In pediatrics, how is assent obtained in addition to parental consent, and when is assent appropriate?

• A. Seek assent only after parental consent
• B. Seek the child’s agreement to treatment when developmentally appropriate; explain simply, offer choices within safe options, and respect refusals when feasible
• C. Seek child assent after the treatment is planned
• D. Do not involve the child in decision making

Answer: (B)

In pediatrics, assent means involving the child in decisions to the extent they can understand. You obtain assent by explaining the proposed treatment in plain, developmentally appropriate language, checking that the child understands what’s being proposed, and inviting questions. You should present options within safe boundaries and, when feasible, offer choices that reflect the child’s preferences. Importantly, you try to honor a willing assent and, if feasible, respect a child's refusals while still ensuring their health needs are met. Assent is appropriate when the child is capable of understanding at least at a basic level, which is usually older school age and up, and the discussion should occur early in the decision-making process, not after a plan is already fixed. In emergencies where there isn’t time for assent, proceed with parental consent and involve the child as soon as possible afterward.