The academy releases its first policy statement to
provide guidance for parents and clinicians through a gender-affirming approach
Transgender and gender-diverse children face many challenges
in life, but, like all children, they can grow into happy and healthy adults
when supported and loved throughout their development.
That is the underlying message within a new policy statement
published by the American Academy of Pediatrics (AAP) called, “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.” The statement, to be published October 2018 issue of Pediatrics
(published Sept. 17 online) aims to help pediatricians and parents navigate
health concerns of gender-diverse youth while advocating for ways to eliminate
discrimination and stigma.
Despite increasing public awareness and some legal
protections, children who identify as lesbian, gay, bisexual, transgender or
gender-diverse often lack adequate health care, including access to mental
health resources. In its first policy statement on the topic, the AAP reviews
the latest research and provides recommendations that focus specifically on
children who identify as transgender or gender-diverse, a term used to describe
people with gender behaviors, appearances or identities that do not align with
those culturally assigned to their birth sex.
“We know that family and community support are essential for
any child’s healthy development, and children who are gender-diverse are no
different,” said Jason Rafferty, MD, MPH, Ed, FAAP, lead author of the
statement. “What is most important is for a parent to listen, respect and
support their child’s self-expressed identity. This encourages open
conversations that may be difficult but key to the child’s mental health and
the family’s resilience and wellbeing.”
While the data is limited, population-based surveys estimate
that 0.7 percent of teens ages 13 to 17 identify as transgender, according to
the report. In this rapidly evolving clinical field, physicians play a role by
offering a safe and inclusive place for transgender and gender-diverse youth,
who have high rates of depression, anxiety, eating disorders, substance use,
self-harm and suicide.
Children who are supported by their parents and family are
more likely to experience better physical and mental health, according to the
AAP. In one study, 56 percent of youth who identified as transgender reported
thinking about suicide at some point, and 31 percent reported a previous
suicide attempt. That compares, respectively, to 20 percent and 11 percent of
youth who identify as cisgender, a term to describe a person who identifies a
gender consistent with the sex they were assigned at birth.
“We encourage families, schools and communities to value
every child for who they are in the present, even at a young age,” said Cora
Breuner, MD, FAAP, the chairperson for the AAP Committee on Adolescence. “As
pediatricians and parents, we also appreciate how challenging, and at times
confusing, it can be for family members to realize their child’s experience and
The AAP recommends taking a “gender-affirming,”
nonjudgmental approach that helps children feel safe in a society that too
often marginalizes or stigmatizes those seen as different. The gender-affirming
model strengthens family resiliency and takes the emphasis off heightened
concerns over gender while allowing children the freedom to focus on academics,
relationship-building and other typical developmental tasks.
Additional AAP recommendations include:
Providing youth with
access to comprehensive gender-affirming and developmentally appropriate
therapy and support be available to meet the needs of parents, caregivers
and siblings of youth who identify as transgender.
Making sure that
electronic health records, billing systems, patient-centered notification
systems and clinical research are designed to respect the asserted gender
identity of each patient while maintaining confidentiality.
plans that offer coverage specific to the needs of youth who identify as
transgender, including coverage for medical, psychological and, when
appropriate, surgical interventions.
Advocacy by pediatricians
within their communities, for policies and laws that seek to promote
acceptance of all children without fear of harassment, exclusion or
bullying because of gender expression.
“Transgender youth are more visible today than ever before,
empowered by others they see on the internet or in their communities,” said
Ilana Sherer, MD, FAAP, executive committee member of the AAP Section on
Lesbian, Gay, Bisexual and Transgender Health and Wellness. “They need our
continued support and love, and those of us in the medical community stand
prepared to help them.”
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds