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Many children are not in the custody of either biological parent. They may be in foster care, under the care of a relative, with a potential adoptive parent, or in other situations in which their caregiver is not a biological parent. If the child has a legally appointed guardian, the guardian must consent to the child's care in the same fashion as for an adult ward.

In some of these cases, no one has asked the court to appoint a guardian for the child. These children are in legal limbo; no one may consent to their care, but it is unthinkable to deny them necessary care because of their legal status. A child in need of immediate care should be treated as necessary while the hospital seeks to have the caregiver appointed as temporary guardian for the child. If the child is in need of simple elective care, that care should be postponed until a guardian is appointed. The physician should always notify child protective services when a child needs a legal guardian.

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