The concept of competency to consent to psychiatric treatment is discussed as a multi-faceted complex interaction involving: the developmental stage of the child and its effect on cognitive ability and rationality; their social environment and previous experience; their relationship with the professional as well as with their own family; the information presented to them about treatment as well as their understanding of that information; and their mental state at the time of deciding. All of these factors exist on a continuum or spectrum (i.e. in shades of grey and not in black and white) and therefore the application of rigid arbitrary limits is inappropriate. What is not in doubt is that the child deserves to be considered as an individual and its rights protected. The doctor's main duty is to the child, as the patient, and every opportunity to allow them to give proper informed consent must be provided. In the event of the child being found to be incompetent to consent, then the issue of proxy consent is also discussed, including the dangers of assuming that the parents will act in the child's best interests.