PEARL-AI Framework
PEARL-AI Framework for Ethical AI in Child Health
Chng SY, Tern MJW, Lee YS, Cheng LTE, Kapur J, Eriksson JG, Chong YS, Savulescu J. npj Digital Medicine. 2025 Mar 10.
Abstract
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.

PEARL-AI framework for clinicians, academics, administrators and developers

RecommendationActionFulfillment (Complete/Partial/Absent/Not Applicable) with Elaboration
Ensure AI used in healthcare promotes children's development and wellbeingAI development/implementation prioritizes benefitting children and supporting children's well-being
There is no or minimal potential risk of harm to children from use of the AI-enabled system
Ensure safety for children when AI is used in healthcareThe 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
A fail-safe design is adopted to assure that the performance of the AI-enabled system does not degrade in unforeseen circumstances
There is thorough testing for accuracy, safety, security, reproducibility and robustness before the AI-enabled system is deployed on children
There is a process to continuously assess and monitor the impact of the AI-enabled system on children
There is clear documentation as to when AI models are created, validated, and set to expire
The AI-enabled system is secure from unauthorized access, modification and disruption whilst maintaining confidentiality, integrity and availability
Ensure inclusion of and for children during the design and development of healthcare AIThere is meaningful child participation in AI policies and in the design and development processes
AI development utilizes randomized controlled trials in children where feasible
Ensure AI used in healthcare for children prioritize fairness, non-discrimination and equitable accessDatasets include children as subjects
Datasets are not biased against certain groups of children based on age, ethnicity, region or socioeconomic status
Tests for fairness (in children and in particular sub-groups of children) using suitable metrics are performed
There is equitable access to the AI-enabled system for all children, regardless of socioeconomic status
Ensure AI-enabled healthcare systems protect children's data and privacyData collection is minimized with only necessary data collected
Consent is required from parents and guardians for the collection, use or storage of younger children's data
Children are able to access, understand the use of, and delete their data in accordance with maturity
Children who reach the age of consent are able to reverse parental consent previously given
Ensure that AI in healthcare supports transparency, explainability and accountability for childrenMedical 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
Parents and children are informed regarding how the AI-enabled system uses and maintains confidential data
The AI-enabled system includes a statement on authorizing its use in children, including evidence that supports use in children or a lack thereof
Developers use interpretable and not black-box AI for building AI-enabled systems for children, in particular for irreversible decisions with far reaching consequences
Developers and manufacturers provide accessible mechanisms to medical professionals and families for reporting and escalating concerns on the AI-enabled system