The pediatric AI readiness framework: bridging evidence to practice in pediatric artificial intelligence

Artificial intelligence (AI) presents a transformative opportunity for pediatric healthcare, promising advancements in early diagnosis, personalized treatment, and operational efficiency. However, the unique developmental, physiological, and ethical considerations inherent to children necessitate a specialized approach to AI integration. This study introduces the Pediatric AI Readiness (PAIR) Framework-a pediatric-focused implementation-readiness checklist intended to support clinicians, health system leaders, regulators, and developers as they plan, evaluate, and operationalize AI tools in pediatric settings. PAIR complements existing AI development, evaluation, and reporting guidance by focusing on institutional and workflow readiness for real-world use. It organizes readiness considerations across seven domains: ethics and governance, population and data representativeness, validation and testing, workflow integration, economic and sustainability analysis, low-resource adaptability, and transparent reporting. By prioritizing child-centric design, rigorous validation, and collaborative governance, the PAIR framework aims to bridge the critical gap between AI innovation and its responsible application, fostering improved design and healthier futures for children.