Children’s health monitoring

In the interests of children’s good health and development regular health check-ups are provided for children. Pediatricians, family physicians, family nurses and medical specialist work together for this purpose.  They monitor children’s development, growth, weight, hearing, sight and speech. In addition, they help children develop healthy eating and exercise habits and provide advice on all other health issues. To prevent infectious diseases, immunization is provided. With regular check-ups they help children develop healthy eating and exercise habits as well as provide consultation to the family.

The purpose of children's health check-ups is to monitor children’s development and to provide the necessary medical care for early detection of health and developmental disorders.

The first seven years of life

During the first days of life, newborns are tested for hypothyroidism and phenylketonuria. Hypothyroidism is a condition where the thyroid gland does not produce enough hormones. Phenylketonuria is the most common congenital metabolic disease. In addition, the newborn's hearing is checked.

A healthy infant is regularly monitored during the first year of life for prophylactic reasons.   You have to take your infant to the family nurse three times. At these visits, the child is weighed and measured. In addition, the nurse is responsible for teaching the parents about feeding, hygiene, care, accident prevention, etc. A pediatrician visit is not intended for a healthy infant. If necessary, the family physician will refer the child to a medical specialist, such as a neurologist or orthopedist.

A 6-7-year-old child must undergo a pre-school health examination by a family physician. The physician assesses the child’s development and readiness for school. Among other things, visual and auditory acuity and speech development are checked. In case of abnormalities, the physician can refer the child for further examination, to a speech therapist or ophthalmologist. You should take your child to the health check-up well before the school starts, as early as in spring. Then you will have enough time to solve any problems found. For example, buying glasses, etc. A project on the integration of children with diabetes into school life has started off well. The project helps diagnose the disease before school and respective specialists provide necessary training and support to school staff.

Monitoring of children’s health in kindergarten

There is no health care provider in the kindergarten who could competently assess a child's state of health. In practice, however, there may be situations where a parent wants to take their child who shows clear symptoms of a disease to kindergarten, while parents of other children want to protect their child from a possible risk of infection. It is important to keep in mind the well-being of both the child with symptoms and other children. 

The parent has the right to make decisions that do not harm the child. If a parent finds that it does not harm the child, he or she can take the child to kindergarten. However, if the employees of the kindergarten do not share the opinion of the parent and engage in a dispute, then such a dispute must be resolved by the head of the institution. It is important to keep in mind that the content of the dispute cannot be the assessment of the child's state of health, for which the parties do not have competence. If kindergarten staff have any doubts about the child's health, they can advise the parent to contact their family physician.

In the case of a child with mild symptoms, it is possible to find ways to support the child appropriately in the kindergarten and, if necessary, to avoid physical contact between the children.

If, despite the staff’s advice, a parent repeatedly brings a child whose health does not allow him/her to cope with the kindergarten daily plan and/or the child's condition endangers others and it is objectively justified (symptoms of infectious diseases, viral diseases, acute diarrhea and vomiting), the child may need protection. In the case of negligent or malicious behavior of a parent, the kindergarten staff should notify of a child in need of assistance as provided in the Child Protection Act. A child in need of assistance must be immediately notified of to the local government or to child helpline service 116 111. In such a case, the kindergarten staff must initiate the process of notification of a child in need of assistance, which is provided for in § 59 of the Child Protection Act. The Constitution of the Republic of Estonia and § 124 of the Family Act leave matters related to the care and upbringing of a child to the parent or guardian with custody of the child.

Health check-ups at school age

To be admitted to the school, you must take your child to your family physician for check-up and submit an officially certified extract of the student's health card to the school. It lists previous vaccinations, chronic diseases, ongoing medicines, as well as medicine or food allergies. Information is needed to monitor a child's health at school, but also to apply the study load and lifestyle.

When a child is admitted to the school, the parent's consent to provide school health care is requested. From April 1, 2020, the school nurse will perform health examinations for 1st, 3rd, 7th and 11th grade students. 5th and 9th grade students have to go to their family physician for a health check-up.

The concept of consent derives from the Law of Obligations Act. Based on this, the patient may be examined and provided with healthcare only with his or her consent. In addition to written consent, orally given consent is equally valid. This is sufficient, for example, when a student asks the school nurse for help during a break.

A consent of a legal representative is necessary, if the patient is unable to consider the pros and cons of the health care responsibly. In the case of a school-age child, it is often questionable when he or she can make decisions about his or her own health and when the parent's opinion is still needed. In the case of a primary school student, the decision must be made by a parent.

Similarly, before each immunization, the school nurse must ask the parent for written consent, even if it has already been given once at school. Parental consent helps to rule out possible contraindications, so it is requested in the interests of the child's health. If the family does not wish to vaccinate their child, this must be confirmed in writing. In the consent given when the child is attended to the school, the family may specify situations in which, regardless of the child's point of view, the school must contact the parents.

What kind of health care can child get at school?

The child is not treated at school. The treatment of a sick child is prescribed and coordinated by a family physician or medical specialist. If a child has fallen ill or suffered a trauma at school, the school nurse must provide first aid and inform the parents. Parents should not send a sick child to school. The school nurse cannot prescribe examinations or treatment for the child and does not write a certificate of absence. In case of illness, you should first consult with your family physician. Outside of family physician’s working hours, you can seek medical 24 hours a day by calling the family physician advisory line (see here  for more details). A school nurse can help, if a student needs special treatment at school due to health, e.g. in the post-illness period. The nurse needs to know about the child's allergies or other illnesses. Only then they can promptly provide appropriate assistance.

In small schools, the nurse is not always present, but their reception hours and telephone number must be available. If the child moves to a dormitory, it is recommended that he or she be registered in the family physician practice list in that area. The child is likely to stay in the dormitory for most of the year. During the study period, the incidence of viral diseases is usually higher, so the family nurse can quickly refer the child registered in the school area to the family physician.

Children's dental care and orthodontics

You should start taking care of your teeth at a young age. You should clean your baby's mouth regularly even before the first teeth are cut. The first visit to the dentist could take place when the child cuts their first tooth or when the child is about one year old. You can get the first advice on oral health from a midwife or family nurse in your child's first year of life.

Home hygiene helps to prevent caries. You can start with constant monitoring already when the baby cuts their first teeth. It is recommended to start regularly visit a dentist, when the child is three years old. On the first visits, the parent could stay with the kid and support him or her. The most important thing is the positive experience you get from the first visits. Children who are already familiar with the dentist and have pleasant experiences will feel comfortable later at the dentist. When a child is afraid of the dentist, it requires patience from everyone.

Studies have shown that if the teeth are strong and healthy by the end of adolescence, treatment will not be needed for several decades. Thus, with the right hygiene habits and preventive controls, it is possible to avoid situations where a significant part of the savings will be spent on dentistry in adulthood.

School nurses also work with dentists to refer children for preventive examinations at the age of 7, 9 and 12. If a child needs dental care, it must be provided with the family's knowledge and approval. However, it should be checked whether the dentist has a contract with EHIF. Only then the service is free for the parent.

EHIF pays for dental care for insured persons under the age of 19. After the child has reached the age of 19, free dental care is provided for one year only, if the need for treatment arose during the last visit before the age of 19. Free service is available at the same dental care provider where the need for treatment was identified.

A parent has the right to choose a dentist for their child. However, always check that the chosen dentist has a contract with EHIF. EHIF's contractual partners are listed on the EHIF's website. If there is no contract, the parent must pay for the service in full and this money cannot be claimed from EHIF. EHIF pays only for the services listed in the EHIF list of health care services. 

Family nurses and school nurses have the obligation to recommend (refer) dental disease prevention appointments - this is regulated both in the family physician's work instructions as well as in the regulation of school nurses work. If health care is provided without the presence of a parent - for example, organized by the school - the child must have their parent’s consent with them.

Orthodontics

EHIF also finances children's orthodontics (including braces), but only in certain cases. This is done for the following severe diagnoses:

1. the upper jaw reaches 9 mm or more over the lower jaw (prognathic bite with sagittal cavity 9 mm or more);
2. the lower jaw reaches further than the upper jaw (progeny bite);
3. there is no contact of the front teeth and only the posterior molars are in contact (occlusal if only molars are in contact);
4. if the front incisor or eye tooth has not been cut in time (delayed incisor or canine teeth);
5. if no more than one permanent tooth has formed on one side of the jaw (if an incisor, canine or more than one tooth on each side of the jaw are missing);
6. cleft lip and cleft palate and other congenital malformations of the maxillofacial system;
7. dental anomaly in severe or moderate obstructive sleep apnea, when adenotonsillectomy and positive air pressure therapy (CPAP) have not been effective;
8.  a deep traumatic bite in which case the lower incisors are in direct contact with the mucosa;
9.  lateral cross-bite along three or more teeth on one side of the jaw, in which the symmetry of the face and the development and growth of the jaws are significantly impaired.

In any other cases, EHIF does not compensate for orthodontic services for children. 

Please bear in mind that even in the above cases, the provider must have a contract with EHIF. Only then EHIF can pay for the treatment. The same applies to services: if it is listed in the list of health care services, EHIF will pay for it.