Understanding Informed Consent for Pediatric Patients
Laura M. Cascella, MA
Informed consent is a pillar of patient engagement and patient-centered care. It helps patients gain a full understanding of the benefits and risks of proposed procedures and treatments, thus allowing them to make informed decisions. But what happens when patients are infants, children, or adolescents?
The right to consent to treatment or refuse treatment generally applies to competent adults. Thus, healthcare providers who treat pediatric patients — such as pediatricians, family medicine physicians, physician assistants, nurse practitioners, and pediatric dentists — should be well-versed in how to address informed consent with patients who are minors. Doing so requires understanding specific state laws related to informed consent and developing thorough organizational policies to guide the consent process.
State Laws
In the United States, consent for treatment of minors in nonemergency situations is addressed in state laws, which can vary from state to state. Typically, parents or legal guardians must consent to treatment if a child is not of the age of majority (usually 18).1 However, exceptions apply, particularly in regard to adolescents.
As noted in guidance from UpToDate, “The circumstances in which adolescents may consent for their own care and in which confidentiality is protected vary from state to state depending upon the adolescent's status as a minor or adult, the service involved, and the provider’s level of concern regarding harm to the patient or others.”2
State laws generally include definitions of “mature or emancipated” minors, and they might have provisions allowing minors to consent to treatment of sexually transmitted diseases, sexual assault, pregnancy, and substance abuse.
Additionally, exceptions to consent laws might apply in emergency situations in which no parent or guardian is present or in circumstances in which lack of parental or guardian consent might result in serious patient harm. Healthcare providers who treat pediatric patients should know their state laws and ensure that organizational policies related to informed consent for minors adhere to these laws.
Organizational Policies
When developing organizational informed consent policies, healthcare providers who treat pediatric patients should take into account situations in which minors may present to the office for clinical care or treatment without their parents or guardians present. For example, the patient might arrive alone or be brought in by a grandparent or sibling. Each organization’s policies should include specific guidance for managing these types of scenarios.
For example:
- Determine if and under what circumstances minors will be seen if they arrive alone or without a parent or guardian present (unaccompanied minors).
- In your practice’s welcome brochure or informational packet, explain your policies related to informed consent for minors and treatment of unaccompanied minors.
- Determine the types of procedures/treatments that will be made available to unaccompanied minors.
- Communicate in advance the limitations of services and care provided to unaccompanied minors.
- Require parents/guardians to provide a phone number where you can readily reach them in the event that questions arise about minors’ care.
- Specify that additional treatment (beyond what office policy allows for unaccompanied minors) will require specific consent discussions.
- Have parents/guardians sign a consent form in advance permitting general treatment of unaccompanied minors.
- Document all care provided in accordance with the organization’s informed consent policies.
Consent policies for minor patients also should include guidance related to assurance of parental/custodial rights for informed consent or refusal, particularly in cases of divorce, separation, protection from abuse orders, etc. For example, for minors whose parents are divorced or separated, “reasonable steps should be taken to determine which parent(s) has the legal authority to consent to treatment, to what extent each parent must be involved in the decision-making process, and who may access information regarding the minor.”3
Organizational leaders and providers also should consult their legal counsel to help review and provide guidance on consent policies for minors and to address questions that arise related to the care and treatment of minor patients.
Resources
The Guttmacher Institute provides a state-by-state overview of minors’ consent law in the United States, including consent for medical services related to contraception, sexually transmitted infections, prenatal care, abortion, and more. For more in-depth information about the informed consent process, see MedPro’s guideline titled Risk Management Strategies for Informed Consent.
1 McNary, A. (2014). Consent to treatment of minors. Innovations in Clinical Neuroscience, 11(3-4), 43–45.
2 Olson, K. A., & Middleman, A. B. (2016, October). Consent in adolescent health care. UpToDate. Retrieved from www.uptodate.com/contents/consent-in-adolescent-health-care
3 McNary, A. (2014). Consent to treatment of minors. Innovations in Clinical Neuroscience, 11(3-4), 43–45. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4008301/
