Health Checks for Children & Adolescents

Health checks for children and adolescents – or U-checkups – are free services the German state offers to all parents and their children. With the U-checkups, you can have your child's health checked regularly by paediatricians. During the tests, the doctors ensure that your child is not ill, has all the recommended vaccinations, and develops well. The checkups begin immediately after your child is born and end when they reach puberty, i.e. between the ages of 12 and 14.

The "Federal Joint Committee" determines what the checkups should include. The committee comprises doctors, therapists, and health insurance companies' and hospitals' representatives. Their decision is based on the diseases each checkup can potentially detect. They also make sure that the tests are safe for children.

You can find a list of the U-checkups in the section "Which health checks are available for my child?".

The U-checkups allow you to have paediatricians regularly check how your child is developing. These tests are crucial because, in some cases, doctors can only treat diseases early on in children of a certain age. That is the case, for instance, if your child's hip joints are not positioned correctly. Such misalignment can only be treated effectively in babies 4 to 5 weeks old.
During the tests, you can also discuss your concerns with the doctors. That is particularly vital if you observe abnormalities in the behaviour or development of your child. The doctors can hear about and investigate your observations. And inform you about possible treatment methods.
During these examinations, the doctors will also inform you about essential vaccinations. These are vaccinations against serious diseases, for example, meningitis, measles or polio. Your child will receive the vaccinations according to a fixed vaccination schedule. You can learn more about these vaccines in our chapter, "Vaccinations for children and adolescents".

All children living in Germany can and should benefit from the U-checkups, regardless of their residence status and whether they are covered by a health insurance company.

If you are covered by a health insurance company, they pay for all the tests listed in the section "What health checks are available for my child?". If you receive asylum seekers' benefits, the Social Welfare Office will cover the costs of these examinations.

In Germany, the individual federal states determine whether U-checkups are compulsory. The legal basis of early detection checkups for children and adolescents is provided by Section 26 of the German Social Code (SGB V). In most federal states, children do not have to go through U-checkups, except for Bavaria, Baden-Württemberg and Hesse (as of 2023). If you live in these three federal states and do not take your child to the U-checkups, the authorities can notify the Youth Welfare Office. In Bavaria, you must also prove that your child has had the necessary medical checkups before starting daycare or school. Otherwise, the daycare centre or school must inform the Youth Welfare Office. The Youth Welfare Office will then contact you to ask why your child has not yet had the U-checkups.

In other federal states, such as North Rhine-Westphalia or Lower Saxony, there is a central office where doctors register when a child has received these checkups. Such central offices are usually part of the State Ministry of Health. If the employees notice that a child has not taken part in a checkup, they send the parents a letter of invitation with an appointment. If the parents do not keep the appointment, there could be consequences. For instance, the Youth Welfare Office may contact you and check whether your child is doing well. These checkups serve the wellbeing of your child– they are intended to help identify possible illnesses at an early stage and detect neglect and child abuse.

That depends on whether your child was born in a hospital or elsewhere.

If your child was born in a hospital in Germany, the first two U-checkups (U1 and U2) usually take place in the same hospital. All further checkups will be carried out in your paediatric practice.

If you have had your child at home, all U-checkups will be carried out in your paediatric practice. If that is the case, you must make an appointment with your child's paediatrician in due time. In case you don't have a paediatrician, you can search for a practice nearby on the National Association of Statutory Health Insurance Physicians' website. First click on your state and then on "Erweiterte Suche" (Advanced Search). You can also search for doctors who speak your language on their website.

Please note: The checkups can be vital for your child's health, so try to make an appointment in due time. Waiting too long may harm your child's health.

You must personally make appointments for the U-checkups. To do so, contact your paediatrician's office. If you don't have a paediatrician yet, you can search for a practice nearby on the National Association of Statutory Health Insurance Physicians' website. First click on your state and then on "Erweiterte Suche" (Advanced Search). You can also search for doctors who speak your language on their website.

When you should make an appointment for an examination depends on your child's age. Doctors determine the exact timing of checkups. On the Federal Center for Health Education website, you can see when your child needs which checkup (in German). Enter your child's birthday in the "Geburtsdatum" (Date of Birth) field.

Please note: You must adhere to the specified schedule for U-checkups. Otherwise, the paediatric practice will not receive the fees from the insurance company and may not be able to examine your child free of charge. However, because of the Coronavirus pandemic, the checkups U6, U7, U7a, U8 and U9 do not currently have to take place at the specified time. That means your child can still go through these checkups later free of charge. Contact your paediatrician for more information.

You can bring an interpreter with you if you or your child do not speak German well enough to communicate with the paediatricians during the checkups, for instance, a friend or acquaintance who can speak German. You can also ask a professional interpreter to accompany you.

However, if you are covered by statutory health insurance, you must pay for the interpreter's service yourself. If you cannot afford it, you can seek help from volunteer interpreters. The Youth Migration Service staff can help you find one - they speak several languages. You can find a Youth Migration Service in your area at jugendmigrationsdienste.de.

If you receive benefits under the Asylum Seekers' Benefits Act, the Social Welfare Office can cover the costs. It is best to ask a local counselling centre for help. The staff can also support you with the application. You can search for a counselling centre nearby on the Pro Asyl or the Refugee Council website.

Please note: you can also search for paediatricians who speak your language on the National Association of Statutory Health Insurance Physician's website. First, click on your federal state and then on "Erweiterte Suche" (Advanced search). There, you can search specifically for doctors who speak your language.

The children's checkup booklet is also often called the "Yellow Booklet" because it is printed on yellow paper. Doctors, midwives or nurses make a note in this booklet and record the results when your child goes through a U-checkup. You will find information on each individual checkup in this booklet.

You can also use the booklet to prove that your child has received a certain U-checkup, for instance, when you want to enrol your child at a daycare centre and later a school. Important: You do not have to present the yellow booklet; however, you may not be able to enrol your child at a daycare centre otherwise.

Important: Remember to take the booklet with you to every checkup. You can find the English version of the booklet on the website of the Joint Federal Committee.

You will receive the booklet (also known as the "yellow booklet") when your child is born. The 10 U-checkups (U1 to U9) will be documented in the booklet at every doctor's visit up to the age of 6 to detect diseases at an early stage. You can obtain the booklet from your maternity clinic or midwife. If you lose your yellow booklet or don't have one yet, you can also ask your doctor's office to provide you with one. The yellow booklet is free. 

Since January 1, 2022, the children's examination booklet has also been available electronically. It is part of the electronic patient record (“elektronischen Patientenakte” or ePA). That means, for instance, that you can see the results of the examinations on the ePA app and you can also receive reminders when the next examination is due.

The U1 takes place immediately after childbirth. With this checkup, the doctors ensure that your child is healthy and has safely come through pregnancy and childbirth. If the doctors or midwives notice anything during their checkups, they can start treatment immediately.

During the U1, doctors or midwives check:

• whether your child is breathing properly,
• whether the heart is beating normally,
• how the child reacts to external stimuli,
• whether all parts of the body are fully developed,
• your child's muscle tension,
• your child's weight, height and head circumference,
• your child's skin (to rule out jaundice),
• and whether your child had enough oxygen during childbirth.

After the checkup, you will receive a "Kinder-Untersuchungsheft" (children's checkup booklet or the "yellow booklet"). The doctors or midwives record in the booklet that your child has undergone the U1. You can learn more about the booklet in the section "What is "Kinder-Untersuchungsheft" (children's checkup booklet)?". The doctors will also tell you about the checkups your child should go through in the days after the birth.

Please note: There are other essential checkups between the U1 and U2 checkups. These tests are all free. For instance, you should have your child checked for a congenital heart defect between 24 and 48 hours after birth. You must also have your child tested for metabolic disorders such as cystic fibrosis. The tests take place 36 to 72 hours after childbirth. You should also have your child's hearing checked up to 72 hours after delivery.

The U2 takes place 3 to 10 days after childbirth. If you and your child are still in hospital, your child will go through U2 checkups there. If you are at home or did not give birth in a hospital, the U2 takes place in a paediatric practice.

Important: Please make an appointment for the U2 in a paediatric practice in due time, preferably before the delivery, to avoid long waiting times and ensure your child can have this crucial checkup not later than 10 days after delivery.

At U2, doctors examine your child's entire body. They weigh your baby and measure its height. They will also ask you how you and your child were doing in the first few days, whether you are breastfeeding and if so, whether you or your baby have any issues during breastfeeding. You can also learn more about nutrition, where to find support in your area, and what you can do to keep your child healthy.

If the crucial checkups concerning metabolic diseases, heart defects and hearing function have not yet taken place, the doctors will carry out these tests during the U2. You can learn more about these essential checkups in the "U1 – Immediately after birth" section.

At the U2, the doctors check:

• your child's skin to ensure the child is not suffering from jaundice,
• your child's senses,
• your child's chest and abdominal organs, such as the lungs or liver,
• your child's genitals,
• your child's mouth, eyes, nose and ears,
• and their bone structure, muscles and nerves.

If family members have hip problems, your child will also have an ultrasound scan of the hip joint so that the doctors ensure your child does not develop hip misalignment later on. If there is no history of hip problems in the family, the child will have this examination during U3 checkups. You can learn more about U3 in the "U3 – weeks 4 to 5" section.

The U3 takes place between week 4 to 5 after delivery. If you are at home with your child and no longer in hospital, you must make an appointment at a paediatrician's practice for U3 checkups. It is best to do so shortly after birth to ensure your child goes through U3 on time.

During the U3, the paediatricians check how your child has developed physically and mentally since birth. They will ask if your child has problems eating, sleeping or digesting. They weigh your baby and measure its height. The paediatricians will also let you know which vaccinations your child needs, and you can ask them any questions about vaccinations. In our chapter "Vaccinations for children and adolescents", you can learn more about different vaccinations.

During the U3, paediatricians examine:

• how your child reacts to noises and bright colours,
• whether your baby can turn its head,
• whether your baby can, for instance, open its hands and grasp a finger.

If doctors have not yet examined your child for a hip misalignment, an ultrasound examination of the hip joint is carried out during the U3 to ensure no issues exist. In most cases, such issues can be easily fixed at this early stage.

You will also receive more information about the nutrition and development of your child.

Important: Becoming a parent and caring for a child is often exhausting. A baby, in particular, often alters your everyday life. If you feel exhausted or overwhelmed, you can consult with the doctors during the U-checkups. They are familiar with the topic and can tell you where to get support.

The U4 takes place in the 3rd and 4th months after childbirth. You must make an appointment with your paediatrician's practice in due time for the examination.

At the U4, the paediatricians re-examine how your child is developing mentally and physically. The doctors measure your child's weight and height and ask how your child eats and sleeps. They also ask you whether and how you soothe your child when they are crying. If you have issues soothing your child, you can consult with the paediatricians during the checkup. The doctors will also tell you how you can help your child learn to speak.

During the U4, paediatricians examine:

• your child's eyes and how well they can see,
• and how large the so-called fontanelle is, i.e., the gap in your child's skull (It is vital to ensure your child's head can continue to grow properly).

Important: If your child has not yet received the recommended vaccinations, you can have your child vaccinated during U4 checkups. To do so, you should make an appointment for U4 before your baby is 9 weeks old. You can learn more about the recommended vaccinations in our chapter "Vaccinations for children and adolescents".

The U5 takes place 6 to 7 months after childbirth. You must make an appointment at your paediatrician's practice in due time for the examination.

During the U5, the paediatricians examine how your child has developed physically and mentally since the U4. The doctors will measure your child's weight and height. They ask how your child eats, digests and sleeps and whether you can soothe them. The paediatricians will tell you what you need to consider when your child starts to grow teeth and how to train them to sleep well. They also check your child's vaccination record.

During the U5, paediatricians examine:

• how well your child can see,
• how well your child can move,
• how they react to strangers,
• and what sounds your child makes.

The U6 takes place 10 to 12 months after childbirth. You must make an appointment with your paediatrician's practice in due time for the examination.

During the U6, the paediatricians examine how your child has developed in their first year. The doctors will tell you how to care for your child's teeth and where you can make an appointment at a dental practice. They will also measure your child's weight and height.

During the U6, paediatricians examine:

• how well your child can see,
• how agile your child is and how they control their movements,
• and how your child reacts to sounds.

The U7 takes place 21 to 24 months after childbirth. You must make an appointment with your paediatrician's practice in due time for the examination.
During the U7, the paediatricians examine how your child has developed up to age 2. The doctors will measure your child's weight and height. The doctors will also ask whether and how your child talks to you, and how they behave toward you, their siblings or other children.

During U7, paediatricians examine:

• how well your child can speak,
• how well your child can see,
• your child's legs and spine,
• and your child's teeth.

The U7a takes place 34 to 36 months after childbirth when your child is between 2 years and 10 months and 3 years old. You must make an appointment with your paediatrician's practice in due time for the examination.

During U7a, paediatricians examine how your child has developed so far. The doctors will measure your child's weight and height. The paediatricians will also check whether your child is missing any vaccinations. In our chapter "Vaccinations for children and adolescents", you can learn more about vaccinations. They tell you how you can help your child learn to speak and whether it is a good idea to let your child watch videos, and use smartphones, tablets or game consoles.

During U7a, paediatricians examine:

• your child's jaw, mouth and teeth,
• how well your child can see and whether your child can see three-dimensionally (i.e. whether it can recognise things in three dimensions),
• and how well your child can speak.

The U8 takes place 46 to 48 months after childbirth. Your child will then be between 3 years and 10 months and 4 years old. You must make an appointment with your paediatrician's practice in due time for the examination.
During the U8, the paediatricians examine how your child has developed up to the age of three. The doctors will measure your child's weight and height. They will also ask you what illnesses your child has had in the past and how it behaves around you, their siblings or other children. They also ask if your child can entertain themselves independently.

During U8, paediatricians examine:

• how well your child sees and hears,
• how well your child speaks,
• how your child moves,
• how your child handles objects, for instance, scissors,
• and your child's jaw and teeth.

The U9 occurs when your child is between 5 years and 5 years and 4 months old. You must make an appointment with your paediatrician's practice in due time for the examination.
The U9 is the last checkup before your child starts school. During the U9, the paediatricians examine how your child has developed up to the age of five. The doctors measure your child's weight and height. They will ask your child about their interests and what they look forward to and fear. You will be asked how your child behaves around other children and the family. For instance, whether they can handle losing at a game or are willing to share something with other children.

During U9, paediatricians examine:

• how well your child sees and hears,
• how well your child speaks - they often examine their verbal skills by having your child talk, for instance, about their day in kindergarten,
• how your child moves - they often examine their movements by having your child walk on their toes,
• how it can handle objects, for instance, scissors,
• and your child's jaw and teeth.

The J1 checkup takes place when your child is between 12 and 14 years old. Just like the U-checkups, you must make an appointment with your paediatrician's practice in due time for the J1.

During the J1 checkups, doctors check whether your child has developed according to age and whether they are generally doing well. To do so, the doctors talk to your child and ask you whether there are illnesses in the family. They also check your child's vaccination record, and (like the U-checkups) measure your child's weight and height.

During J1, paediatricians examine:

• your child's posture,
• your child's blood pressure,
• your child's thyroid,
• and organs such as the liver or lungs.

After the examination, the doctors will discuss the results with your child and allow them to ask questions about the results and other health-related topics.

Please note: Your child can decide whether you should be present during J1. It is best to speak to your child before going to the practice.