Intended for healthcare professionals

Practice Essentials

Consenting children aged under 18 for vaccination and treatment

BMJ 2022; 377 doi: (Published 14 June 2022) Cite this as: BMJ 2022;377:e068889
  1. Sonia Saxena, general practitioner/professor of primary care1,
  2. Helen Skirrow, clinical NIHR doctoral research fellow11,
  3. Arti Maini, general practitioner, coaching lead for Imperial Medical Education Innovation and Research Centre (MEdIC) and deputy director for undergraduate primary care education1,
  4. Benedict Hayhoe, general practitioner, clinical lecturer1,
  5. Nina Pollok, medical student2
  1. 1Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Leeds School of Medicine, University of Leeds, Leeds, UK
  1. Correspondence to S Saxena s.saxena{at}

What you need to know

  • Consider children’s best interests in all decisions about their medical treatment

  • Children under 18 are entitled to have a say in all decisions that affect them

  • Assess competence in any child under 16

  • Seek medical-legal expertise when competent children aged under 18 refuse treatment that may be in their best interest

Vaccine programmes for young people during the covid-19 pandemic have highlighted common legal and ethical dilemmas that can arise when consenting children aged under 18 for medical treatment or intervention.123 These can be especially challenging when a parent or guardian’s views differ from those of the child.

This article summarises the issues around consenting children under 18 for treatment using vaccination as an exemplar. Most of the article is based on guidance and law in the UK; however, the principles behind the laws described may be applicable in other settings. We recommend that health professionals outside the UK also check their local laws regarding consent for children’s treatments and vaccinations.

What are the governing principles for consenting under 18s?

To uphold human rights standards, the World Health Organization advises health professionals to adhere to principles laid out in the United Nations Convention on the Rights of the Child (box 1).45 These state that children’s best interests must be at the heart of all decisions and actions that affect them, that children have the right to have a say in decisions affecting them, and that their views must be considered and taken seriously.4

Box 1

Governing principles for consenting under 18s

  • Always consider the best interests of the child when making decisions

  • Good practice involves balancing obligations to promote and protect the interests of children while respecting their emergent autonomy

  • Children have rights to confidentiality, but they are not absolute

  • Children have a right to participate in decisions about their healthcare


In England and Wales, health professionals use Gillick competence …

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