Original article from the American Academy of Pediatrics:
Gender-Diverse & Transgender Children
By: Jason Rafferty MD, MPH, EdM, FAAP
Some children have a gender identity that is different from their gender assigned at birth, and many have interests and hobbies that may align with the other gender. Some children, as the American Academy of Pediatrics explains, do not identify with either gender. They may feel like they are somewhere in between or have no gender. It is natural for parents to ask if it is "just a phase." But, there is no easy answer.
Gender diverse: An umbrella term to describe an ever-evolving array of labels people may apply when their gender identity, expression, or even perception does not conform to the norms and stereotypes others expect.
Gender identity: One's internal sense of who one is, based on an interaction of biological traits, developmental influences, and environmental conditions. This may be male, female, somewhere in between, a combination of both or neither. Self-recognition of gender identity develops over time, much the same way a child's physical body does.
Sexual orientation: One's sexual identity as it relates to who someone falls in love with or is attracted to. A person who is transgender still identifies as straight, gay, bisexual or something else. Like gender identity, an individual's physical and emotional attraction to a member of the same or the opposite sex cannot be changed and is very difficult to predict early in childhood.
Transgender: Usually used when gender diverse traits remain persistent, consistent, and insistent over time.
Accepting your child's gender-diverse identity
Research suggests that gender is something we are born with; it can't be changed by any interventions. It is critically important that children feel loved and accepted for who they are.
When disclosing their gender diverse identity, some kids might expect immediate acceptance and understanding. However, there is evidence that family members go through their own process of becoming more comfortable and understanding of a child's gender identity, thoughts, and feelings. One model suggests the process resembles the stages of grief: shock, denial, anger, bargaining, and acceptance.
Just as gender diverse children do best when their feelings are explored and validated, some parents may need their own emotional supports. They may also have many questions along their child's journey.
What parents can do:
When your child discloses their identity to you, respond in an affirming, supportive way. Understand that although gender identity is not able to be changed, it often is revealed over time as people discover more about themselves.
Accept and love your child as they are. Try to understand what they are feeling and experiencing. Even if there are disagreements, they will need your support and validation to develop into healthy teens and adults.
Stand up for your child when they are mistreated. Do not minimize the social pressure or bullying your child may be facing. See How You Can Help Your Child Avoid & Address Bullying.
Make it clear that slurs or jokes based on gender, gender identity, or sexual orientation are not tolerated. Express your disapproval of these types of jokes or slurs when you encounter them in the community or media.
Be on the look out for danger signs that may indicate a need for mental health support, such as anxiety, insecurity, depression, low self-esteem, and any emotional problems in your child and others who may not have a source of support otherwise.
Connect your child with LGBTQ organizations, resources, and events. It is important for them to know they are not alone.
Celebrate diversity in all forms. Provide access to a variety of books, movies, and materials—including those that positively represent gender diverse individuals. Point out LGBTQ celebrities and role models who stand up for the LGBTQ community, and people in general who demonstrate bravery in the face of social stigma.
Support your child's self-expression. Engage in conversations with them around their choices of clothing, jewelry, hairstyle, friends, and room decorations.
Reach out for education, resources, and support if you feel the need to deepen your own understanding of LGBTQ youth experiences. See Support Resources for Families of Gender Diverse Youth.
Gender affirmative care
Gender affirmative care is based on the belief that all children benefit from love and support. The goal of gender affirmative care is not treatment; it is to listen to a child and, with the help of parents and families, build understanding.
Sometimes, disagreements can cause frustration. But, the conversation can remain respectful. Through strong, nonjudgmental partnerships with patients and their families, pediatricians create a safe environment in which complicated emotions, questions, and concerns related to gender can be appreciated and explored. Gender affirmative care is most effective in a collaborative system with access to medical, mental health, and social services, including specific resources for parents and families.
Mental health support for gender-diverse youth
Support or rejection ultimately has little influence on the gender identity of youth; however, it may strongly affect young person's ability to openly share or discuss concerns about their identity and feelings. Gender-diverse identities and expressions are not mental disorders, but suppressing gender concerns can harm a child's emotional health and development and possibly contribute to high rates of depression, anxiety, and other mental health issues. A large proportion of teenage suicide attempts are linked to issues of gender and sexuality, particularly feelings of rejection. Many gay, lesbian, bisexual, and transgender individuals unfortunately attempt suicide during their lifetime.
As a parent, even when you struggle to understand and may not see eye-to-eye, your most important role is to offer understanding, respect, and unconditional love for your child. This builds trust and puts you in a better position to help them through difficult times. Research has shown that if a transgender teen has even just one supportive person their life, it greatly reduce their risk of suicide.
Transgender and gender-diverse children – like all children – need support, love and care from family, school and society. When supported and loved as they grow and develop, kids mature into happy and healthy adults. Pediatricians stand ready to assist in the healthy development of transgender and gender-diverse children.
When to talk with your child's pediatrician Talk to your child's pediatrician early and often. It is recommended that pediatricians start conversations with children as young as preschool about their bodies, feelings, and relationships. Pediatricians can help them understand and appreciate difficult feelings and concerns.
It is important to recognize that cross-gender preferences and play is a normal part of exploring gender and relationships for children regardless of their future gender identity. Routine conversations about gender creates an environment of support and reassurance so that children feel safe bringing up questions and concerns. It is also good practice for continuing these discussions at home. The best approach, for parents or pediatricians, is to nonjudgmentally ask questions that allow the child to talk about their experience and feelings before applying any labels or assumptions.
If your child is struggling with symptoms of depression, anxiety, isolation, or other emotional concerns, they may need to see a mental health professional who can offer additional support. If your child mentions any suicidal thinking, then it should be brought to the attention of your pediatrician or mental health professional right away.
For more information or help finding a support group for yourself or your child, please talk with your pediatrician. Ask your pediatrician if a telehealth visit by phone or video call is an option. Your child may feel more comfortable talking to their doctor from home. For teens, the telehealth visit should take place in as private of a place as possible so they can have a one-on-one conversation with the doctor. You can make a plan with the doctor about talking before or after they talk to your teen privately. If it’s a video call, and your child or teen would prefer to have the camera off, they can ask their doctor if that is okay. Telehealth visits can also be used for follow-up visits to check on your child’s progress.