Synopsis
Obtain valid paediatric consent, assess decision-specific competence, involve children through assent, verify parental responsibility and act lawfully during disagreement, incapacity or emergency.
- Consent is a voluntary, informed decision by a person with legal authority and sufficient capacity or competence for that specific decision at that time.
- Young people aged 16 and 17 are presumed able to consent to their own medical treatment unless evidence shows they cannot make the particular decision.
- A child younger than 16 can consent when Gillick competent: able to understand, retain, use and weigh the relevant information and communicate a choice.
- Competence is decision specific; a child may decide a simple low-risk treatment but not yet understand a complex high-consequence intervention.
- Seek assent from children who cannot legally consent: explain, invite questions and respect cooperation and dissent as far as safety permits.
- Parental responsibility is a legal status, not the same as biological relationship, daily care, next of kin or attendance at the appointment.
- Usually one person with parental responsibility can consent, but major disagreement about significant non-urgent treatment needs resolution and often legal advice.
- Give developmentally appropriate information about purpose, process, benefits, material risks, alternatives and what happens without treatment.
- Do not promise absolute confidentiality; explain that information may be shared to protect the child or another person from serious harm.
- A competent child or young person can seek confidential advice and treatment; encourage safe parental involvement but do not make it an automatic condition.
- In an emergency, treat in the child's best interests when delay to find consent would risk death or serious harm and document the justification.
- Record who decided, their authority, information provided, questions, the child's views, capacity or competence assessment, disagreement and the agreed review point.
Key red flags
A parent refusing treatment needed to prevent death or serious irreversible harm requires immediate senior, safeguarding and legal escalation; emergency care continues when delay is unsafe.
A competent young person's refusal, especially of high-consequence treatment, is legally complex and must not be overridden casually by a clinician or relative.
An accompanying adult is not automatically authorised to consent; verify relationship and parental responsibility before non-urgent significant treatment.
Coercion, family violence, exploitation, communication barriers or a child looking to an adult before every answer can undermine voluntariness and require private safeguarding assessment.
Consent obtained for one procedure, indication or level of risk does not automatically cover a materially different intervention.
Investigation priorities
Identify whether the child or young person can authorise this intervention.
Confirm authority when an adult is asked to consent for the child.
Management branches
A 16–17-year-old is offered investigation or treatment.
- Provide accessible information directly and assess capacity only when there is reason for doubt.
- Obtain and document the young person's voluntary decision and invite family involvement with permission when safe.
- For high-consequence refusal or incapacity, seek senior and legal advice rather than assuming parental consent automatically resolves it.