We introduce the Pediatrics EthicAl Recommendations List for AI (PEARL-AI) framework for clinicians and AI developers to ensure ethical AI enabled systems in healthcare for children.

Link to paper: <a href="https://www.nature.com/articles/s41746-025-01541-1">https://www.nature.com/articles/s41746-025-01541-1 </a>

There does not exist any previous comprehensive review on AI ethics in child health or any guidelines for management, unlike in adult medicine. This review describes ethical principles in AI for child health and provides recommendations for child-centered medical AI. We also introduce the Pediatrics EthicAl Recommendations List for AI (PEARL-AI) framework for clinicians and AI developers to ensure ethical AI enabled systems in healthcare for children.<div class='projects__section'><div class='projects__pearlTable'><p class='projects__tableCaption'>PEARL-AI framework for clinicians, academics, administrators and developers</p><div class='projects__pearlTableScroll'><table class='projects__table'><thead><tr><th>Recommendation</th><th>Action</th><th>Fulfillment (Complete/Partial/Absent/Not Applicable) with Elaboration</th></tr></thead><tbody><tr><td rowspan='2'>Ensure AI used in healthcare promotes children's development and wellbeing</td><td>AI development/implementation prioritizes benefitting children and supporting children's well-being</td><td></td></tr><tr><td>There is no or minimal potential risk of harm to children from use of the AI-enabled system</td><td></td></tr><tr><td rowspan='6'>Ensure safety for children when AI is used in healthcare</td><td>The AI-enabled system used for pediatric healthcare has appropriate human agency, oversight and control measures with a human in the loop as far as possible</td><td></td></tr><tr><td>A fail-safe design is adopted to assure that the performance of the AI-enabled system does not degrade in unforeseen circumstances</td><td></td></tr><tr><td>There is thorough testing for accuracy, safety, security, reproducibility and robustness before the AI-enabled system is deployed on children</td><td></td></tr><tr><td>There is a process to continuously assess and monitor the impact of the AI-enabled system on children</td><td></td></tr><tr><td>There is clear documentation as to when AI models are created, validated, and set to expire</td><td></td></tr><tr><td>The AI-enabled system is secure from unauthorized access, modification and disruption whilst maintaining confidentiality, integrity and availability</td><td></td></tr><tr><td rowspan='2'>Ensure inclusion of and for children during the design and development of healthcare AI</td><td>There is meaningful child participation in AI policies and in the design and development processes</td><td></td></tr><tr><td>AI development utilizes randomized controlled trials in children where feasible</td><td></td></tr><tr><td rowspan='4'>Ensure AI used in healthcare for children prioritize fairness, non-discrimination and equitable access</td><td>Datasets include children as subjects</td><td></td></tr><tr><td>Datasets are not biased against certain groups of children based on age, ethnicity, region or socioeconomic status</td><td></td></tr><tr><td>Tests for fairness (in children and in particular sub-groups of children) using suitable metrics are performed</td><td></td></tr><tr><td>There is equitable access to the AI-enabled system for all children, regardless of socioeconomic status</td><td></td></tr><tr><td rowspan='4'>Ensure AI-enabled healthcare systems protect children's data and privacy</td><td>Data collection is minimized with only necessary data collected</td><td></td></tr><tr><td>Consent is required from parents and guardians for the collection, use or storage of younger children's data</td><td></td></tr><tr><td>Children are able to access, understand the use of, and delete their data in accordance with maturity</td><td></td></tr><tr><td>Children who reach the age of consent are able to reverse parental consent previously given</td><td></td></tr><tr><td rowspan='5'>Ensure that AI in healthcare supports transparency, explainability and accountability for children</td><td>Medical professionals, parents and children are informed about the use of an AI-enabled system, how the AI-enabled system makes its decisions, and its limitations</td><td></td></tr><tr><td>Parents and children are informed regarding how the AI-enabled system uses and maintains confidential data</td><td></td></tr><tr><td>The AI-enabled system includes a statement on authorizing its use in children, including evidence that supports use in children or a lack thereof</td><td></td></tr><tr><td>Developers use interpretable and not black-box AI for building AI-enabled systems for children, in particular for irreversible decisions with far reaching consequences</td><td></td></tr><tr><td>Developers and manufacturers provide accessible mechanisms to medical professionals and families for reporting and escalating concerns on the AI-enabled system</td><td></td></tr></tbody></table></div></div></div>