A new standard of care

In the October 2018 issue of Pediatrics, the American Academy of Pediatrics issued its first-ever policy statement on the care and support for transgender and gender-diverse youth. In that statement, the AAP took an official stand against some of the legacy practices such as “watchful waiting” — hoping the child grows out of gender confusion — and “conversion therapy” — the process of trying to push a child toward a more socially acceptable identity. Instead, the AAP issued its support for an approach that focuses on “promoting the health and positive development of youth that identify as transgender or gender diverse while eliminating discrimination and stigma (Raferty, 2018, para. 1)."

“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,” according to a summary of the statement. “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 (AAP Policy Statement Urges Support and Care, 2018, para. 8)."

The AAP crafted the statement after a thorough analysis of the most recent data, citing one study in particular that found 56% of youth who identify as transgender have contemplated suicide and 31% have attempted suicide. For those who identify with the sex assigned to them at birth, those numbers are markedly lower, with 20% reporting suicidal thoughts and 11% reporting suicide attempts.

“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 Dr. 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 well-being (AAP Policy Statement Urges Support and Care, 2018, para. 4)."

In an interview with NBC News, Rafferty stressed that this statement does not mark a policy change for the AAP, but instead brings the AAP’s policies more in line with current best practices.

“Just being able to stay on top of that gives the provider a sense of confidence and understanding that they actually can play an important role even if they're not the one providing the treatments,” Rafferty told NBC News. “Those initial steps of supporting someone through coming out, and through disclosure, and working with their family — it can really be lifesaving (Pediatric group recommends 'affirmative care' for transgender youth, 2018, para. 10)."

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Read the AAP’s policy statement as presented in the AAP journal Pediatrics, along with its list of recommendations for parents and practitioners.

Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents


Fitzsimons, T. (2018, September 17). Pediatric group recommends 'affirmative care' for transgender youth. NBC News. https://www.nbcnews.com/feature/nbc-out/pediatricians-group-recommends-affirmative-care-transgender-youth-n910451

Rafferty, J., AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. (2018, October). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142(4). https://pediatrics.aappublications.org/content/142/4/e20182162

Gender Identity Gender identity icon Our core sense of who we are as a man, a woman, a mixture of both, or neither.

Gender Expression Gender expression icon How we show up in the world through choices like clothing, hair style, mannerisms or tone of voice.

Attraction attraction icon How we feel toward others sexually, romantically and/or emotionally.

Biological Sex Biological sex icon Physical attributes such as reproductive organs and genitalia, chromosomes, genes and hormone levels.

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