Payments related to research participation have a role to play in reducing barriers and equalizing access to research participation. The primary concern is that certain types or levels of payment may unduly influence a parent’s or child’s judgment about research participation and encourage decisions that are not in the child’s best interest. Payments to physicians for enrolling children in research also raise questions about undue influence and conflict of interest. Such payments should be limited to reimbursement for costs related to the conduct of research.

Although the specifics of an individual protocol may affect judgments about what payment practices are appropriate, IRBs should develop written policies to provide basic guidance for investigators and IRB members in developing or reviewing protocols and reduce inconsistent, ad hoc judgments. The process of developing written policies should encourage more systematic reflection on the fit between different payment practices and the ethical standards for clinical research involving children.