known as pulse oximetry screening is used to identify certain types of heart defect that the baby might already have.
• The parents are given information about nutrition for children, preventing sudden infant death syndrome, and the use of vitamin D and fluoride.

In the fourth to fifth week after birth:

• A physical examination is carried out especially to check for any problems in the baby’s development.
• With the parents’ consent, the baby is given another dose of vitamin K.
• Gross and fine motor skill tests are done. Can the baby hold its head up briefly while lying on its stomach? Does it open its hand spontaneously?
• The baby’s perceptual skills are tested. For instance, can it track an object with its eyes? Does it look at familiar people when they approach it? Do rocking, singing or talking to the baby have a calming effect? Does the baby react appropriately to loud noises, bright light and touch?
• An ultrasound scan is carried out to check whether the baby’s hip joints are correctly positioned.
• The doctor asks about any abnormal stress within the family.
• Initial advice on vaccinations is provided.
• The parents are given information about nutrition for children, sudden infant death syndrome, preventing accidents, dealing with excessive crying and the use of vitamin D and fluoride.

At the age of three to four months:

• A physical examination is carried out.
• The doctor assesses the baby’s development: Can it bend and stretch all of its limbs? Can it hold head up for at least 30 seconds while seated? Can it spontaneously move its hands to the middle of its body? Can it track faces with its eyes? Can it turn its head to see where a noise came from? Does it enjoy being shown affection and react when spoken to?
• The doctor checks to see whether the baby seems happy, whether it attempts to make eye contact with its parents and whether being shown affection has a calming effect on it.
• The doctor will also look at the facial expressions and gestures the parents use and how the baby reacts to them.
• The doctor will also ask whether there are any problems with breastfeeding or bottle feeding, and whether the baby is very restless or cries a lot.
• Information about vaccinations is provided. With the parents’ consent, the baby will be given its first vaccinations during this appointment at the latest.

At the age of six to seven months:

• A physical examination is carried out.
• To assesses the baby’s development, the doctor examines the baby: Does the baby push itself up with its palms on the floor and arms stretched? Does it reach for toys? Does it form simple chains of (speech) syllables and react appropriately when shown affection?
• The doctor checks whether the baby seems happy and responds when it is spoken to. Does it smile and attempt to make eye contact? Can the baby be soothed by rocking or by being spoken to? Does the baby react appropriately to loud noises or touch?
• The parents will be asked whether the baby cries a lot or is very restless.

At the age of ten to twelve months (just before the baby’s first birthday):

• A physical examination is carried out.
• The doctor assesses the baby’s mental development and ability to move: Can the baby sit up and roll from its back to its stomach and back again on its own? Can it drink from a bottle without help? Does it understand simple words and requests? Can it give its parents an object they ask for? Can the baby form double syllables like “da-da” and longer chains of syllables? Does it imitate sounds?
• The doctor checks whether the baby seems happy and attentive. Does it attempt to make eye and physical contact with people it knows?
• The doctor checks whether the baby shows an interest in playing with its mother or father (with toy blocks, for instance)? And can the baby control its feelings in an appropriate way for its age (e.g. cope with minor disappointments)?

At the age of 21 to 24 months (just before the child’s second birthday):

• A physical examination is carried out.
• The doctor takes a close look at the child’s speech development, fine motor skills and control over its own body. Can the child can walk confidently? Can it unpack small objects? Can it say single words and follow simple commands? Does it point to objects it knows in picture books, and can it play on its own for a short time?
• The doctor will also ask the parents whether the child is a good sleeper or whether it has problems falling asleep or sleeping through the night.

At the age of 34 to 36 months (just before the child’s third birthday):

• A physical examination is carried out.
• The doctor assesses the child’s development: Can they jump from a low step onto the ground without any problems and without losing their balance? Can they grasp things with their thumb, index and middle fingers? Do they speak in sentences of at least three words? Do they know their own name? Can they listen and engage in concentrated play? Can they be apart from their parents for several hours without any problems? Can they play with other children, and enjoy the playing?
• The doctor will also ask whether the child independently seeks contact with others and makes eye contact.

At the age of 46 to 48 months (just before the child’s fourth birthday):

• A physical examination is carried out.
• The child’s hearing is tested.
• The doctor closely examines the development of the child’s speech, pronunciation and behavior: Can the child speak in sentences of at least six words? Do they ask why/how/where questions? Can they confidently ride a “balance bike” (a special bike with no pedals, designed to train toddlers’ sense of balance)? Can they hold a pen properly between their thumb, index and middle fingers? Can the child get dressed and undressed on their own, and play with other children of the same age?
• The doctor also asks about the child’s emotional development. These questions cover aspects such as: Can the child cope with minor disappointments? Do they seem happy or are they often sad? Do they cry a lot or have temper tantrums? Can they cope with being separated from loved ones or do they get very anxious?

At the age of 60 to 64 months (usually just after the child’s fifth birthday):

• A physical examination is carried out.
• The doctor assesses the child’s motor skills: Can the child hop on one foot? Can they catch a relatively large ball? Can they copy pictures of circles or squares?
• Speech development is also assessed: Can they say most words properly? Can they name at least three colors?
• The doctor also asks about the child’s emotional and social development: Does the child seem happy or do they have specific anxieties? Is the child particularly impulsive and prone to temper tantrums? Can they take turns when playing with other children and engage in role play with other children?

All health insurers reimburse the costs of the U1-U9 examinations. Most health insurers also pay for the U10 and U11 examinations and supply special booklets for the results because they’re not included in the standard booklet.

The main aim of the U10 examination, which takes place between the ages of seven and eight, is to identify any learning disorders. But the doctor also assesses the child’s motor skills, emotional development and behavior (checking for signs of ADHD, for example).

The U11 examination, which is conducted between the ages of nine and ten, is intended to identify any learning difficulties, antisocial behavior or mental health problems. It also includes a dental check-up and questions about any problems related to diet, exercise or media consumption.

When the child reaches adolescence, there is another examination (“J1”), which statutory health insurers pay for. It takes place between the ages of 12 and 14. J1 comprises a physical examination, questions about the child’s development and any physical or mental health problems. It also includes an assessment of their vaccination status.

Some health insurers also cover the costs of the J2 examination for 16 to 17-year-olds. Apart from a physical examination, J2 focuses on issues relating to puberty, sexuality, mental health and nicotine/alcohol/drug consumption. In addition, it covers topics such as career interests, friendships and diet. The doctor will also offer any booster shots that are needed.