Children's health

If your child has questions about gender identity or gender expression, you probably have questions too. Find out what you can do to help and support your child.

What are the basics of gender identity?

Sex assigned at birth and gender identity are two separate things. Sex assigned at birth is typically made based on external genital anatomy. But gender identity is the internal sense of being male, female, or a gender along the spectrum between male and female. People communicate their gender to others through gender expression. This may be done through mannerisms, clothing and hairstyles.

Gender identity develops separately from sexual orientation. People's sexual orientation is related to whom they're attracted to on a physical, emotional and romantic basis.

Is my child transgender?

Children who are transgender have a gender identity that doesn't match their assigned sex at birth.

In many cases, children will say how they feel. They may strongly identify as boys or girls. And sometimes they identify as neither or not fully male or female (nonbinary).

Most children go through periods of gender exploration through the way they dress and the toys they choose and by role-playing. Some may even insist that they are a gender that differs from that of their birth sex. However, this is likely not a phase if they continue to do so as they get older.

Most children between ages 18 and 24 months can recognize and label gender groups. They may identify others as girls, women or feminine. Or they may label others as boys, men or masculine. Most also label their own gender by the time they reach age 3.

However, society tends to have a narrow view of gender. As a result, some children learn to behave in ways that may not reflect their gender identity. At age 5 or 6, most children are rigid about gender and preferences. These feelings tend to become more flexible with age.

It's important to remember that gender identity and gender expression are different concepts. A child's gender identity doesn't always lead to a certain gender expression. And a child's gender expression doesn't always point to the child's gender identity.

Gender expressions and behaviors might include:

• Certain bathroom behavior, such as a girl insisting on standing up to urinate
• An aversion to wearing the bathing suit of the child's sex assigned at birth
• A preference for underwear typically worn by a different sex
• A strong desire to play with toys typically assigned to a different sex

Don't rush to label your child. Over time your child will continue to tell you what feels right.

How can I support a transgender child or a child who doesn't conform to assigned sex at birth?

Listen to your child's feelings about gender identity. Talk to your child and ask questions without judgment. To support your child, you can:

• Allow your child to express gender in public or at family activities. It's important to do this even if it makes you or someone else uncomfortable.
• Give your child access to gender-diverse friends, activities or resources.
• Don't assume your child's gender expression is a form of rebellion or defiance.
• Don't try to shame or punish your child for gender expression.
• Don't allow others in your family to belittle or ridicule your child's gender expression.
• Understand that experiencing discrimination isn't your child's fault.

Remember to speak positively about your child. Do this both to your child and to others. Show your approval for your child's gender identity and expression of it. You'll foster a positive sense of self in your child when you allow your child to express preferences. You'll also help keep lines of communication open.

Also, try to let go of expectations you might have had about your child's future. Instead, focus on what brings your child joy and security. A child living with supportive parents and caregivers is likely to be a happier child.

What kind of health care does my child need?

Your child needs a respectful and knowledgeable health care provider. Talk to your child's provider about your child's gender identity and behaviors. Your child's provider might recommend working with a specialist. If you're having trouble finding a provider with training in gender identity, ask a support group to recommend a specialist.

Talking to a therapist also is critical. Ask your child's health care provider to help you find a counselor with training in transgender needs.

What is social transitioning?

A social transition is a reversible step in which a child lives partially or completely in the preferred gender role. This can involve changing hairstyles, clothing, pronouns and, possibly, names. Limited research suggests that social transitioning might help ease depression or anxiety a child may have about gender identity.

Talk to your child and decide details about the transition. You may consider whom to tell about it. You might also plan which bathroom or locker room your child will use. You'll also need to consider whether transitioning at school or in the community will endanger your child. Seek the advice of a social agency or an advocacy group to help you determine the safety of the transition.

How can I advocate for my child?

You might worry that your transgender child will be shunned and experience discrimination. You may also worry your child could be physically harmed at school or in your community. Advocating for your child may help prevent these things from happening. Take these steps:

• Connect with other families who have gender-diverse children. This can help reduce isolation you and your child might be going through. Look for an in-person or online support group.

• Work with your child's school and teachers. Talk to them about how to stop or prevent bias and bullying before it starts. Ask for gender training to be included in staff development.

  Also come up with a plan for how your child will be addressed in school and which bathroom your child will use. It's helpful to talk to your child's school about how to interpret rules about taking part in team, club and overnight activities. Choose whether you want to share information about your child's gender identity with other parents.

  If your child is being harassed or discriminated against at school, speak to the school administrators. If the school system fails to address the problem, research your legal options.

• Reach out within your community. Outside of school, work with local institutions to make them safer for gender-diverse and transgender children. Also consider supporting or volunteering for gender diversity groups to learn more and help others.

Whatever your child's gender identity, do your homework and seek proper care. Showing love and acceptance helps children feel comfortable in their bodies and in the world.