Development of gender identity in children

Gender Identity Development in Children

By: Jason Rafferty MD, MPH, EdM, FAAP

There are many ways parents can promote healthy gender development in children. It helps to understand gender identity and how it forms.

What's the difference between gender and sex?

Being a boy or a girl, for most children, is something that feels very natural. At birth, babies are assigned male or female based on physical characteristics. This refers to the "sex" or "assigned gender" of the child. Meanwhile, "gender identity" refers to an internal sense people have of who they are that comes from an interaction of biological traits, developmental influences, and environmental conditions. This may be male, female, somewhere in between, a combination of both or neither.

Self-recognition of gender identity develops over time, much the same way a child's physical body does. Most children's asserted gender identity aligns with their assigned gender (sex). However, for some children, the match between their assigned gender and gender identity is not so clear.

How does gender identity develop in children?

Gender identity typically develops in stages:

• Around age two: Children become conscious of the physical differences between boys and girls.

• Before their third birthday: Most children can easily label themselves as either a boy or a girl.

• By age four: Most children have a stable sense of their gender identity.

During this same time of life, children learn gender role behavior—that is, do­ing "things that boys do" or "things that girls do." However, cross-gender preferences and play are a normal part of gender development and exploration regardless of their future gender identity. See The Power of Play - How Fun and Games Help Children Thrive.

The point is that all children tend to develop a clearer view of themselves and their gender over time. At any point, research suggests that children who assert a gender-diverse identity know their gender as clearly and consistently as their developmentally matched peers and benefit from the same level of support, love and social acceptance.

What parents can do:

All children need the opportunity to explore different gender roles and different styles of play. Parents can make sure their young child's environment reflects diversity in gender roles and encourages opportunities for everyone. Some ideas would be to offer:

• Children's books or puzzles showing men and women in non-stereotypical and diverse gender roles (stay-at-home dads, working moms, male nurses and female police officers, for example).

• A wide range of toys for your child to choose from, including baby dolls, toy vehicles, action figures, blocks, etc.

• By age 6, most children spend most of their playtime with members of their own sex and may gravitate towards sports and other activities that are associated with their gender. It is important to allow children to make choices regarding friend groups, sports and other activities they get involved in. It is also a good idea to check in with your child to learn about their preferences and to make sure they feel included without teasing or bullying.

How do children typically express their gender identity?

In addition to their choices of toys, games, and sports, children typically express their gender identity in the following ways:

• Clothing or hairstyle
  

• Preferred name or nickname

• Social behavior that reflects varying degrees of aggression, dominance, dependency and gentleness.

• Manner and style of behavior and physical gestures and other nonverbal actions identified as masculine or feminine.

• Social relationships, including the gender of friends, and the people they decide to imitate.

While a child's gender-specific behavior (i.e. gender expression) at any time seems to be influenced by exposure to stereotypes and their identification with the people in their lives, the internal sense of being a girl, boy, in between or something else (i. e. gender identity) cannot be changed.

How have gender stereotypes changed over time?

Our expectations of "what girls do" and "what boys do" have changed. Many female athletes excel at their sports. Girls increasingly pursue subjects traditionally thought of as "masculine." There are many famous male chefs, artists, and musicians―fields traditionally thought of as "feminine." Over time, society has recognized that stereotypes of "masculine" and "feminine" activities and behaviors are inaccurate and limiting to a child's development. Such interests also do not determine or influence one's gender identity. Furthermore, our ability to predict who a child is based on early preferences is not very accurate and may be harmful if it leads to shame or attempts at suppressing their skills, talents and genuine self.

Still, when a child's interests and abilities are different from what society expects, they may be subjected to discrimination and bullying. It is natural for parents to have gender-based expectations for their children and to want to protect them from criticism and exclusion. Instead of pushing children to conform to these pressures and to limit themselves, parents can play an important role in advocating for safe spaces where their children can feel comfortable and good about themselves.

If your child doesn't excel in sports or even have an interest in them, for example, there will still be many other opportunities and areas in which they can thrive. Regardless of gender identity, each child has their own strengths that may not always conform to society's or your own expectations, but they will still be a source of current and future success.

Remember

Gender development is a normal process for all children. Some children will exhibit variations―similar to all areas of human health and behavior. However, all children need support, love and care from family, school and society, which fosters growth into happy and healthy adults.

Additional Information & Resources:

• Gender-Diverse & Transgender Children
  

• Parenting a Gender-Diverse Child: Hard Questions Answered
  

• Sex, Gender Identity & Puberty
  

• How You Can Help Your Child Avoid & Address Bullying
  

• Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents (AAP Policy Statement)
  

About Dr. Rafferty

Jason Rafferty, MD, MPH, EdM, FAAP, is a "Triple Board" residency graduate who is pediatrician and child psychiatrist at Thundermist Health Centers, a Patient-Centered Medical Home in Rhode Island. He specializes in adolescent substance use disorders and gender and sexual development, and also practices in related specialty clinics at Hasbro Children's Hospital and Emma Pendleton Bradley Hospital. Dr. Rafferty is an advocate in his local community and on a national level through work with the American Academy of Pediatrics on issues including the emotional health of young men, access to care for LGBTQ youth, and prevention of childhood homelessness.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Gender identity | Caring for kids

Gender identity refers to the deep and intimate feeling a person has of themselves. Children begin to understand and express their gender identity early in life.

This article discusses how gender identity typically develops and how parents and caregivers can promote healthy development of gender identity and expression in children. It's important to remember that each child is unique and may develop at a different pace.

Sex at birth: When children are born, sex is assigned based on external genitalia. A child who has a penis is said to be male. A child who has a vulva is said to be female. A child who is born with reproductive or sexual anatomy that doesn't fit the description of “female” or “male is referred to as an intersex child. 

Gender identity: Gender identity is “who you know yourself to be”. It is important to know that gender identity exists on a spectrum. A person’s gender identity can be masculine, feminine, or other.

Gender expression: This is how you express your gender to others, whether through behaviour, clothing, hairstyle, the name you choose to go by, etc. Words to describe someone’s gender expression could be “masculine,” “feminine,” “androgynous,” etc.

Sexual orientation: This refers to sexual or emotional attraction that one feels for another person.

Transgender: When a person’s gender identity is not the same as the assigned sex at birth, they may be referred to as “transgender” (often shortened to “trans”). For example, a child born with female genitalia may identify as a boy. A child may also say that they are not a boy or a girl, but just “themselves” because they don’t want their sexual characteristics to define who they are. Some cultures and Indigenous people use the term “two-spirit” to represent a person who embodies both a masculine and feminine spirit. Two-spiritedness has many subtleties of a spiritual and cultural nature.

Gender dysphoria: Describes the level of discomfort or suffering that can exist when there is conflict between the assigned sex at birth and gender identity. Some transgender children experience no distress about their bodies, while others may express significant discomfort. This distress can be more obvious as puberty begins and the body starts to change.

Here is what you can typically expect at different ages:

• 2 to 3 years old:
  • At around 2 years old, children are aware of differences between boys and girls.
  • Most children can identify themselves as a “boy” or “girl”. This term may or may not match the assigned sex at birth.
  • Some children’s gender identity remains stable over their life, while others may alternate between identifying themselves as “boy” or “girl”, or even assume other gender identities at different times (sometimes even in the same day). This is normal and healthy.
     
• 4 to 5 years old:
  • While many children at this age have a stable gender identity, gender identity may change later in life.
  • Children become more aware of gender expectations or stereotypes as they grow older. For example, they may think that certain toys are only for girls or boys.
  • Some children may express their gender very strongly. For example, a child might go through a stage of insisting on wearing a dress every day, or refusing to wear a dress even on special occasions.
     
• 6 to 7 years old:
  • Many children begin to reduce outward expressions of gender as they feel more confident that others recognize their gender. For example, a girl may not feel that she has to wear a dress every day because she knows that others see her as a girl no matter what she wears.
  • Children who feel their gender identity is different from the assigned sex at birth may experience increased social anxiety because they want to be like their peers, but realize they don’t feel the same way.

• 8 years old and up:
  • Most children will continue to have a gender identify that matches the assigned sex at birth.
  • Pre-teens and teens continue to develop their gender identity through personal reflection and with input from their social environment, like peers, family and friends.
  • Some gender-stereotyped behaviours may appear. You may notice your teen or pre-teen making efforts to “play up" or "downplay" some of their body’s physical changes.
  • As puberty begins, some youth may realize that their gender identity is different from their assigned sex at birth.
  • Because some children’s gender identification may change, especially around puberty, families are encouraged to keep options open for their child.

Younger children may express their gender very clearly. For example, they may say “I am a she, not a he!”, “I am not your daughter, I am your son.”

Children may also express their gender through their:

• Clothing or hairstyle
• Choice of toys, games, and sports
• Social relationships, including the gender of friends  
• Preferred name or nickname

Remember: Gender expression is different from gender identity. You can’t assume a child’s gender identity based on their gender expression (for example, their choice of toys, clothing, or friends).

Some children go through a phase of resisting gender expectations. Remember that gender expression and gender identity are two different things. The way you express yourself does not necessarily define your gender.

Children do best when their parents or caregivers show them that they are loved and accepted for who they are.  Discouraging your child from expressing a gender can make them feel ashamed. Give them unconditional support. In doing so, you are not framing a gender, but simply accepting who they are and how they are feeling.  

For many children, this is a phase. No one can tell you whether your child’s gender identity or expression will change over time. What children need to know most is that you will love and accept them as they figure out their place in the world. In older children, you can also gently help prepare them for negative reactions from other children, for example, by role-playing how best to confidently respond to teasing.  

Gender-creative children express their gender differently from what society may expect. For example, a boy who wants to wear dresses might be considered “gender-creative”. Society’s expectations for gender constantly change and vary in different cultures and at different times in history.

Gender diversity is not a result of illness or parenting style. It isn’t caused by letting your child play with dolls or trucks.  

If your child is transgender or gender-creative, they can live a happy and healthy life. Get support from other parents of transgender and gender-creative children, or talk to a mental health professional who specializes in the care of transgender and gender-creative children (if available in your community). Indigenous families can talk to a two-spirit elder or leader. See additional resources listed below.

Strong parent support is key!  

• Love your child for who they are.
• Talk with your child about gender identity. As soon as your child is able to say words like “girl” and “boy,” they are beginning to understand gender.
• Ask questions! This is a great way to hear your child’s ideas about gender.
• Read books with your child that talk about many different ways to be a boy, a girl, or having another gender identity.
• Don’t pressure your child to change who they are.
• Find opportunities to show your child that transgender and gender-diverse people exist and belong to many communities who appreciate and love them.
• Ask your child’s teachers how they support gender expression and what they teach about gender identity at school.
• Be aware that a child who is worrying about gender may show signs of depression, anxiety, and poor concentration. They may not want to go to school.
• Be aware of potentially negative issues that your child may face. Let your child know that you want to hear about any bullying or intimidation towards them.
• If you are concerned about your child’s emotional health, talk to your child’s family doctor, paediatrician, or other mental health professionals that specialize in the care of transgender and gender-creative children.
• Some parents have a hard time accepting that their child’s gender identity is different from the assigned sex at birth, often in cultures and religions where this is not easily accepted. If you are having difficulties, please seek additional help through websites, printed resources, support groups or mental health providers. See below for additional resources.

Thank you to the Child, Youth, and Family Committee of the Canadian Professional Association for Transgender Health and Gender Creative Kids Canada for their guidance and expertise in the development of this resource.

More information from the CPS

Additional resources

Reviewed by the following CPS committees

• Community Paediatrics Committee
• Mental Health and Developmental Disabilities Committee
• Public Education Advisory Committee

Last updated: March 2021

PSYCHOLOGIST'S ADVICE: Formation of gender identity in a child

01. 12.2017

Gender identity is a person's inner self-perception as a representative of one or another gender. At preschool age, the child assumes a gender role.

At the age of two or three, a child understands whether he is a boy or a girl. By the age of four or seven, children understand that gender will not change (gender stability is being formed). Girls know for sure that they will become women, and boys - men. nine0003

Gender education contributes to the formation of such qualities as femininity or masculinity, forms a culture of relationships between a man and a woman, teaches appropriate social roles.

How to form a child's gender identity - says Marina Sorokina, coordinator of the Psychological Service of the Rinat Akhmetova Humanitarian Center.

In today's world, the boundaries between male and female roles are often quite blurred. The task of parents is not only to preserve what is given by nature, but also to fully reveal and develop the gender identity of the child. If we pay insufficient attention to the education of gender identity, later we can observe too feminine boys or masculine girls. Not to mention more serious deviations. nine0003

More and more often one can observe a picture that a child is raised and brought up by one of the parents, even in a complete family, most often, a woman is engaged in raising a child. And in preschool and school institutions, a male educator or a male teacher is a rarity.

Whether a child can fully develop and fully reveal his potential in such conditions is more of a rhetorical question. From the first days of the appearance of the baby, parents need to realize the fact that they need to raise a child together. nine0003

These guidelines will help you develop a healthy gender identity.

1. Dear parents, you have not just a cute toddler, but a boy or a girl. Remember this.

2. If you have a girl:

• warm, close family relationships between mom and dad will contribute to the formation of a healthy identity and create impressions of a happy family life
• a girl needs her father's attention, care, love no less than her mother's
• respect your daughter as a person, this will help to form an adequate self-esteem
• if dad is strict or even rude to his daughter, remember that by doing so you will form a distorted idea of ​​how a man can (should) treat a woman. The girl will be the future husband, relying on the standard - the father.
• it's good if mother and daughter have their own "female secrets" that can be discussed in a secluded corner
• mother is a kind of girl's guide to the female world. Teach the girl everything that you know yourself (it can be needlework and the secrets of signature dishes and daily self-care)

3. If you have a boy

• Both mom and dad should take part in raising a boy. If a boy is brought up only by a woman, then he can become too feminine, too soft. If only the father-boy can grow up tough, do not reckon with a woman in the future.
• it is important for dad to treat his son with respect. Excessive harshness, strictness, rigidity, commanding tone can suppress the masculine principle in a boy. The child will grow up unsure of himself and his own abilities. nine0022
• dad and son can have their own secrets, common activities and entertainment. Mom should rely on dad for this.
• it's great if dad teaches his son about men's housework. Instills the skills of showing care and attention towards a woman (helping mom carry a bag, choose flowers together on mom's birthday)
• it is important to form responsibility in a boy. Without screaming and punishment, but calmly and kindly helping the child learn to take responsibility for their words and actions, keeping promises. nine0022
• do not forbid the boy to show his feelings

Parents, a sense of proportion will always be a good companion in raising a child. Do not overdo it. Remember that a child of any gender needs your love and acceptance first of all!

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Personal characteristics of adolescents with different gender identity status

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