Decision-making capacity in pediatric health care is crucial for upholding ethical practices and protecting patient autonomy. It involves a patient’s ability to understand the benefits, risks, and alternatives of a proposed treatment or intervention, demonstrate understanding, appreciate the consequences, reason clearly, and communicate their wishes. Informed consent and assent are essential concepts in pediatric decision-making, ensuring that patients, including children, clearly understand their treatment options, and voluntarily agree to them. The involvement of children in medical decisions should be proportional to their developmental stage, with adolescents having more autonomy in health care decisions.