{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:09:33Z","timestamp":1789006173479,"version":"build-2803163510"},"reference-count":8,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,1]]},"abstract":"<jats:p>Despite widespread therapeutic needs, the majority of medical and surgical devices used in children do not have approval or clearance from the Food and Drug Administration (FDA) for use in pediatric populations. The clinical need for devices to diagnose and treat diseases or conditions occurring in children has led to the widespread and necessary practice in pediatric medicine and surgery of using approved devices for \u201coff-label\u201d or \u201cphysician-directed\u201d applications that are not included in FDA-approved labeling. This practice is common and often appropriate, even with the highest-risk (class III) devices. The legal and regulatory framework used by the FDA for devices is complex, and economic or market barriers to medical and surgical device development for children are significant. Given the need for pediatric medical and surgical devices and the challenges to pediatric device development, off-label use is a necessary and appropriate part of care. In addition, because of the relatively uncommon nature of pediatric conditions, FDA clearance or approval often requires other regulatory pathways (eg, Humanitarian Device Exemption), which can cause confusion among pediatricians and payers about whether a specific use, even of an approved device, is considered experimental. This policy statement describes the appropriateness of off-label use of devices in children; the use of devices approved or cleared through the FDA regulatory processes, including through the Humanitarian Device Exemption; and the important need to increase pediatric device labeling information for all devices and especially those that pose the highest risk to children.<\/jats:p>","DOI":"10.1542\/peds.2016-3439","type":"journal-article","created":{"date-parts":[[2016,12,26]],"date-time":"2016-12-26T05:10:44Z","timestamp":1482729044000},"source":"Crossref","is-referenced-by-count":50,"title":["Off-Label Use of Medical Devices in Children"],"prefix":"10.1542","volume":"139","author":[{"name":"SECTION ON CARDIOLOGY AND CARDIAC SURGERY","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SECTION ON ORTHOPAEDICS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy J.","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Beekman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Hennrikus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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Overview of device regulation. Available at: www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/Overview\/default.htm. Accessed November 30, 2015"},{"issue":"1","key":"2021120904334094600_B2","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2008-3726","article-title":"Pathways to approval of pediatric cardiac devices in the United States: challenges and solutions.","volume":"124","author":"Beekman","year":"2009","journal-title":"Pediatrics"},{"key":"2021120904334094600_B3","unstructured":"US Food and Drug Administration. Guidance for industry and FDA Staff \u2013 humanitarian use device (HUD) designations. Available at: www.fda.gov\/ForIndustry\/DevelopingProductsforRareDiseasesConditions\/DesignatingHumanitarianUseDevicesHUDS\/LegislationRelatingtoHUDsHDEs\/ucm283517.htm. 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