Paeds · professional-practice-and-evidence
Confidentiality with children and adolescents
Also known as Adolescent confidentiality · Conditional confidentiality paediatrics · Mature minor doctrine · Gillick competence confidentiality · Fraser guidelines contraception · Information sharing in child health · Privacy and the young patient
Fellowship-level approach to confidentiality with children and adolescents: conditional confidentiality, Gillick/Fraser competence and the mature-minor doctrine, the three narrow overrides (serious harm, abuse, legal duty), parental requests for information, electronic-record and billing breaches, safeguarding overrides and regional frameworks across ANZ, UK and North America.
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Target exams
Red flags
- A clinician promising absolute secrecy to coax a disclosure — the promise is a betrayal waiting to happen
- Portal or billing auto-disclosure that reveals a contraception, mental-health or sexual-health visit to a parent
- A competent adolescent's information handed to a parent who demands it, without assessing capacity or the young person's wishes
- Confidentiality breached for low-grade risk such as occasional vaping, without a defensible threshold
- An override performed silently — the young person never told what was shared or why
- All minors assumed to lack capacity, so every result defaults to the parent by rule rather than by assessment
Life stages
Care settings
Clinical exam formats
Board mappings
- Ethics and Professionalism
- Adolescent Medicine
- General and Community Paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 14: Professional behaviour and ethical conduct
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 19: Ethics and professional behaviour
- Renewed curriculum for first-year trainees from 2027 — Learning goal 20: Child safety and maltreatment
- Clinical Applications
- Communication
- Long Cases
- 1. Professional values and behaviours
- 2. Professional skills and knowledge: communication
- 8. Safeguarding
- General Paediatrics: Works in partnership with children, young people and families
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History taking and management planning
- General Pediatrics Content Outline — Domain 4: Psychosocial Issues
- General Pediatrics Content Outline — Universal Task 5: Communication
- General Pediatrics Content Outline — Universal Task 6: Systems-Based Practice
- General Pediatrics Content Outline — Domain 9: Ethics
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Professionalism 1: Professional Behavior and Ethical Principles
- Professionalism 2: Accountability and Conscientiousness
- Systems-Based Practice 2: System Navigation for Patient-Centered Care
- Communicator
- Professional
- Collaborator
- Health Advocate
- Pediatrics: Foundations EPA #8 — Communicating assessment findings and management plans to patients and/or families
Overview & Definition
A 15-year-old sits opposite you and asks, "If I tell you something, will you tell my parents?" The answer you give in that moment is the whole topic. Get it right and the young person talks; get it wrong and they go quiet, then go elsewhere. Confidentiality is the duty to protect personal health information shared within the clinical relationship, and for an adolescent it is also a developmental claim on their own privacy. [1] [2]
Confidentiality is not secrecy. The clinical relationship cannot run on a promise that nothing will ever leave the room, because some disclosures must be acted on. What you offer instead is conditional confidentiality: private unless there is serious risk of harm to the young person or others, abuse or neglect, or a legal duty to act. The conditional framing is the safeguard that lets you keep the promise you actually make. [6] [8]
Two legal tools sit underneath the practice. Capacity decides whether the young person can consent to care and control their own information — assessed by the Gillick or Fraser test in the UK and by the mature-minor doctrine in common-law Australasia. The override threshold decides when the duty to protect outranks the duty to keep confidence. Your job is to hold both, for every young person, every visit. [9] [10]
References14ShowHide
- [1]Chung RJ, Lee JB, Alderman EM, et al Confidentiality in the Care of Adolescents: Policy Statement. Pediatrics, 2024.PMID 38646690
- [2]Ford CA, Millstein SG Delivery of confidentiality assurances to adolescents by primary care physicians. Archives of pediatrics & adolescent medicine, 1997.PMID 9158445
- [3]Miller VA, Friedrich E, García-España JF, et al. Adolescents Spending Time Alone With Pediatricians During Routine Visits: Perspectives of Parents in a Primary Care Clinic. The Journal of adolescent health, 2018.PMID 29887486
- [4]Pasternak RH, Alderman EM, English A 21st Century Cures Act ONC Rule: Implications for Adolescent Care and Confidentiality Protections. Pediatrics, 2023.PMID 37010402
- [5]McKay EA, Brar P, Mehus CJ, et al. Parents' Perspectives on Confidentiality in Clinical Preventive Services for Adolescents. The Journal of adolescent health, 2025.PMID 40580168
- [6]Berlan ED, Bravender T Confidentiality, consent, and caring for the adolescent patient. Current opinion in pediatrics, 2009.PMID 19474734
- [7]Sharko M, Jameson R, Ancker JS, et al. State-by-State Variability in Adolescent Privacy Laws. Pediatrics, 2022.PMID 35531640
- [8]American College of Obstetricians and Gynecologists Confidentiality in Adolescent Health Care: ACOG Committee Opinion, Number 803. Obstetrics and gynecology, 2020.PMID 32217979
- [9]Larcher V, Hutchinson A How should paediatricians assess Gillick competence? Archives of disease in childhood, 2010.PMID 19948515
- [10]Wheeler R Gillick or Fraser? A plea for consistency over competence in children. BMJ, 2006.PMID 16601020
- [11]Bird S Adolescents and confidentiality. Australian family physician, 2007.PMID 17676192
- [12]Breuner CC, Alderman EM, Jewell JA The Hospitalized Adolescent. Pediatrics, 2023.PMID 36995186
- [13]Silber TJ Adolescent brain development and the mature minor doctrine. Adolescent medicine: state of the art reviews, 2011.PMID 22106735
- [14]Royal Australasian College of Physicians Privacy in paediatrics. Journal of paediatrics and child health, 2016.PMID 27124837