Age assessment practices: a literature review & annotated ... - Unicef

school records and exercise books and health clinic records for example, although
Cleveland notes that with health records, the date of birth recorded is generally quite
inaccurate unless the first clinic visit occurred within a few months of birth (1989:404).
However, the accuracy of age assessment using a community ranking system is dependent
on a number of factors including the size of the community and the age of the relative
children. McKay (1970:27) outlines how in larger villages (of 400 plus inhabitants) there will
be an increasing number of mothers who are unaware of births which may be close to each
other. He also suggests that it becomes more difficult with older children (age 5 and over)
when maternal memory becomes confused by several subsequent pregnancies, and in
smaller villages (under 100) where births may be too spread out in time for an adequate
ranking matrix to be developed. In addition, the creation of such calendars or ranking
systems is time and resource intensive, and can take weeks to prepare (Jelliffe, 1966:827).
4.5 Ethical concerns regarding age assessment methodologies
In addition to concerns about the accuracy of bone and dental age assessments, many from
within the medical community, as well as external critics, have raised concerns about the
ethics of such forms of medical testing, and the Royal College of Radiologists in London has
advised its fellows and members that it was „inappropriate‟ to undertake a radiograph
examination for the purposes of age estimation‟ (Ruxton in Einzenberger 2003).
Although the exposure to radiation during an X-ray in relation to an age assessment is
minimal there are also ethical concerns around exposing children to any level of radiation.
European Council Directive 97/43/Euratom on health protection of individuals against the
dangers of ionizing radiation in relation to medical exposure, notes that medical exposure
constitutes the major source exposure to artificial sources of ionising radiation in European
Union citizens. Article 3 of this Directive outlines that the net benefit to an individual must
outweigh the risks to the detriment of the individual. It is difficult to see how exposure to
radiation as part of an age assessment procedure can have any benefits to the individual.
Article 3 further states that special attention should be given to the justification of exposure
to radiation where there is no direct health benefit to the individual. The Directive also calls
for special attention to be exercised when exposing children to radiation and outlines that
Member States must use appropriate radiological equipment, practice techniques and
equipment when the individual is a child. In any event exposure should only take place with
the consent of the individual after they have been informed of the risks inherent in the
procedure.
Crawley notes how in the UK, central to the dental and medical professions‟ ethical codes
are principles of patient autonomy, welfare and consent. Dental and bone age testing is
carried out by a small number of physicians and dentists who are contracted and paid by the
government, which breaches all three of these ethical principles (Crawley 2007). Ranta
(2003) also explains that when age assessment is done for forensic reasons, there are
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