AAP Policy Statement Urges Support and Care of Transgender and Gender-Diverse Children and Adolescents

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 feelings.”

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 health care.
• Providing family-based 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.
• Supporting insurance 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.”

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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