Pediatrics, or more specifically, the medical care of children, is the most legally distinct of the medical specialties. This legal uniqueness has three threads. The first is consent to care. Children may not legally determine their own care, but neither are parents fully empowered to control their child’s medical care. The second is communication with the physician. Very young patients are unable to communicate their medical needs to a physician effectively. Finally, childhood immunizations are the front line in protecting society from epidemic communicable diseases. Immunization, with the potential risk of serious sequelae, creates a conflict between the child’s individual medical care needs and the protection of society.

Until the late 1800s, parents had almost unlimited power over their children. Physical abuse of children was tolerated, and neglect, even to the point of death, was common. Children were treated as the property of the father. This presumption of complete power over the child was challenged under the laws designed to prevent cruelty to animals. Specific child protective laws followed, and now all states attempt to protect children from abuse and neglect. These laws, combined with public health laws and the U.S. Supreme Court decisions on reproductive rights, have greatly limited parental rights to deny children needed medical care.

In general, persons under 18 years old do not have the right to consent to their own medical care. Unless the parents’ legal rights have been terminated, the parents of a minor have the sole authority to consent to medical care for the minor. In most states, if the parents are married to each other, they have an equal right to consent to medical care for the children of that marriage. If the parents are divorced or were never married, the parent with legal custody of the child may have the sole right to consent to care for the child. This does not give the physician the legal right to force care on a mature minor, nor may the physician render medically questionable care, such as a sterilization, at the parents’ request.