June 18, 2021

How to support positive gender identity development in your children


Discover what you need to know about gender identity and how to tap into medical and community resources.

The topic of gender identity can be confusing for both parents and children. Learning about it can help you create an open and supportive environment for your children if they are exploring gender identity or gender variance. Leading by example and avoiding the perpetuation of gender stereotypes, you can instill in your children the values of inclusivity and compassion.

We asked Cassandra Brady, M.D., at Vanderbilt’s Pediatric and Adolescent Transgender Clinic to provide some useful guidelines for navigating gender identity with kids and where to turn for support.

Assigned gender and gender identity: What’s the difference?

At birth, a child is assigned a gender based on physical parts, such as genitalia, but assigned gender and gender identity can be different (or variant). We all develop an internal sense of being, and part of that relates to gender. According to the American Academy of Pediatrics, we may identify as male, female, somewhere in the middle, a combination of male and female, or as neither of these genders.

“Gender identity begins around age 2,” Brady said. “This is about the time when children can tell the difference between boy or girl.” At around 3 to 3 and a half years, they can then often label the gender with which they identify. By about 3 and a half to 5 years, children are even more consistent with gender identity, Brady added.

Avoid policing gender identity

If your child is expressing a gender-variant identity at any age, your role as a parent should be to remain open and supportive, Brady said. Don’t force or “police” your child to conform to their assigned gender. “Policing could increase anxiety and depression in an already at-risk group of children,” Brady explained. “Policing could cause low self-esteem.”

Children who are gender variant have an increased risk for mental health conditions and suicide, Brady cautioned. However, a recent study in BMC Public Health shows parental support can dramatically reduce suicide risk in gender-variant individuals.

Avoid perpetuating gender stereotypes

Through your words and actions, you can help your child develop a positive gender identity and an overall empowered sense of self. This is important whether or not your child’s gender identity is the same as their assigned gender.

Brady recommends letting children choose the things they like to do. “It is important that parents do not always assign a gender label with activities or toys,” she said. For example, girls should be allowed to play with action figures, and boys should be allowed to play with dolls if they wish.

How we talk to or praise our kids is just as important. “Children begin to associate terminology with a specific gender,” Brady said. “Parents can focus on strengths that are not related to appearance or that are not gender specific.” The National Center on Parent, Family and Community Engagement has a helpful guide on fostering healthy gender development and expression as well as modeling inclusivity.

Recognizing gender variant identity and how to support your child

Your child might express a gender-variant identity in different ways. “The child or adolescent will be persistent, insistent and consistent with their desires and behaviors,” Brady said. “Examples may be what the child pretends to be in playtime or how the child chooses to dress. The child or adolescent may also voice that they prefer a different name.”

Support is key. “Parents should not, in any way, make the child feel bad or wrong for their behavior,” Brady said. “They should not try to ‘change’ the child either.”

She recommends families seek support and guidance from a mental health provider, a primary care physician or a care provider at the Pediatric and Adolescent Transgender Clinic.

The clinic, part of the Monroe Carell Jr. Children’s Hospital at Vanderbilt, works to develop a personalized plan of care that best suits the needs of the child or adolescent and their family. The clinic provides pubertal blocking therapy and hormonal therapy and addresses adolescent health, gynecological care and psychological needs. Providers at the adolescent clinic also work closely with adult providers to aid the person in their transition to adulthood and help navigate any surgical considerations.

“We serve as advocates for the individuals in our clinic and provide resources for them,” Brady said. For example, Trans Buddy is an advocacy resource through Vanderbilt’s Program for LGBTQ Health. “It pairs an individual advocate with an LGBTQ patient to support them in their healthcare navigation.”

Brady suggests that parents also consider connecting with a local youth center that fosters positive development through a variety of programs, and PFLAG Nashville, which offers free support and community to LGBTQ individuals and their loved ones.

“Parents should realize that this process is not only a transition for their children but a transition for the entire family,” Brady said. “They should also seek care for themselves in this process so they can best provide support to their children. And reach out to other families who are in this process to learn from them and to support each other.”

Christy Mullen, M.S.N., R.N., CPN Case Manager, and Carla Jackson, LMSW, also contributed to this story.

Monroe Carell Jr. Children’s Hospital at Vanderbilt’s Division of Endocrinology provides care to gender variant and transgender children and adolescents. The Transgender Clinic offers a setting for your family to receive education and resources regarding medical transition. For more information, call 615-322-7427 or click here.