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Cosmetic surgery to insert silicone prosthesis may be indicated when the woman has very small breasts, is afraid of not being able to breastfeed, has noticed a reduction in their size or has lost a lot of weight. But it can also be indicated when a woman has breasts with different sizes or needed to remove the breast or part of the breast due to cancer. This surgery can be done from the age of 15 with parental permission, and is performed under general anesthesia, taking about 45 minutes, and can be with a short hospital stay of 1 or 2 days, or even in an outpatient setting, when he is discharged on the same day.

Obtaining parental consent for youth to participate in research is a standard requirement in the United States. However, the assumption that involving parents is the best way to protect youth research participants is untenable for some populations. This study draws on interviews with 19 LGBTQ+ mixed-race participants to examine lay views of parental consent requirements for LGBTQ+ youth research participants. Qualitative data analysis found concerns about potentially outing LGBTQ+ youth to intolerant parents. Interviewees also asserted that adolescents aged 16 and older are competent enough and should have the autonomy to consent themselves. Finally, interviewees raised several methodological concerns regarding the biased research that may result from parental consent requirements. We agree with others that U.S. Institutional Review Boards should end uncritical requirements for parental consent for older adolescents and should routinize the use and study of alternative protective measures.

Purpose One third of people newly living with HIV/AIDS are adolescents. Research on adolescent HIV prevention is critical owing to differences between adolescents and adults. Parental permission requirements are often considered a barrier to adolescent enrollment in research, but whether adolescents view this barrier as the most important one is unclear. Methods Adolescents were approached in schools in KwaZulu-Natal, South Africa, and at a sexually transmitted infection clinic at the Children’s Hospital of Aurora, Colorado. Surveys with a hypothetical vignette about participation in a pre-exposure prophylaxis trial were conducted on smartphones or tablets with 75 adolescents at each site. We calculated descriptive statistics for all variables, using 2-sample tests for equality of proportions with continuity correction. Statistical significance was calculated at p Results Most adolescents thought side effects (77%) and parental consent requirements (69%) were very important barriers to research participation. When asked to rank barriers, adolescents did not agree on a single barrier as most important, but the largest group of adolescents ranked parental consent requirements as most important (29.5%). Parental consent was seen as more of a barrier for adolescents in South Africa than in the United States. Concerns about being experimented on or researchers’ mandatory reporting to authorities were ranked much lower. Finally, most (71%, n = 106) adolescents said they would want to extra support from another adult if parental permission was not required. Conclusion Adolescents consider both parental permission requirements and side effects important barriers to their enrollment in HIV prevention research. Legal reform and better communication strategies may help address these barriers.

Recent research has documented significant mental health disparities for transgender adolescents. However, the extant literature is hindered by vague operationalizations of gender identity and limited measurement of trans-specific stressors. In this article, we (1) introduce and describe the Gender Minority Youth (GMY) Study, a large-scale study of transgender youth disparities; and (2) provide evidence of the feasibility of using social media to recruit a diverse sample of U.S. transgender and cisgender youth. Facebook and Instagram advertisements targeted 14–18-year-old adolescents to complete an online survey. Participants (N = 3318) self-reported gender assigned at birth and current gender identity, mental health symptoms, and transgender-specific stressors and milestones. Adolescents included 1369 cisgender (n = 982 cisgender female; n = 387 cisgender male), 1938 transgender (n = 986 transgender male; n = 132 transgender female; n = 639 nonbinary assigned female at birth; n = 84 nonbinary assigned male at birth; n = 84 questioning gender identity assigned female at birth; n = 13 questioning gender identity assigned male at birth), and 11 intersex youth. The GMY Study is the first nationwide sample of U.S. adolescents recruited specifically for a study of mental health disparities between transgender and cisgender youth. We demonstrate the feasibility of using social media advertisements and a waiver of parental permission to recruit a large sample of adolescents, including subsamples of gender minority youth. We remedied limitations in the existing literature by including appropriate measures of gender assigned at birth, current gender identity, and detailed questions about transgender-specific stressors and transition milestones.

Pediatric medical decision making has been a matter of discussion for the last few decades. Generally, the currently prevailing viewpoints are that the children’s wishes should be heard and that children should be allowed to participate in medical decision-making according to their development. Those discussions do not only touch on ethical, legal and political matters, but are also based on empirical research. There are no simple answers to those large issues, especially the age limit at which children can be considered capable of giving informed consent. In that context, a balance needs to be struck between the protection of children’s interests and the respect for their “developing autonomy”. The first part of this article outlines the principle of autonomy that informed consent is based on, whereas the second part focuses on two concepts: that of parental permission and of assent of the child, both of which are well-known in the contemporary medico-legal realm. The term “assent” is commonly used in cases when individuals are not legally allowed to give informed consent but are capable of taking part in the process of medical decision-making. In the third part of the paper, three Croatian legal acts were analyzed in a context of the informed consent of the child: the Protection of Patient’s Rights Act, the Family Act and the Civil Obligations Act. The fact that several legal regulations, in particular the Protection of Patient’s Rights Act, the Family Act and the Civil Obligations Act, must be used in parallel when it comes to the issue of informed consent of a child, can be, legally speaking, quite confusing. Thus, such regulation may leave some doubts and difficulties in the immediate application, especially with regard to emergency medical interventions. In this regard, perhaps the fact of adopting a special law on the consent of children to medical procedures could be considered, or at least the provision within the Family Act or the Protection of Patient’s Rights Act, which uniformly summarizes all the above regulations., Posljednjih nekoliko desetljeća vode se opsežne rasprave o problematici donošenja medicinskih odluka koja se tiču djece. Općenito, trenutno prevladava gledište da se djetetove želje treba poslušati i da se djeci treba omogućiti sudjelovanje u donošenju medicinskih odluka u skladu s njihovim razvojem. Te rasprave ne dotiču se samo etičkih, pravnih i političkih pitanja, već se temelje i na empirijskim istraživanjima. Nema jednostavnih odgovora na ta bitna pitanja, osobito na ona koja se tiču dobne granice u kojoj se djeca mogu smatrati sposobnima dati informirani pristanak. U tom kontekstu potrebno je uspostaviti ravnotežu između zaštite interesa djece i poštivanja njihove “autonomije u razvoju”. Prvi dio ovog članka prikazuje načelo autonomije na kojem se temelji informirani pristanak, dok se drugi dio usredotočuje na dva koncepta: roditeljsko dopuštenje i pristanak djeteta, koja su oba dobro poznata u suvremenoj medicinskoj praksi. Izraz „pristanak“ (assent) obično se koristi u slučajevima kada pojedincima nije zakonski dopušteno davanje informiranog pristanka, ali se smatraju sposobnima sudjelovati u procesu donošenja medicinskih odluka. U trećem dijelu rada analizirana su tri hrvatska pravna akta u kontekstu informiranog pristanka djeteta: Zakon o zaštiti prava pacijenata, Obiteljski zakon i Zakon o obveznim odnosima. Činjenica da se nekoliko zakonskih propisa, a posebno Zakon o zaštiti prava pacijenata, Obiteljski zakon i Zakon o obveznim odnosima, moraju koristiti paralelno kada je u pitanju pristanak djeteta, može biti, pravno gledano, prilično zbunjujuće. Stoga takva regulativa može ostaviti određene nedoumice i poteškoće u neposrednoj primjeni, posebno u pogledu hitnih medicinskih intervencija. S tim u vezi, mogla bi se razmotriti mogućnost donošenja posebnog zakona o pristanku djece na medicinske zahvate koji bi ujednačeno sažimao sve navedene propise.

Objective We describe the essential elements of professional ethics in perinatology and explain how professional ethics in perinatology should guide decision making with pregnant patients and with parents. Findings Professional ethics in perinatology draws on two ethical principles, beneficence and respect for patient autonomy, the ethical concept of the fetus as a patient, and the best interests of the child standard and the concept of parental permission. Counseling about intrapartum management should be based on the ethical concept of the fetus as a patient and on the role of the pregnant patient as the ultimate decision maker. Counseling about setting ethically justified limits on perinatal clinical management should be based on four specified concepts of futility, but not on quality-of-life futility. Counseling about innovation and research should emphasize that investigation clinical management is an experiment. Conclusion Professional ethics in perinatology is an essential component of perinatal practice, innovation, and research

In situations like the one presented here (Johnson et al. 2020), adolescent participants should be allowed to consent independently, without parental permission being required or even solicited.The...

This article provides practical guidance for researchers who wish to enroll and collect data from pediatric research participants through online and mobile platforms, with a focus on the involvement of both children and their parents in the decision to participate.

Objective: Parental perspectives on the use of technology in neonatal intensive care units (NICU), and its impact on enhancing communication and closeness during COVID-19 parental presence restrictions. Methods: A co-designed online survey targeting parents of infants admitted to a Canadian NICU from March 1st, 2020 until March 5th, 2021. Results: Parents (n=117) completed the survey from 38 NICUs. Large variation in policies regarding parental permission to use technology across sites was reported. Restrictive use of technology in the NICU was reported as a source of stress for families, with parents reporting privacy concerns, overstimulation, and infection control as primary institutional reasons for restriction. While families felt that technology helped them feel close to their infant when they could not be in the NICU, it did not replace being in-person. Conclusion: Large variation in policies regarding parental permission to use technology was reported across Canadian NICUs. Despite legitimate concerns about devices in NICUs, good evidence on how to mitigate these concerns exists. There appears to be substantial benefits to using technology to enhance parental experiences and many parents choose to ignore restrictions. Future study is needed to inform recommendations on technology use in the NICU, in the Canadian context and elsewhere.

Indoor tanning (IT) increases risk of developing skin cancer. A social media campaign to reduce mother’s permissiveness toward their teenage daughters IT was evaluated. Mothers (N = 869) of daughters aged 14–17 in 34 states without bans on IT by minors were enrolled in a randomized trial with assessments at baseline and 12-months follow-up in 2017–19. A year-long adolescent health campaign was delivered to all mothers. The intervention group received posts on preventing IT and the control group, posts about preventing prescription drug misuse. Daughters (n = 469; 54.0%) completed the assessments at baseline and 12 months. At 12-month follow-up, intervention-group mothers were less permissive of IT by daughters (unadjusted means = 1.70 [95% CI: 1.59, 1.80] v. 1.85 [1.73, 1.97] [5-point Likert scale], b = -0.152), reported more communication about avoiding IT with daughters (4.09 [3.84, 4.35] v. 3.42 [3.16, 3.68] [sum of 7 yes/no items], b = 0.213), and had lower intentions to indoor tan (1.41 [1.28, 1.55] v. 1.60 [1.43, 1.76] [7-point likelihood scale], b = -0.221) than control-group mothers. Daughters confirmed intervention-group mothers communicated about IT (3.81 [3.49, 4.14] v. 3.20 [2.87, 3.53] [sum of 7 yes/no items], b = 0.237) and shared IT posts (unadjusted percentages = 52.4% v. 36.4%, b = 0.438) more than control-group mothers. No differences were found in IT behavior, self-efficacy to refuse permission, and negative attitudes toward IT. A social media campaign may be an effective strategy to convince mothers to withhold permission for IT, which may help increase the effectiveness of state laws designed to reduce IT by minors by requiring parental permission.

Despite the breadth of health benefits associated with regular physical activity (PA), many children in the UK are not sufficiently active enough to meet health guidelines, and tend to become less active as they mature into and throughout adolescence. Research has indicated that children&rsquo, s school, home and neighbourhood environments can all significantly influence their opportunities to engage in moderate-to-vigorous physical activity (MVPA). However, less is known about how children&rsquo, s MVPA patterns within these key environments may change across the school year. The current mixed-methods case study aims to explore this issue by tracking key stage 2 (KS2) and key stage 3 (KS3) children&rsquo, s MVPA patterns across the school year. Fifty-eight children (29 boys, 29 girls, KS2 = 34, KS3 = 24) wore an integrated global positioning systems (GPS) and heart rate (HR) monitor over four consecutive days in the first term of school (autumn), before these measurements were repeated in the two remaining school terms (winter&ndash, summer). A subsample of children (n = 6&ndash, 8 per group) were invited to take part in one of six focus groups each term to further explore their PA behaviours and identify the barriers and facilitators to PA. The children&rsquo, s MVPA was significantly lower (p = 0.046) in term 2 (winter/spring term) than during the warmer terms (autumn and summer). All the locations showed reductions in MVPA in term 2, except indoor MVPA, which increased, and MVPA on foot in the neighbourhood, which remained consistent. Focus groups revealed location, friends, and the variety of options to be associated with MVPA, and poor weather, parental permission, and time limitations to be barriers to MVPA. This mixed-methodological, repeated-measures design study highlights differences in the activity patterns and perceptions of children over the school year. Future studies should implement longitudinal, multi-method approaches to gain deeper insight into how children&rsquo, s PA behaviours differ over time. Consequently, this can inform future health policies promoting children&rsquo, s PA throughout the year.

BackgroundChildren have reported that one reason for participating in research is to help their doctor. This is potentially harmful if associated with coercive consent but might be beneficial for recruitment. We aimed to explore children’s perceptions of the child-doctor relationship in research.MethodsThis is a multicenter qualitative study with semi structured interviews performed between 2010 and 2011 (United Kingdom) and 2017–2019 (the Netherlands). Interviews took place nationwide at children’s homes. We performed a secondary analysis of the two datasets, combining an amplified analysis aimed to enlarge our dataset, and a supplementary analysis, which is a more in-depth investigation of emergent themes that were not fully addressed in the original studies. All participants had been involved in decisions about research participation, either as healthy volunteers, or as patients. Recruitment was aimed for a purposive maximum variation sample, and continued until data saturation occurred. We have studied how children perceived the child-doctor relationship in research. Interviews were audiotaped or videotaped, transcribed verbatim, and thematically analyzed using Atlas.ti software.ResultsIn total, 52 children were recruited aged 9 to 18, 29 in the United Kingdom and 23 in the Netherlands. Children’s decision-making depended strongly on support by research professionals, both in giving consent and during participation. Often, their treating physician was involved in the research process. Familiarity and trust were important and related to the extent to which children thought doctors understood their situation, were medically competent, showed support and care, and gave priority to the individual child’s safety. A trusting relationship led to a feeling of mutuality and enhanced children’s confidence. This resulted in improving their experiences throughout the entire research process. None of the participants reported that they felt compelled to participate in the research.ConclusionsThe child-doctor relationship in pediatric research should be characterized by familiarity and trust. This does not compromise children’s voluntary decision but enhances children’s confidence and might result in a feeling of mutuality. By addressing the participation of children as an iterative process during which treatment and research go hand in hand, the recruitment and participation of children in research can be improved.

This chapter focuses on the interaction between the family and the adolescent in the context of health. The healthy adolescent will have no physical disease, feel competent, and self-actualized on the psychological level, practice no activities harmful to health on the behavioral level, and engage in appropriate role requirements on the social level. Adolescents are usually accompanied by a parent during a visit to a health-care provider. The annual visit for health maintenance by an adolescent may identify no health problems for the teen. From a developmental point of view, parental permission for adolescents to seek medical care independently can be viewed as providing the adolescent with a level of responsibility that is highly desirable because it allows adolescents to accomplish a major developmental task. The number of adolescents with chronic illness in the United States has been steadily increasing.

Decisions regarding whether or not to pursue experimental therapies or life-sustaining medical treatment of children with life-limiting illness can be a significant source of distress and conflict for both families and health care providers. This article reviews the concepts of parental permission (consent), assent, and emerging capacity and how they relate to decision-making for minors with serious illness. Decision-making capacity for adolescents is discussed generally and in the context of emotionally charged situations pertaining to the end of life. Strategies for minimizing conflict in situations of disagreement between children and families are provided.

Objectives. To examine the association between state indoor tanning laws and indoor tanning behavior using nationally representative samples of US high school students younger than 18 years. Methods. We combined data from the 2009, 2011, 2013, and 2015 national Youth Risk Behavior Surveys (n = 41 313) to analyze the association between 2 types of state indoor tanning laws (age restriction and parental permission) and the prevalence of indoor tanning during the 12 months before the survey, adjusting for age, race/ethnicity, and survey year, and stratified by gender. Results. Age restriction laws were associated with a 47% (P Conclusions. Age restriction laws could contribute to less indoor tanning, particularly among female high school students. Such reductions may reduce the health and economic burden of skin cancer.

Video-recording was first used to assess performance during neonatal resuscitation by Neil Finer and colleagues at the University of California, San Diego (UCSD).1 I visited UCSD in 2003, where Wade Rich very kindly showed me recordings from their delivery rooms (DRs). Some of them, he opined, were ‘not our finest moments’. The first showed three anxious clinicians, each simultaneously applying a stethoscope to the chest of a spontaneously breathing preterm infant to assess the heart rate. I quickly concluded that (1) while no harm was done, it was a bit of a stuff-up; (2) it was very familiar; (3) as this was the first video I had seen, I had done it myself or had been present when it happened; and (4) this was so enlightening, I had to convince my colleagues in Melbourne, Australia, that we should video in the DR too. At UCSD, recording was part of a quality assurance project; parental permission was not required and confidentiality was assured under California law. As this did not apply in Victoria, enthusiasm was tempered by fears of medicolegal repercussions and staff rebellion. We proposed seeking parents’ permission to record before birth if time allowed. If it did not, we proposed recording and seeking their permission to view it afterwards. We agreed that we would not make copies because, if we did, we could not control where the recordings might end up or guarantee the confidentiality of the babies or the staff involved (perhaps prescient, as it predated social media). With the blessing of our ethics committee, we …

Highlights • Removing minimum age firearm law associated with increased rate of monthly patients. • No differences noted in patient race, age, sex, or county of residence. • Intentionality and shooter characteristics were similar in both groups. • Rates of mortality and permanent disability increased following implementation. • Mean hospital length of stay increased from 7.36 to 9.50 days., At this time, the relationship between firearm minimum age laws and pediatric injury rates remains unclear. In September 2015, Alabama implemented Act 2015–341 (Act 341) which allowed minors to carry guns with parental permission. The purpose of this study was to evaluate the effect that Act 341 had on firearm injury rates. We created a database of all pediatric patients who presented to the Children’s of Alabama’s (CoA) emergency department and the Jefferson County Coroner’s Office (JCCO) with a gunshot wound injury between May 2011 to December 2019. Wilcoxon ranked sum test analysis were used to contrast the average number of monthly patients arriving before and after implementation of Act 341 and Wilcoxon ranked sum test and Fisher Exact were used to evaluate differences in demographic and outcome data. A total of 316 patients presented within the specified time period with 116 arriving prior to Act 341 and 200 arriving after; an average of 2.21 and 3.85 patients per month respectively. We found an increase of 1.63 patients per month (p