Früherkennungsuntersuchungen als Instrument im Kinderschutz

Abstract

Routine well-child visits, implemented as a means of secondary prevention and covered by health insurance, lead to early identification of disorders and abnormalities in child development."Guiding principles for children" (by the G-BA) have determined the content of the eleven examinations, ranging from U1 immediately after birth to J1 in adolescence; eight of them take place within the first four years of age. Since cases of child maltreatment, neglect, or abuse became public in 2007, almost all German federal states have established mandatory examination and notification processes in the new child welfare surveillance programs. First results in the German federal states (six of which are exemplarily illustrated) point out that mandatory requirements have collectively increased the frequency of medical check-ups in children, especially starting from four years of age and most significantly in families with social disadvantages (young/single parents, immigrant background, uneducated or socially disadvantaged families), which have so far been difficult to reach. Subsequently, provision of primary prevention (vaccinations and health promotion advice) by pediatricians has also increased. As a sole instrument for the complete identification of threats for children's welfare, however, systems inviting and reminding parents about check-ups are only of limited benefit.

Utilization of early detection examinations by children in Germany. Results of the cross-sectional KiGGS Wave 2 study

“…The increased utilization of early detection examinations and also the reduction of social differences in participation rates can be linked to various measures. Since 2007, new invitation, reminder and feedback systems were introduced in all federal states, even though the regulations vary from one federal state to the other [ 13 , 14 ]. In Brandenburg, for example, in cooperation with the ‘Bündnis Gesund Aufwachsen’, a registration system for the U6 to U8 was established in 2008 that commits doctors to confirm to a newly introduced central body, when the corresponding examinations have taken place.…”

Implementing an Inpatient Social Early Warning System for Child Maltreatment

“…Early Child Health Checkups starting with the birth of the child have long been the main national prevention strategy to preserve child well-being. However, parents' participation in these early child health checkups has not become compulsory yet (Hock et al, 2012) and advocacy to expand their scope to the identification of child physical and sexual abuse has yet remained unsuccessful (Thaiss et al, 2010). But recent tragic events of child maltreatment forced a change in national maltreatment prevention initiatives.…”

Background paper for the recommendation of HPV vaccination for boys in Germany

“…An analysis of ASHIP data has shown that 12-year-old girls have a 7 times higher probability of having received at least one HPV vaccine dose if they attended the J1 health checkup [118]. The introduction of a compulsory invitation and response procedure for the J1 health check-up could be helpful: in the Rhineland-Palatinate, this procedure has increased attendance at the J1 health check-up by 25% [119]. The routine well-child check-up 'U11' (9-10 years of age) is another option for offering the vaccination, but not all SHI funds cover this screening examination, so it is not offered consistently in Germany.…”