1. Informed Consent In general, the legal system should protect the rights of every person, regardless of that person’s age. Certain individuals have a limited ability to understand the nature of a medical practice and how it affects them, as is the case with pediatric patients. The development of cognitive abilities in childhood, like the development of emotional responses, is based on a gradual broadening that eventually reaches the level of competence in adulthood. Informed consent regarding pediatric patients should not be arbitrarily based on the age of the patient, but rather the process of obtaining informed consent should be based on the personality development of the child. The ability to consent and refuse to accept treatment requires a certain level of maturity and understanding. Certainly a child can refuse to accept the pain caused by an injection even though the immunization process is beneficial to prolong life. Obviously informed consent for surgical procedures is more complex, and it is impractical for young children to understand the process and its inherent risks and potential benefits. There is a new approach recommended for obtaining consent from or for children; this allows for interventions in children based on age and developmental maturity. For children 6 years of age and younger, who are highly limited in their ability to make decisions, consent should be given based on what is in the best interest of the child. As age increases along with the ability to make decisions, the opportunity for children to be formally approved and given consent to participate in the informed consent process increases based on maturity level. Even when older children and adolescents do have the capacity to give informed consent, parents are often asked to sign informed consent documents on behalf of their children. Parents are the natural guardians of their children and can be expected to always be looking for the treatment that is in the best interest of their child. If there is a question as to whether it is in the child’s best interest to withhold consent or refuse treatment, it is necessary to intervene through the legal system. Each state has established a legal framework to protect abused and neglected children, and the law allows anyone to petition the court to obtain custody of a person who lacks legal capacity. As a rule, the court will uphold a medical decision that is in the best interest of the child and generally will not appoint someone other than a parent as guardian unless there are special reasons. State capitals have established Child Protective Services to house children who are unable to obtain the necessities of life – such as housing, clothing, food, education, and medical services – and who may have sufficient access to medical services, but ultimately, unless the state has proven by clear and convincing evidence that all legal requirements have been met, it is extremely unlikely that parental rights will be terminated. rights and maintain institutionalization. Injuries to children are common victims of trauma and accidents are the leading cause of death for children between the ages of 1 and 14. Most often the form of the injury is of concern, especially in acute injuries where signs of trauma, such as bruises, abrasions, and healing fractures, may suggest “abused child syndrome. Abuse can be sexual or it can manifest as neglect, i.e., failure to meet the child’s needs for shelter, clothing, food, and medical care. The course of events leading to the present and previous injuries is not sufficient to explain the extent of the trauma, and the details may change over time. When a child needs treatment, but the affected parent refuses to treat him or her, the issue of informed consent will lead directly to a court action, and the judge will almost always make a pronouncement allowing the hospital to treat the child. When Child Protective Services gets involved in the situation, a longer-term plan is set in motion.