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Transgender children need support from families, doctors, schools: report :

September 29, 2016

“I’m really a girl on the inside.” “I should have been born in a different body.” “I wish I could be a boy.”

Some children, even those in supportive families, grapple with extreme distress or discomfort when their gender identity is different from their sex assigned at birth. While patience and support are recommended for a child exploring gender identity, transgender children often require even more active care, according to a new AAP-endorsed brief out today from the Human Rights Campaign Foundation.

The brief “Supporting & Caring for Transgender Children,” available at explores myths, presents a review of what medical and education experts know about transgender children and offers suggestions for adults with a transgender child in their life, focusing on ages 5-10 years.

Medical and mental health providers are vital resources for transgender and gender-expansive children exploring their gender identity, the report states. Transgender children whose families work with a trusted medical provider are generally less anxious and depressed, and their families also have more effective coping strategies.

“The pediatrician’s office, and the entire health care setting, should be a safe, accepting place for transgender children and youth,” said AAP President Benard P. Dreyer, M.D., FAAP. Dr. Dreyer addressed the topic in the August AAP News “Letter from the President,”

Understanding terms, forms of expression

The brief describes terms and reviews gender dysphoria, gender transition and understanding the transition debate. For example, transgender is not a sexual orientation; it describes someone’s gender, not the person’s attraction to other people.

The signs that a child’s gender is “different” can be evident at any age, according to the report. Some youths are clear about their identity and others take time to figure it out. Sometimes identity can appear to be in flux. And kids may express themselves differently in different settings.

Some children are just nontypical in their gender expression and are exploring roles that don’t conform to society’s expectations. They are described as gender-expansive, and transgender kids are a subset of gender-expansive children.

Gender transition — the steps taken to affirm the gender that is authentic to the child — can include social, medical, surgical and legal changes but, for children who have not reached puberty, the transition only involves social changes, like a preferred name or clothing choices.

Patience, support

A transgender child’s pressures at home, school and elsewhere in the community can be overwhelming, even leading to depression, anxiety, self-harm and suicide. That is why patience and support are so important.

Many families, as well, face stress and uncertainty over their children’s gender-expansive behaviors. However, the report authors advise refraining from trying to force the child to pick one identity over another.

“Gender-expansive children are healthiest when they are in control of their gender expression, whether that means the toys they play with or the name they ask to be called,” the report states.

Several members of the AAP Section on Lesbian, Gay, Bisexual and Transgender Health and Wellness contributed to the brief and helped review it. The document also is endorsed by the American College of Osteopathic Pediatricians.

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