A three-year-old preoperatively will need restraints to stop pulling an NG tube out. Consent has been given by the parents preoperatively. Should the nurse apply the restraints?

• A. Yes, parents gave consent.
• B. No, restraints require the child’s assent.
• C. Only if the patient agrees at the time.
• D. Restraints are not permitted in pediatrics.

Answer: (A)

When a child is too young to give legal consent, the authority to authorize a treatment or safety measure falls to the parent or guardian. Restraints to prevent pulling out an NG tube are a safety-related treatment, so parental consent covers their use in this situation. A three-year-old cannot provide informed assent in a way that would substitute for parental consent, and requiring the child’s agreement at the moment isn’t appropriate. With the parents’ preoperative consent, applying restraints is appropriate if they are used minimally and for the shortest duration necessary, with ongoing monitoring and reassessment by the care team. Restraints are not categorically prohibited in pediatrics; they may be used when medically necessary with proper consent and oversight.