Child screening

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Child check-ups are intended to ensure that defects and illnesses in newborns , toddlers and children , especially those that endanger the normal physical and mental development of the child, are identified as quickly as possible by a pediatrician or family doctor in order to initiate therapy at an early stage to be able to. At the same time, the investigations should help to identify cases of neglect , neglect , child abuse or sexual abuse and to prevent corresponding misconduct by the legal guardians. In some German countries, therefore, a binding invitation and reporting system for presentations to the examinations has been decided.

Germany

The Federal Joint Committee of Doctors and Health Insurance Funds has laid down the medical measures for the early detection of diseases in children up to the age of 6 in the “Children's Guidelines”. The child preventive examinations U1 to U9 are documented in the yellow children's examination booklet "Yellow Booklet" of the Federal Joint Committee by the pediatrician or family doctor. Legal basis of the child test is § 26 SGB V .

Child check-ups were first introduced in Germany in 1971 as a mandatory measure for the early detection of illnesses in children. Since July 1, 1971, 7 preventive medical check-ups for children up to the age of 4 as early detection measures for babies and toddlers have been part of the compulsory health insurance benefits . Since May 2006, parents have been able to receive an additional preventive care booklet for their children and adolescents with four new preventive measures (U7a, U10, U11, J2), which close the gaps between the previous appointments in order to provide better prevention in the various areas that are crucial for the child's development Allow ages. Two years after its introduction, the U7a (with a reduced scope of services) was included in the compulsory offer of all statutory health insurances. But the costs for the other three new pension schemes (marked in italics in the table ) are also covered by many statutory health insurances.

The "Yellow Booklet", which has been revised from September 1, 2016, provides parents with more detailed information about the content of the individual examinations and contains a removable participation card with which parents or guardians can document participation in kindergartens etc. without giving out detailed information. From September 1, 2016, the parent-child relationship will also move more into the focus of preventive medical check-ups. At the same time, advice on vaccination protection will be introduced as a mandatory component of the U-examinations, cystic fibrosis screening for newborns and established standards for U1 to U9. The latter mainly concern hearing and eye tests.

Preventive medical checkups are an essential part of pediatrics and care by the family doctor / general practitioner. For some time now, one focus of further training has been the reliable diagnosis of child abuse and sexual abuse of children.

Independently of this, there are mandatory school entrance examinations in Germany .

The individual examinations

Surname Age examination
APGAR 1st + 5th + 10th minute of life An assessment is made according to the Apgar score .
U1 2-4 Hour of life The U1 is used to uncover defects in vital functions that require immediate action, while the U2 is a detailed examination of the child, in which especially the posture , motor skills and basic muscle tension ( tone ) are examined.

The aim is to assess the child's state of health with all senses, which is made up of the following components:

The examination includes measuring (body length and head circumference) and weighing the baby.

U2 3rd - 10th Day of life The U2 is usually carried out in the clinic and includes an assessment of the skin, organs, and genitals as well as a blood sample for screening for various congenital treatable metabolic diseases and hormonal disorders. In recent years, a hearing test has also found its way into the examination concept, since an early detection of a hearing disorder offers the possibility of sustainably promoting the affected child in his social and emotional development and avoiding speech development disorders. In June 2008, the Federal Joint Committee decided to introduce this newborn hearing screening from 2009 as a benefit from the statutory health insurance.

As part of this examination, the doctor usually also provides information about rickets prophylaxis with vitamin D preparations and an optimal sleeping environment to prevent sudden infant death syndrome .

U3 4th to 5th Week of life U3 is usually the first examination to be carried out by one's own pediatrician or family doctor. Checking various body functions. The hearing ability is tested using a so-called rattle test. A rattle (or other source of noise) is used to determine whether the child is showing reactions such as “turning its head” or moving its eyes to the source of the noise. In addition, the so-called newborn hip screening is carried out. This is done by performing an ultrasound of both hips (hip ultrasound) to diagnose hip dysplasia (in 1–3% of all newborns). An initial consultation on vaccinations takes place.
U4 3rd to 4th Month of life In the following examinations (up to U7), the main focus is on the child's timely physical development, for example in order to uncover cerebral movement disorders. In this regard, timely vaccinations should be discussed with the doctor .
U5 6-7 Month of life
U6 10-12 Month of life
U7 21.-24. Month of life
U7a 34-36 Month of life The U7a is essentially about the detection of allergic diseases , socialization and behavioral disorders, obesity , language development disorders , tooth, mouth and jaw anomalies . The U7a was introduced on July 1, 2008 as a service of the statutory health insurance (GKV).
U8 46-48 Month of life The U8 examines , among other things, the child's mobility and coordination skills, as well as reflexes, muscle strength, pronunciation and dental status.
U9 60th-64th Month of life The U9 takes place in the year before school starts. It in turn contains tests for coordination skills ( gross and fine motor skills ), language comprehension, and hearing and eyesight.
U10 8th-9th age

(Age of the child 7–8 years)

With the U11, the U10 should close the gap between U9 (at around five years of age) and J1 (with around 12 to 14 years of age). Focus: Recognizing and initiating treatment of specific developmental disorders (e.g. reading, spelling and arithmetic disorders), motor development disorders and behavioral disorders (e.g. ADHD ) voluntary participation.
U11 10-11 age

(Age of the child 9-10 years)

The focus of the U11 is: Recognizing and initiating treatment for school performance disorders, socialization and behavior disorders, tooth, mouth and jaw anomalies, and media behavior that is harmful to health. Among other things, this investigation is intended to promote exercise and sport, identify and prevent problematic handling of addictive substances, but also support health-conscious behavior (including advice on nutrition, exercise, stress, addiction and media), voluntary participation.
J1 13-15 Age (age of the child 12-14 years) The penultimate examination of the "U-series" is the J1 (youth health examination), in which postural anomalies are examined again. In addition, the vaccination status , goiter prophylaxis , blood pressure , special family situations, school development, health behavior and motor skills are recorded. Puberty development and sexual behavior are discussed.
J2 17.-18. Age (age of the child 16-17 years) The priorities of the last check-up in adolescence J2 are: Recognizing and initiating treatment for puberty and sexuality disorders, posture disorders, goiter formation, diabetes prevention, socialization and behavior disorders. Accompanying advice on choosing a career.

Medical associations advise adhering to the examination periods in the interests of the child. The improved child protection legislation in 2012 introduced further instruments, such as the law on cooperation and information in child protection via the KSchG. The paediatricians have acc. SGB ​​VIII § 8b now has a legal right to advice.

In order to support parents in keeping their children's vaccination and check-up dates, the Professional Association of Paediatricians e. V. (BVKJ) offers a free vaccination and prevention reminder service, which informs parents in good time by email about upcoming vaccination and prevention appointments.

Binding invitation and registration system

In some federal states, including Berlin, Bremen, Hesse, Saarland, Rhineland-Palatinate, Brandenburg, Saxony, Schleswig-Holstein, Lower Saxony, North Rhine-Westphalia and Thuringia, laws have come into force through data transmission by the registration authorities and paediatricians should ensure participation in the preventive examinations. The legislative initiative goes back to a resolution of the youth ministers' conference “Children and Health” in May 2005. The 79th Conference of Health Ministers of the Länder in 2006 followed suit.

In North Rhine-Westphalia , the ordinance on data reporting for participation in child screening examinations / U-examinations (UTeilnahmeDatVO) of 10 September 2008 is decisive. The State Institute for Health and Work performs the tasks of the Central Office . Section 3 provides:

"If there is still no participation report three weeks after the reminder for the respective early diagnosis examination - six weeks after reminder for the U 5 - the central office informs the public youth welfare agency responsible for the child's place of residence. (...) The local public youth welfare agency decides on its own responsibility whether there are significant indications that the well-being of a child is at risk and which measures are appropriate and necessary, if any. The transmitted data can be used as a further indicator. Cooperation is particularly recommended with the public health service providers and other authorities, agencies, institutions and people who are responsible for the best interests of the child. "

The State Commissioner for Data Protection in Schleswig-Holstein commented in his 31st activity report of March 31, 2009 on the controlling invitation system:

"However, there is no obligation for parents to notify the youth welfare office to participate in the examination, e.g. B. by presenting the yellow booklet to prove. After all, there is still no obligation whatsoever to participate in the examinations. The youth welfare office is legally obliged to take action, but must limit itself to determining whether there are any signs of a child's welfare being at risk by taking an inventory. If this is not the case, it cannot take any further steps in order to obtain the information as to whether the examinations were carried out or not. "

The Saxon state data protection officer writes in his 14th activity report of March 31, 2009:

"In view of this, I do not see any justification for the planned recording and surveillance measures that can be recognized under constitutional law, so that the search for the 4% shares of non-participants ordered by the law according to the standards of the Federal Constitutional Court as an investigation into the blue in the sense of the search decision (E. 115, 360 f.) Or the decision to automatically compare car license plates (NJW 2008, 1515 rSp.) And is therefore at least disproportionate in the narrower sense (inappropriate) and therefore unconstitutional. "

Dental screening examination

Individual prophylaxis for children and adolescents is particularly encouraged by the legislature and has been anchored as a health insurance benefit in Section 22 of the Social Code Book V.

Registration in health portals

In addition to the yellow U-booklet, the data can be recorded in health portals.

Netherlands

In the Netherlands , basic medical care for children up to the age of four, including child check-ups and vaccinations, does not take place in the practices of individual paediatricians, but centrally in institutions of the youth health authority, the consultatiebureaus . Parents receive an invitation to participate from the community and the medical information is entered in a book, similar to Germany.

Austria

In Austria, a mother-child pass is a preventive healthcare system that an expectant mother receives from the responsible gynecologist, family doctor or pregnancy counseling center once a pregnancy has been determined. This booklet documents the results of preventive examinations both during pregnancy and in the child's first years of life. The examinations provided for in the mother-child pass program are used for the early detection and timely treatment of pregnancy complications and for monitoring the child's level of development. The mother-child pass or the examinations provided therein are not required by law, but complete proof of all examinations is a prerequisite for the granting of full childcare allowance from the 21st month of life.

Sweden

In Sweden, parents are entitled to time off when they visit a doctor, if a child is ill, start school or in similar situations, and are entitled to a temporary parental allowance ( tillfälldrapenning ) of 80% of their income.

Switzerland

After the first examinations according to the Apgar test after 1, 5 and 10 minutes, the first detailed examination is carried out within hours, the so-called initial examination , which is carried out by a midwife or a doctor.

The first check-up usually takes place between the 3rd and 7th day of life. These and others are carried out according to the checklist of the Swiss Society for Pediatrics (status 2011):

All key data is documented in the health booklet, which parents should have to hand.

Childhood Content (examples, focus)
1 week Anamnesis ( puerperium ), development (motor skills, look, can be comforted), sonography of the hip joints, metabolic screening, POx, vitamin K, vitamin D prophylaxis
1 month History, development (response to response)
2 months Anamnesis (diet, sleeping, risk factors for abuse, etc.), development (motor skills, smile, noises), examination, 1st vaccinations
4 months Anamnesis (sensitivities, diet, etc.), development (motor skills, grasping, oral inquiries, etc.), examination, 2nd vaccinations
6 months Anamnesis, development (motor skills, communication), examination, 3rd vaccinations
9 months Anamnesis (nutrition, strangers), development (sitting, exploring the environment), examination
12 months Anamnesis, development (movement, play, reaction to language), examination (especially eyes, ears)
18 months Anamnesis, development (motor skills, play, language, emotional skills), examination (especially eyes, ears)
24 Months History (cleanliness), development (jumping, eating, imitating parents, expressing itself in language, jealousy, etc.), examination
3 years History (nutrition), development (tricycle riding, drawing, emotional skills), examination
4 years Anamnesis (play group / child contacts), development (one-legged stance, following the rules of the game, telling stories, “dry”), examination (whispering, speech audiometry)
6 years Anamnesis, development ( cycling , language, reading), family (social situation and behavior), examination (leg length, scoliosis, etc.)
ten years Anamnesis, body image & sexuality (education, preparation for puberty), school, social issues, autonomy, family, leisure time, friends (integration, isolation, relationships), examination
12 years Anamnesis, body image & sexuality (subjective overweight / underweight), school, social affairs, autonomy, family, leisure time, friends (integration, isolation, relationships), examination
14 years Anamnesis, body image & sexuality (sexual development, menstruation, drug use, bulimia), school, social affairs, autonomy, family, leisure time, friends (career plans, integration, isolation, relationships), examination, farewell

literature

  • Peter Allhof: Early Disease Detection Program for Children - Preparation and interpretation of the test results from the statutory early detection measures 1978–1985. Deutscher Ärzte-Verlag, Cologne 1988, ISBN 3-7691-8033-X .

Web links

Germany

Switzerland

Individual evidence

  1. ↑ Children's guidelines, version of June 18, 2015 (PDF) , entered into force on March 16, 2018. Children's guidelines of the Federal Joint Committee .
  2. ↑ H. Schuster: Preventive examinations for infants and small children. Springer Verlag, Berlin, Heidelberg 1975, ISBN 978-3-540-79792-0 , pp. 7–8, DOI https://doi.org/10.1007/978-3-642-95872-4_1.
  3. ↑ BVKJ: Overview of assumption of costs U10, U11, J2 .
  4. ↑ Britta Pedersen / dpa: Early detection examinations: That will change on September 1 at the pediatrician. Hannoversche Allgemeine Zeitung, August 30, 2016, accessed on August 31, 2016 .
  5. ↑ Early detection examinations for children: restructuring of the directive decided. (PDF) In: Press Release No. 16/2015. Federal Joint Committee, June 18, 2015, accessed on August 31, 2016 .
  6. ↑ Press release on the decision ( Memento of the original from March 18, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.g-ba.de
  7. ↑ BabySOS: U3 examination. In: BabySOS. BabySOS, August 11, 2018, accessed November 11, 2018 .
  8. ↑ Guidelines for youth health examinations of the Federal Joint Committee (PDF; 22 kB).
  9. ↑ Barbara Ritzert: Care Atlas: Check-up for young people - personal approach is important. Care atlas , press release from October 17, 2016 at Informationsdienst Wissenschaft (idw-online.de), accessed on October 18, 2016.
  10. ↑ Online reminder of all vaccination and preventive care appointments for your child .
  11. ↑ Ordinance on data reporting for participation in child screening examinations - UTeilnahmeDatVO ( GV.NRW . S. 609, 624) ( PDF )
  12. ↑ Resolutions of the Youth Ministers' Conference in May 2005 ( Memento of the original from May 12, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 439 kB). @1@ 2Template: Webachiv / IABot / www.vivafamilia.de
  13. ↑ Ordinance on data reporting of participation in child screening examinations / U-examinations NRW .
  14. ↑ 31st activity report of the State Commissioner for Data Protection Schleswig-Holstein ( Memento of the original from September 16, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.datenschutzzentrum.de
  15. ↑ 14. Activity report, 4.4.6 (PDF; 901 kB).
  16. ↑ Irina Zuboff: Living and Working in the Netherlands. 2008, p. 35 .
  17. ↑ HELP.gv.at ( Memento of the original from April 13, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Information on the mother-child pass in Austria. @1@ 2Template: Webachiv / IABot / www.help.gv.at
  18. ↑ Sweden. (PDF) ec.europa.eu, 2002, archived from the original on February 5, 2009 ; Retrieved August 24, 2009 . or (PDF, p. 14, section Parental Allowance. ) In: Your social security rights in Sweden. at ec.europa.eu, accessed December 8, 2014.
  19. ↑ www.swiss-paediatrics.org (PDF; English).