摘要
The recently published article by Narchi et al[1]brings an important empirical insight into a very complex issue of parental consent for lumbar puncture(LP)in children;quite worrisome observation from authors'clinical practice that almost half of the parents refused to give consent for the LP is confirmed.[1]However,the concept of(parental)consent,used by Narchi et al,[1]would need to be further elaborated with introduction of two other important concepts in pediatrics-child's assent and parental permission.The concepts were endorsed by the policy statement of the American Academy of Pediatrics(published in 1995;reaffirmed in 2011).[2]Accordingly,only the patients with appropriate decisional capacity could give their informed consent.In all other situations,parents provide informed permission for an intervention on their child,with assent of the child if appropriate.[2]Most of children from age seven are thought to understand basic information if adequately presented,[3]The need for assent was also supported by the Confederation of European Specialists in Pediatrics,stating that all children have a right to give their assent(or dissent)and may refuse interventions that are not necessary to save their lives or prevent serious harm.[4]Furthermore,the responsibility to make decision in children is shared between physicians and parents.The later should provide informed permission before interventions(except in emergency situations),which includes all the elements of informed consent,reflecting the child's best interests.
