Working with children is one of the most rewarding aspects of physiotherapy practice but it also comes with complex legal, ethical and professional responsibilities. 

Whether you’re treating a toddler with developmental delay, a young athlete recovering from injury or a teenager navigating chronic pain, providing healthcare to children goes beyond diagnosis and treatment. 

It means recognising children as individuals with rights, emerging autonomy, unique vulnerabilities and diverse support systems. 

It also requires physiotherapists to uphold strict legal obligations in areas like consent, confidentiality and child safety laws, while working in partnership with families, schools and other health professionals to ensure that each child receives safe, culturally appropriate care. 

As a physiotherapist, you hold a position of trust—often treating children in situations where they may feel anxious, dependent or unsure. In addition to protecting you professionally, understanding the legal and ethical boundaries of your practice protects children, strengthens therapeutic relationships and leads to better clinical outcomes. 

Consent 

Consent forms the bedrock of safe and lawful physiotherapy practice. 

While we often think of consent as paperwork, legally and ethically, it represents a shared understanding between practitioner and patient. 

For adults (18 and over), consent must be: 

• informed—the patient has a clear understanding of the treatment, risks and alternatives
• voluntary—free from pressure
• given by someone with decision-making capacity. 

Without valid consent, treatment could be considered unlawful, with consequences ranging from professional complaints to allegations of assault. Physiotherapists must ensure that patients (or their guardians) understand:

• what a treatment involves
• the potential risks or complications
• all reasonable alternative options. 

This communication is not optional; it is part of the legal definition of valid consent. 

Consent can be: 

• express—spoken or written (eg, signing a consent form) 
• implied—demonstrated through behaviour (eg, offering a limb for assessment). 

Regardless of format, the key point is understanding and willingness. 

Who decides?

When working with children, the consent landscape becomes more nuanced. The usual rule is that a parent or legal guardian must give consent to a child’s healthcare. 

Gillick competence

Some children under 18, however, may possess enough maturity and understanding to make their own medical decisions. This is known as Gillick competence. 

A child may be considered Gillick competent if they: 

• demonstrate sufficient maturity
• understand the proposed treatment and its consequences. 

If assessed as competent, the young person can legally consent to their own care and in some cases their consent overrides parental preference. 

However, involving parents or guardians is still encouraged whenever appropriate, especially when there is uncertainty about the child’s understanding. 

Images, videos and recordings

If you are capturing images, video or a recording of a child for clinical, educational or research purposes, you must obtain clear, written consent. 

The child may consent themselves if they are Gillick competent. 

Otherwise, consent must come from a parent or guardian. 

You must explain the purpose and how the images will be used or stored. 

Documentation is critical here, particularly with rising digital privacy concerns in health settings. 

Confidentiality 

Physiotherapists have a legal and ethical obligation to protect patient privacy, including that of children. 

Clear, respectful communication with families about how information is used builds trust and helps prevent misunderstandings, especially in situations involving separated parents or complex family dynamics. 

You may only use or disclose a child’s information when: 

• it relates to the primary purpose it was collected for
• the patient or guardian has consented to its secondary use
• the use is required by law
• it is necessary to prevent a serious threat to life, health or safety
• it is needed for law enforcement purposes. 

Documentation 

Detailed, objective documentation is your first line of legal protection and one of the most powerful tools physiotherapists have to demonstrate ethical and lawful practice. 

Good documentation doesn’t just protect you; it supports continuity of care and ensures that every practitioner involved has a clear understanding of the child’s needs and circumstances. 

You should always document: 

• how you assessed a child’s capacity (especially when determining Gillick competence)
• any written consent obtained 
• explanations provided to the child or guardian
• any concerns regarding the child’s understanding or decision‑making ability
• any referrals to specialists for further assessment. 

Child safety obligations across Australia 

Physiotherapists across Australia share core legal and ethical duties when working with children but each state and territory has its own child safety frameworks, deadlines and regulatory requirements. 

It’s vital that physiotherapists have a solid understanding of both the national framework and their state or territory laws to remain compliant no matter where they practise. 

National Quality Framework 

Australia applies the National Principles for Child Safe Organisations, developed from the Royal Commission into Institutional Responses to Child Sexual Abuse. 

These principles guide states and territories in building safe, accountable environments for children. 

The National Principles for Child Safe Organisations are embedded in the National Quality Framework, which regulates early childhood education and care in Australia. 

Reforms under the National Quality Framework introduced major changes in September 2025 and January 2026, including: 

• stricter rules on using and storing images and video of children
• new policies for digital technology safety
• stronger reporting requirements for incidents of abuse. 

State and territory legislation

Since the introduction of the National Principles for Child Safe Organisations, states and territories have steadily strengthened their own laws to ensure greater accountability and consistency in how organisations protect children. 

Across Australia, governments have tightened reporting requirements, expanded oversight bodies and introduced or upgraded child‑safe standards that apply to health providers, schools, sporting groups and community organisations. 

These reforms aim to shift systems from reactive responses to proactive prevention—emphasising stronger governance, clearer expectations in relation to digital safety practices, improved incident reporting and culturally safe environments for Aboriginal and Torres Strait Islander children. 

While the specifics vary by jurisdiction, the national direction is clear: organisations working with children must embed robust, transparent and consistently applied safety measures into everyday practice. 

If you are a physiotherapist working with children, it’s critical that you understand your state and federal legal obligations for child safety. 

Putting it all into practice 

Working with children is both a privilege and a profound responsibility. 

As state and national governments strengthen their child safety frameworks, physiotherapists have an opportunity to lead by embedding ethical decision‑making, transparency and cultural safety into everyday practice. 

To deliver safe, ethical, legally compliant care to children, physiotherapists should: 

• strengthen communication with children in age‑appropriate ways
• assess capacity thoughtfully and document the process thoroughly
• involve parents and guardians whenever appropriate
• obtain written consent for treatment, images and video
• maintain transparent privacy practices
• develop or review child safety policies in line with state, territory and federal laws
• ensure training for all staff on legal obligations. 

By understanding the legal landscape—from consent to confidentiality and child‑safety legislation—and by approaching each child with curiosity, respect and care, physiotherapists can ensure that young people receive not only clinically effective support but support that protects their rights, nurtures their independence and promotes their overall wellbeing.