Confidentiality is key to the trust that children and young people need to have in their doctors. Without trust, children and young people might not give you important information.

In this guide:

Underlying principles
Access to medical records by young people or their parents
Sharing information without consent
Disclosures without consent for child protection
Child safeguarding: responding to requests for information
Sexual activity

Underlying principles

As set out in the GMC's guidance, you have the same duty of confidentiality to children and young people as to adults. This means that you should ask for the patient's consent (or the authority of someone with parental responsibility) before disclosing their identifiable information unless in exceptional circumstances.

Decisions about disclosure need to be taken carefully and the overriding consideration must always be the best interests of the child or young person.

Laws relating to children and young people vary across the UK. Get advice whenever you are not sure.

Access to medical records by young people or their parents

You should usually let children access their own health records, but not including information that would cause them serious harm or information about another person, who has not consented.

When a person with parental responsibility requests access to the records of a child or young person, you can provide access if the child/young person consents, or if they lack capacity and disclosure does not go against their best interests. You should not normally disclose information given to you by the child or young person in confidence, unless they agree.

Children and young people develop the capacity (maturity and understanding) to make their own disclosure decisions at their own pace. In England and Wales, children aged 16 and over can be presumed capable of consenting to medical treatment, and in the same way are usually considered able to agree to the release of their confidential information.

A child under 16 may be mature enough to understand what is involved in their proposed treatment. If so, they are also likely to be competent to make a decision about the extent to which information relating to that treatment can be provided to others, which may include their parents.

The position is different in Scotland, where a person aged 12 or over is presumed to be of sufficient age and maturity to be able to exercise their data protection rights, unless the contrary is shown.

We are commonly asked about disclosure of records to estranged parents of children and young people. For more on this, read our separate guide on children whose parents are separated.

Sharing information without consent

Disclosure without consent is justified when:

you judge that the disclosure is in the best interests of a child or young person who does not have the maturity or understanding to make a decision about disclosure
there is an overriding public interest in the disclosure
disclosure is required by law or ordered by a court.

Decisions about disclosure without consent are often nuanced and you need to be prepared to justify your decision, whether or not you disclose information. This can be particularly challenging if a child or young person has refused disclosure, in which case you should take their views into account but should disclose information if necessary to protect them, or someone else, from a risk of death or serious harm.

Seek advice when needed and keep careful records of your decisions and reasons.

If you do decide to disclose information without consent, it should be the minimum necessary information for the purpose, disclosed promptly to an appropriate person or authority.

Occasionally, this will include sharing information with a parent when a child has refused. This may happen when you judge that the child does not have the capacity to make their own decision and you believe it is necessary in the child's best interests for the information to be shared.

Keep a record of your discussions and reasons for sharing information without consent.

Disclosures without consent for child protection

If you believe a child or young person is the victim of, or at risk of, abuse or neglect, you must promptly inform an appropriate person or statutory body to prevent further harm.

Ask for consent to share information unless:

you have already decided to share information in the public interest, to protect the child/young person or others from serious harm
delay caused by seeking consent would increase the risk of serious harm
there is another compelling reason not to seek consent (for example, if you believe that asking the parent might increase the risk to the child),

The information you share should be restricted to what is reasonably necessary to achieve the object of child protection.

You should tell your patient what information has been shared, with whom and why, unless doing that would put the child, young person or anyone else at increased risk.

Such situations are often finely-balanced, so get advice from your local child protection lead if you are ever uncertain, and if you are concerned about possible abuse or neglect but do not believe that the child or young person is at risk of significant harm.

Members can also call us for advice.

Child safeguarding: responding to requests for information

Deal promptly with requests for information for child protection, to avoid delays that could increase risk to the child/young person.

If you are ordered by a court to provide information, you must abide by that. If you are ever unsure whether a court order is valid, or what it means for you, as an MDU member you can contact us to check.

You must also co-operate with requests for information needed for formal reviews relating to a child who has died or been seriously harmed, when abuse or neglect may have been a factor.

Before sharing, check the identity of the person who has requested the information, and that the request is valid, find out what information is needed and why, and how it may be used. If you do not have consent, you can still share information when you believe that doing so meets the public interest in protecting children and young people.

In England and Wales, the three safeguarding partners (the local authority, the Integrated Care Board (ICB) and the chief of police) are responsible for coordinating the effective safeguarding and welfare of children locally.

If a child dies unexpectedly, the local authority and the ICB will hold a child death review and may call you to a meeting to discuss the case. We can advise you on how best to contribute to the process.

The death of a child in suspicious circumstances may result in a child death review under chapter five of Working together to safeguard children. Again, we can assist you if you're involved in an investigation after the death of a child in such circumstances.

In either case, you may need to disclose the deceased child's records, but care should be taken not to disclose the notes of other family members without their consent. In some circumstances, you may be justified in disclosing limited information about other family members.

In Scotland, Child Protection Committees (CPCs) are responsible for multi-agency child protection policy, procedures, guidance and practice.

If a child dies unexpectedly, the death must be reported to the Crown Office and Procurator Fiscal Service (COPFS), and Police Scotland may investigate after appointing a child death senior investigating officer (CDSIO).

We can assist if you're involved in the investigation of such a death. Given that a collaborative and coordinated interagency approach is necessary, you may well need to disclose the medical records of the child in question. The safety of other children in the household will also need to be considered.

Sexual activity

Children and young people need a confidential sexual health service but, if a child or young person is involved in abusive or seriously harmful sexual activity, you must protect them by sharing information quickly and professionally with appropriate people/agencies (usually the police or social services).

Children under 13 are considered in law to be unable to consent so you should usually share information about sexual activity involving a child aged 12 or younger. If you are considering a decision not to disclose, you should discuss with a named or designated child protection lead and keep a good record of your reasoning.

Take each case on its merits taking into account maturity and any particular vulnerabilities or concerns.

Other than these exceptional cases, you should keep consultations with children and young people confidential. As outlined in the GMC's guidance, you can provide sexual health advice and treatment (including about contraception, abortion, STIs) without parental knowledge or consent, to young people under 16 provided that:

they understand all aspects of the advice and its implications
you cannot persuade the young person to tell their parents or to allow you to tell them
in relation to contraception and STIs, the young person is very likely to have sex with or without such treatment
their physical or mental health is likely to suffer unless they receive such advice or treatment, and
it is in the best interests of the young person to receive the advice and treatment without parental knowledge or consent.

Members can contact us for individual advice at any time.

Confidentiality: children and young people

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