In addition to the determinations required under other applicable sections of this subpart D, the IRB must determine that adequate provisions are made for soliciting the assent of the children when in the judgment of the IRB the children are capable of providing assent.

In determining whether children are capable of providing assent, the IRB must take into account the ages, maturity, and psychological state of the children involved. This judgment may be made for all children to be involved in clinical investigations under a particular protocol, or for each child, as the IRB deems appropriate.

The assent of the children is not a necessary condition for proceeding with the clinical investigation if the IRB determines:

That the capability of some or all of the children is so limited that they cannot reasonably be consulted, or

That the intervention or procedure involved in the clinical investigation holds out a prospect of direct benefit that is important to the health or well-being of the children and is available only in the context of the clinical investigation.

Even where the IRB determines that the subjects are capable of assenting, the IRB may still waive the assent requirement if it finds and documents that:

The clinical investigation involves no more than minimal risk to the subjects;

The waiver will not adversely affect the rights and welfare of the subjects;

The clinical investigation could not practicably be carried out without the waiver; and

Whenever appropriate, the subjects will be provided with additional pertinent information after participation.

In addition to the determinations required under other applicable sections of this subpart D, the IRB must determine, in accordance with and to the extent that consent is required under part 50, that the permission of each child's parents or guardian is granted.

Where parental permission is to be obtained, the IRB may find that the permission of one parent is sufficient for clinical investigations to be conducted under § 50.51 or § 50.52.

Where clinical investigations are covered by § 50.53 or § 50.54 and permission is to be obtained from parents, both parents must give their permission unless one parent is deceased, unknown, incompetent, or not reasonably available, or when only one parent has legal responsibility for the care and custody of the child.

Permission by parents or guardians must be documented in accordance with and to the extent required by § 50.27.

When the IRB determines that assent is required, it must also determine whether and how assent must be documented.