Issues of consent and competency in children and young people

Understanding issues of consent and competency in young people is essential for good practice in paediatrics. Usually situations are straightforward, with agreement between the doctor or healthcare professional, child and parent or carer on what treatment is necessary. Difficulties arise in more complex situations, for example, when there is disagreement about what is best for a child or young person, or there is no one available to give valid consent. More consideration is needed when there appear to be conflicting issues of confidentiality, or when the therapeutic alliance with parents is challenged as in child protection work. These and other common clinical situations are discussed in this article, with clarification of the legal and professional framework in which decisions need to be made. The article does not cover issues of consent and competency in areas of research practice.