Kinderarzt check-ups: what happens at each preventive visit

0-12 months · Healthcare · Reviewed 20 June 2026 · All articles

Bringing a new baby home is joyful and overwhelming in equal measure. Among the many things on a new parent's mind, keeping track of paediatric appointments is one that carries real weight. In Germany, the statutory programme of preventive check-ups - called U-Untersuchungen and colloquially referred to as "die Us" - is one of the most thorough routine child health systems in the world. It runs from the first hours of life through to the pre-school years and is fully covered by statutory health insurance.

This guide walks through each examination from U1 to U7a, explaining what the paediatrician is looking for, which vaccinations are typically given, and what parents can do to prepare. Whether you have just arrived in Germany or have lived there for years, understanding the U-programme helps you advocate for your child at every stage.

What the U-Untersuchungen programme is and why it exists

The U-Untersuchungen are a series of standardised preventive health examinations mandated by the Gemeinsamer Bundesausschuss (G-BA), the body that sets the rules for statutory health insurance benefits in Germany. The G-BA defines the content, timing, and documentation requirements for each examination. Because they are part of the statutory catalogue, all families covered by gesetzliche Krankenversicherung (GKV) receive them at no direct cost.

The programme currently runs from U1 at birth to U9 at age 5. For children covered in this guide - babies from birth to 12 months - the relevant examinations are U1, U2, U3, U4, U5, and U6, with U7 at 21 to 24 months and U7a at 34 to 36 months also covered here because parents of babies will soon need to understand them.

The philosophy behind the programme is early detection rather than treatment. Many conditions that would become serious problems if left unaddressed - hip dysplasia, metabolic disorders, hearing loss, developmental delays - can be identified and managed effectively when caught early. The U-Untersuchungen create a structured series of windows at the moments when specific conditions are most detectable.

All results are recorded in the Vorsorgeheft, often called the yellow booklet because of its distinctive colour. This small booklet stays with the child throughout childhood and adolescence and is required by many Kitas and schools as proof that preventive care is up to date.

U1 and U2: the first days of life

U1 - immediately after birth

The U1 examination takes place in the delivery room or neonatal ward within the first ten minutes of life. It is performed by the attending paediatrician or, in settings where a paediatrician is not immediately present, by the midwife, with a paediatrician completing it shortly after.

The U1 is a rapid but systematic assessment of whether the newborn has made the transition to independent life successfully. The key components include:

If everything is normal at U1, the baby goes to the postnatal ward with their parent. If concerns are identified, the appropriate response - from observation to neonatal intensive care - is initiated without delay.

U2 - day 3 to day 10

The U2 is typically carried out in hospital before discharge, or at the Kinderarzt practice if the family has already gone home. It is the most investigation-rich of all the U-Untersuchungen.

Jaundice (Neugeborenenikterus): physiological jaundice is extremely common in newborns, peaking around day 3 to 5. The U2 paediatrician visually assesses yellowing of the skin and eyes and may measure bilirubin levels. Significant jaundice requires phototherapy and, in rare cases, further intervention.

Neugeborenen-Screening (metabolic screening): a heel-prick blood sample is taken and sent to a screening laboratory. This single test screens for more than 20 rare but serious metabolic, hormonal, and haematological disorders including congenital hypothyroidism, phenylketonuria (PKU), and cystic fibrosis. Most results return within a few days. If a result is outside normal range, the family is contacted promptly for confirmatory testing. A normal result provides strong reassurance but is not a guarantee - the screen has high sensitivity but is not exhaustive.

Hip ultrasound (Huftsonographie): every newborn in Germany receives a standardised ultrasound of both hip joints at U2. This screens for developmental dysplasia of the hip (DDH), a condition in which the femoral head does not sit correctly in the acetabulum. DDH is common (approximately 2 to 3 per 1,000 live births), runs in families, and is more common after breech presentation. When caught at this stage, it can usually be corrected with a simple harness worn for several weeks, avoiding surgery entirely. The Graf classification system is used to grade hip development on the ultrasound image.

Hearing screening (Neugeborenen-Horscreening): automated otoacoustic emissions (OAE) or automated auditory brainstem response (AABR) testing is performed while the baby sleeps or is settled. Congenital hearing loss affects approximately 1 to 2 in 1,000 newborns and is most effectively managed when identified within the first months of life. A refer result - meaning the initial test needs to be repeated - does not mean hearing loss is confirmed; many babies pass on retest.

Vitamin K prophylaxis: at U2, the paediatrician confirms that three doses of oral Vitamin K have been given (at birth, at U2, and at U3). Vitamin K deficiency bleeding (VKDB) is rare but devastating and entirely preventable with prophylaxis.

U3 and U4: the first months

U3 - week 4 to week 5

The U3 is the first visit to the Kinderarzt practice. It usually takes place around the four-week mark and is many parents' first introduction to the paediatric team who will look after their child for years.

The paediatrician assesses growth by plotting weight, length, and head circumference on the child's percentile chart in the Vorsorgeheft. Weight gain that tracks consistently along a percentile is reassuring; significant drops across percentile lines warrant attention.

Motor development is assessed: by four weeks a baby should be showing some head movement, reacting to sound, and briefly fixing their gaze on a face or light. The paediatrician checks muscle tone, assesses the fontanelles, and re-examines the hips if the U2 hip ultrasound showed any borderline findings.

The third dose of oral Vitamin K is given at U3. The paediatrician will also discuss feeding - breast or formula - and ask about any concerns parents have noticed in the first weeks at home.

U4 - month 3 to month 4

The U4 is one of the most important visits in the first year because it marks the start of vaccinations. STIKO - the Standige Impfkommission, which sets the national vaccination schedule - recommends that the primary vaccine series begins at 2 months, with the U4 visit at 3 to 4 months typically covering the second round.

Developmental milestones assessed at U4 include:

The physical examination continues with heart auscultation - some cardiac murmurs not heard at U1 or U2 become audible as the circulation matures. The hips are re-checked clinically. The skin, eyes, and fontanelle are assessed.

Vaccinations given around the U4 window (following the STIKO schedule) typically include doses of the hexavalent combination vaccine (against diphtheria, tetanus, pertussis, Hib, polio, and hepatitis B) and the pneumococcal conjugate vaccine (PCV). The rotavirus oral vaccine is also given in the first weeks of life and its series should be completed by 8 weeks. Your specific vaccination dates depend on when the series started at 2 months.

U5 and U6: six to twelve months

U5 - month 6 to month 7

At the U5, the paediatrician is looking for motor development consistent with mid-infancy: sitting with support, reaching and grasping objects with both hands, beginning to transfer objects from hand to hand, and showing interest in surroundings. Babbling - chains of consonant-vowel sounds like "ba-ba" or "da-da" - should be emerging.

The examination includes a re-check of the hips clinically, assessment of the eyes for strabismus (squinting), and listening to the heart and lungs. Growth is plotted and the paediatrician discusses complementary feeding - the introduction of solid foods alongside breast milk or formula typically begins around 6 months.

Further vaccination doses are given in accordance with the STIKO schedule. By this point the primary series of the hexavalent vaccine and PCV is typically complete, and the meningococcal C vaccine is given.

U6 - month 10 to month 12

The U6 is the last U-Untersuchung of the first year and looks ahead to the emerging independence of a baby approaching toddlerhood.

Motor milestones assessed at U6 include pulling to stand, cruising along furniture, and - in some babies - first independent steps, though walking at 12 months is on the earlier side of the normal range (10 to 18 months is typical). Fine motor development includes a pincer grasp - picking up small objects between thumb and forefinger.

Cognitive development is explored through object permanence: does the baby search for an object that has been hidden under a cloth? This milestone, typically present from around 8 months, indicates that the baby understands objects continue to exist when out of sight.

Language development is assessed. At 12 months most babies understand simple words and commands ("no", their own name, "come here") and are producing one or two words with meaning. Babbling should be varied and communicative.

The STIKO vaccination schedule at this stage includes the MMR (measles, mumps, rubella) and varicella vaccines, recommended from 11 months. If these are given at the U6, parents should expect 5 to 12 days later a mild rash or low fever as the live vaccines take effect - this is a normal immune response, not illness.

U7 and U7a: the second and third years

U7 - month 21 to month 24

The U7 is a substantial examination that spans the transition from baby to toddler. By 24 months most children are walking confidently and starting to run. The paediatrician assesses gait - limping, toe-walking, or significant asymmetry warrant further investigation.

Language development receives particular attention at U7. Two-word phrases ("more milk", "daddy go") should be emerging by 24 months. A child who is not combining words by this age is referred to a speech and language therapist for assessment. Expressive vocabulary of at least 50 words and the ability to understand simple two-step instructions ("pick up the ball and give it to me") are the benchmarks used.

Formal vision and hearing screening is included at U7 using age-appropriate tests. The paediatrician checks for strabismus systematically, tests visual acuity where cooperation allows, and uses behavioural hearing tests to identify any undetected hearing loss that might be contributing to speech delay.

A booster vaccination against meningococcal C and, where not yet given, the second dose of MMR and varicella, is recommended at this stage.

U7a - month 34 to month 36

The U7a was added to the programme in 2008 specifically to address a gap between U7 and U8 (at age 4) that was missing a critical window for language and behavioural development.

At U7a, the paediatrician uses a validated language development screening tool to assess whether the child is on track for the vocabulary, sentence structure, and comprehension expected at around 3 years. This is also when school-readiness precursors begin to be considered: attention span, ability to follow rules in play, social interaction with peers, and emotional regulation.

The physical examination includes re-checking vision and hearing and assessing fine motor skills such as drawing and stacking. Weight, height, and BMI are plotted. The child's general health, nutrition, and family context are discussed.

What to expect, and developmental red flags

The U-Untersuchungen are designed to identify deviation from typical development, not to judge children or parents. Paediatricians using the programme are trained to frame findings constructively and to distinguish between variants of normal and genuine cause for concern.

Some developmental red flags that may be identified at various U-Untersuchungen include:

When a red flag is identified, the paediatrician will explain what has been noticed, what it may mean, and what the next step is. A flag at a U-Untersuchung is not a diagnosis. It is a prompt for closer attention, which is precisely what the programme is designed to provide. Referrals to specialists such as paediatric orthopaedists, audiologists, ophthalmologists, neurologists, or speech and language therapists are a normal and appropriate outcome of the process.

The STIKO vaccination schedule and the U-Untersuchungen

STIKO is an independent expert body at the Robert Koch Institute (RKI) that issues annual vaccination recommendations for Germany. Its schedule is widely followed and forms the basis for what is offered at each U-Untersuchung.

The current STIKO calendar for the first year of life includes:

The exact timing of vaccine doses at a given U-Untersuchung will depend on when the series started and how many doses have already been given. Your paediatrician will confirm what is due at each visit and record it in the Vorsorgeheft. Germany maintains high childhood vaccination coverage and the STIKO schedule is considered one of the most evidence-based in Europe.

Track every U-Untersuchung with Cubby

Cubby lets you log each paediatric check-up, record what was examined and noted, set reminders before each appointment window closes, and keep the full picture in one private place. Never miss a U - and never lose the notes from one either.

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Frequently asked questions

Are the U-Untersuchungen free of charge?

Yes. All U-Untersuchungen from U1 through U9 are fully covered by statutory health insurance in Germany with no co-payment required. Families on private health insurance are similarly covered under their standard policy terms. The only potential cost is for optional add-on screenings that fall outside the statutory catalogue.

What is the Vorsorgeheft and why does it matter?

The Vorsorgeheft is the yellow booklet issued to every newborn in which the Kinderarzt records all findings, vaccinations, and developmental notes from each U-Untersuchung. It is a legal health record and an important document for nurseries, Kitas, and schools, many of which require sight of it before enrolment. Keep it safe and bring it to every paediatric appointment.

What happens if my baby's paediatrician flags something at a check-up?

A flag at a U-Untersuchung does not mean a diagnosis. It means the paediatrician wants to look more closely. They will typically recommend a follow-up appointment, a referral to a specialist such as a paediatric orthopaedist or audiologist, or an additional diagnostic test. Early identification is the entire purpose of the U-programme, and the vast majority of concerns flagged are resolved with straightforward follow-up.

Can I use Cubby to track U-Untersuchung appointments?

Yes. Cubby lets you log each U-Untersuchung as a care event, record the paediatrician's notes, and set reminders for upcoming visits so no appointment window is missed. The details stay private within your circle.

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