# Pediatricians’ Perspective on the Role of Stepparents in Pediatric Medical Decision-Making

## TL;DR

Pediatricians in Belgium face challenges involving stepparents in medical decisions due to unclear legal guidelines, leading to inconsistent practices and risks for families and children.

## Contribution

The study provides new insights into how pediatricians navigate legal and relational complexities when involving stepparents in medical decision-making for minors.

## Key findings

- Pediatricians differentiate between information-sharing and formal consent when involving stepparents.
- Relational dynamics and perceived vulnerability strongly influence decisions about stepparent involvement.
- Inconsistent legal recognition of stepparents leads to risks for children, families, and physicians.

## Abstract

What are the main findings?
•Pediatricians consistently distinguish between information-sharing (often allowed) and formal consent (rarely granted) when stepparents accompany a child.•Decisions about involving stepparents depend strongly on the medical context, relational dynamics, and the perceived vulnerability of all actors involved.

Pediatricians consistently distinguish between information-sharing (often allowed) and formal consent (rarely granted) when stepparents accompany a child.

Decisions about involving stepparents depend strongly on the medical context, relational dynamics, and the perceived vulnerability of all actors involved.

What are the implications of the main findings?
•The absence of legal recognition for stepparents leads to inconsistent practices and exposes children, families, and physicians to avoidable risks.•Clearer guidance could support more consistent, child-centered decision-making.

The absence of legal recognition for stepparents leads to inconsistent practices and exposes children, families, and physicians to avoidable risks.

Clearer guidance could support more consistent, child-centered decision-making.

Background/Objectives: Shared decision-making is a central principle in pediatric practice, yet its implementation becomes challenging in the context of alternative family configurations. Stepparents have substantial caregiving roles, but Belgian legislation does not include them in medical information or decision-making authority, creating a gap between legal frameworks and clinical realities. The objective of this study was to explore pediatricians’ perspectives on the involvement of stepparents in medical information sharing and decision-making for minors, and to identify factors influencing whether and how stepparents are included. Methods: A qualitative study was conducted using six semi-structured focus group interviews with 30 pediatricians from six hospitals across Flanders, Belgium. Participants were purposively sampled based on clinical experience. The interviews explored experiences with consent, confidentiality, and stepparent involvement in pediatric care. Data were audio-recorded, transcribed verbatim, and analyzed using constant comparative analysis to identify overarching themes. Results: Three overarching themes emerged. First, the medical context strongly shaped decisions: medical information and minor decision-making were frequently shared, while major decision-making often involved consultation with the legal guardian. Second, relational dynamics, including the quality of the stepparent–child relationship, co-parenting conflict, and physicians’ intuitive assessments, influenced the extent to which stepparents were involved. Third, vulnerability was a recurring theme across all actors: physicians felt legally exposed, children risked fragmented care, legal guardians feared loss of control, and stepparents lacked recognition despite significant caregiving roles. Conclusions: This study shows the importance of a better alignment between clinical practice and legal reality. Aligning legal frameworks with contemporary family patterns may support more consistent, child-centered decision-making in pediatric practice.