From the Guidelines
In pediatric psychiatry, consent involves both the child and their parents or legal guardians, with parents typically providing informed consent for evaluation, medication, and therapy, while the child's assent should be sought whenever possible, as stated in the most recent guideline from 2020 1. The process of obtaining informed consent in pediatric psychiatry is crucial for ensuring that children and their families are fully aware of the diagnosis, treatment options, potential benefits, side effects, risks, and alternatives.
- The child's assent should be sought whenever possible, taking into account their age and developmental level.
- Parents or legal guardians typically provide informed consent for evaluation, medication, and therapy.
- However, many states allow adolescents aged 12-17 to consent to certain mental health services independently, particularly in crisis situations or for substance use treatment.
- A thorough informed consent process should include discussion of diagnosis, treatment options, potential benefits, side effects, risks, and alternatives.
- For medications like stimulants, antidepressants, or antipsychotics, parents need detailed information about effects, monitoring requirements, and potential adverse reactions.
- Clinicians should document consent discussions in the medical record, including who provided consent and what information was shared, as emphasized in the guideline from 2009 1. This process respects the developing autonomy of young patients while acknowledging their vulnerability and need for protection.
- In emergency situations where a child presents immediate danger to themselves or others, treatment may proceed with abbreviated consent processes, though full consent should be obtained as soon as feasible. The incorporation of cultural and spiritual values, beliefs, and attitudes in treatment interventions can enhance the child’s and family’s participation in treatment and treatment effectiveness, as noted in the most recent guideline from 2020 1.
From the Research
Guidelines for Informed Consent in Pediatric Population
The guidelines for informed consent in the pediatric population in psychiatric care involve a complex interaction of various factors, including the child's developmental stage, social environment, and mental state 2.
- The child's competency to consent to psychiatric treatment is a multi-faceted concept that exists on a continuum, and rigid arbitrary limits are inappropriate 2.
- Informed consent should be seen as an essential part of health care practice, and parental permission and childhood assent is an active process that engages patients in their health care 3.
- The child's developmental maturation allows for increasing inclusion of their opinion in medical decision-making, and their rights should be protected 2, 3.
Age Limits for Informed Consent
Research suggests that children's competence to give informed consent can be accurately assessed, and age limits for children to be deemed competent to decide on research participation have been studied 4.
- Generally, children of 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not 4.
- It is recommended that a dual consent procedure, including both child and parents, be implemented for children from the age of 12 until they reach majority 4.
Essential Elements of Informed Consent
The essential elements of informed consent in pediatric practice include:
- Nature of procedure
- Risks
- Benefits
- Alternatives 5
- The process of informed consent should be a communication process that provides the patient/parents/guardians with relevant information regarding the treatment and diagnosis 5.
Special Circumstances
In pediatric emergency settings, involving patients or their surrogate decision-makers in their care is an important element of modern medical practice 6.
- Special circumstances include treatment for sexual and mental health conditions, emancipated minors, mature minors, and situations when custody is unclear 6.