You wake up in the middle of the night to the sound of a seal barking inside your house. More specifically, from inside the crib or toddler bed. Unless you actually have a pet seal, that bark is the sound of your child with croup.
The news is filled with stories about boys wearing pink nail polish, a baby whose gender will be kept a secret by his/her parents, and Chaz Bono’s new book and identity as a man. What’s the deal with gender, and why have the media waves exploded in the past few years? Is gender variance becoming more common, or just more recognized? And what should you do if your son wants to wear pink or your daughter cuts her hair short?
First, some definitions.
–Gender is one’s internal sense of self as male, female, or neither, while sex is assigned at birth based on external appearance. As one astute child told me, “sex is what’s between your legs, while gender is what’s between your ears.”
–Gender expression is how one chooses to portray his or her sex or gender—for example a male child (sex assigned at birth) who feels he is a girl (gender) might still wear boys’ clothing and hairstyles to fit in with peers (gender expression). Or, a female child (sex) feels she is a girl (gender) but prefers to wear boys’ clothing (gender expression) and chooses a gender-neutral name. Her gender expression is masculine.
–Gender variant, gender diverse, and gender nonconforming refer to a child who expresses gender identity or expression that is different than what one expects based on sex. These terms refer to a wide range of children—from the little boy who likes to play with Polly Pocket dolls to the male child who insists he is a girl and wears dresses to school. Some gender variant children will be transgender, which refers to a child who persistently feels the sex assigned at birth is incorrect.
When gender variant children reach puberty, they may become aware of their sexual orientation, or who they are sexually attracted to. They may find that they are attracted to the “opposite gender” and have a straight (heterosexual) orientation, or they may be attracted to the same or any gender, and identify as gay, lesbian, or bisexual. Of course, these labels become especially confusing when discussing gender variant teenagers. For example, is a female-bodied teen who identifies as a man (transgender) and attracted to women heterosexual or homosexual? For this reason, many young people choose to identify as queer, an umbrella term with a positive connotation that conveys many ways of loving people with different bodies and gender expressions.
How common is gender variance?
International epidemiologic studies estimate the prevalence of transgender adults to be anywhere from 1 in 1,000 to 1 in 30,000. That’s a huge range. When you include children who are gender variant but not transgender, the numbers are much higher. For example, Gender Spectrum, an organization that I work with in California, conducts trainings at schools that have identified a gender variant child who is facing bullying or discrimination. To date, they have been invited to nearly every elementary and middle school in their geographic area. Most schools in this area have approximately 100-500 students, so my best estimate of gender variance in my geographic area is 1 in 500.
How do you know if a child is gender variant?
The child tells you. Many of the gender variant children I know recall telling their parents at an early age that they felt different. For example, some transgender boys (i.e. born in a female body, identify as male) I know corrected the adults who tried to call them girls as children, insisting they were boys. One parent recalls her transgender son telling adults “I am a boy now, but when I grow up I will be a mommy.”
Most kids exhibit some sort of gender exploration in their early childhood, and this is a normal part of development. However, a child who is shows gender variance generally makes claims that are early and persistent, and then develops distress when corrected by adults. The “test” becomes when a child is given the freedom to express his/her internal sense of gender. In gender variant children, this distress will be alleviated.
What do you do if this describes your child?
The emerging consensus among experts is to let your child guide you, and to aid your child in his or her gender exploration by working with local resources to create a supporting and accepting environment. In the past, some experts recommended a sort of reparative therapy, for instance removing all “girlish” toys from a boy-bodied child’s home and insisting that he wear only “masculine” clothing. While this may have worked for a short time, the child’s distress often emerged later on, often in puberty, with depression and suicide. In fact, a survey of transgender adults showed that one-third of them had attempted suicide in their life, some as young as age seven or eight. These are good reasons to pay attention to your young child. Research shows that children raised in supportive families have more positive outcomes.
Parents raising gender variant children worry about their safety and acceptance in their schools, neighborhoods, and extended families—and for good reason. Gender variant children are bullied and face discrimination, abuse, and violence at rates much higher than their peers. Often, parents do not agree with each other—as one parent may allow more gender exploration than the other. The child’s gender presentation may not be accepted in churches or within the family’s religious belief. It is imperative that families obtain professional help, especially when there is disagreement between parents on how to support the child. In addition, there are many parents groups and conferences where families can meet each other for mutual support.
If you are concerned about a child in your own life, there are wonderful organizations that can help you.
Resources:
Resources: Gender Spectrum www.genderspectrum.org
Family Acceptance Project http://familyproject.sfsu.edu/
Trans Youth Family Allies http://www.imatyfa.org/
My favorite blogs, articles, and videos about raising Gender Variant Children
Sarah Hoffman’s Parent Blog http://www.sarahhoffmanwriter.com/
A Boy’s Life from the Atlantic http://www.theatlantic.com/magazine/archive/2008/11/a-boy-apos-s-life/7059/
Two Families Grapple with Son’s Gender Identity from NPR http://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences
Transgender Kids recent CNN segment http://www.cnn.com/2011/09/27/health/transgender-kids/index.html
Ilana Sherer, MD
Returning guest blogger Dr. Ilana Sherer is the Director of General Pediatrics of the Child and Adolescent Gender Center at UCSF. She is a recipient of the Chancellors Award for LGBT leadership at UCSF and also of the American Academy of Pediatrics Dyson Child Advocacy Award.
©2012 Two Peds in a Pod®
As a call to service in honor of Martin Luther King Day, we bring you an eye opening child advocacy post from guest blogger Dr. Heidi Román, who works with underserved children and their families in California .
Early in my pediatric residency training I entered the exam room to see a one-year old patient. Her mom blurted out excitedly, “We finally have a place to live.” It turned out that they had been living in motels or with relatives for most of the child’s life. I paused for a moment as I realized that it had never really registered. She had been seen in our clinic for multiple visits, but no one had noticed the changing addresses. No one had asked the questions in a way that allowed her to tell us. They were homeless. This was my wake up call. Since then, I have met many families affected by homelessness. Many hard working families are pushed into poverty and homelessness by loss of a paycheck, foreclosure, or divorce. They are reluctant to talk about it. Children and families are the “hidden” homeless.
While the mainstream media consistently covers the recession, quoting jobs numbers and the like, there is a disturbing new set of data out that doesn’t seem to be getting much press. Last month the The National Center on Family Homelessness released their report on child homelessness entitled “America’s Youngest Outcasts 2010“, and the news is not good. During the time period of the recession (2007-2010) there was a 38% spike in the number of homeless children. Currently, there are 1.6 million homeless children in the United States. Children now make up almost 40% of the homeless population and families with children are the most rapidly growing segment of the homeless population.
That’s a lot of kids and families. And, as children are often not included in homeless statistics, the number is probably higher. Why don’t we hear about it more? Well, homeless families tend to be the invisible segment of the homeless population. They fly under the radar. They move from place to place. They “double up” with friends or relatives for a few months, and then stay in a shelter or motel for a while. They sleep in their car. Parents may not even report that they are homeless to teachers or health care providers for fear of losing their children. There are various reasons that families become homeless. Certainly worsening poverty, due to job loss or changes in welfare programs, is a major cause of housing loss for families. But, domestic violence or parental separation is also very often to blame.
Once families become homeless, it is very difficult to escape. Even if the parents are lucky enough to find a job, it will likely pay only minimum wage. Adequate housing is still out of reach for these families. This is true regardless of the state, city, or town the family lives in; and the gap between income and housing costs is even greater in areas with a high cost of living.
Experiencing homelessness profoundly affects a child’s physical, psychological, and educational health. Homeless children have higher incidence of trauma-related injuries, poorly controlled asthma, developmental delays, growth problems, and anemia, among other health problems. Homeless children are far less likely to have a medical home or adequate health insurance. They are far more likely to utilize the ER for care at a later stage of illness. Homeless adolescents have much higher risk of being victims of violence or sexual abuse and have higher rates of substance use, HIV, and teen pregnancy.
Homeless children, regardless of cognitive ability, do far worse in school. They are more likely to change schools during the year or miss more school days, greatly affecting their ability to do well academically and flourish socially. Even simple things, like being asked by a teacher to draw their room or describe their house, become awkward and painful.
What’s being done about this? Sadly, not much. Per the State Report Card on Child Homelessness, only seven states have extensive plans relating to services for homeless families. In the current economic and political climate, the number of homeless children and families continues to increase and the services provided to them are shrinking.
What can we do?
Heidi Román, MD
Heidi Román MD, FAAP is a mother and pediatrician who practices in San Jose, California. She has special interest and experience working with under-served families from diverse racial and socio-economic backgrounds. Dr. Román is a passionate child health advocate who works towards improved health for all kids, both in and out of the clinic. She writes about everything from parenting to policy at mytwohats.wordpress.com.
©2012 Two Peds in a Pod®
When I was a kid I used to be afraid the suction tube used at the dentist’s office would suck up my tongue. I have never seen that happen, but I have noticed that when children undergo long dental procedures, the suction is often hooked at the corner of the mouth for an extended period of time. Between the saliva that accumulates under the hook and “digests” the lip and the wet irritation from a piece of plastic pressing against the edge of the mouth, the kids may emerge with a sore at the corner of their mouths. The catch: the sore usually does not appear for a couple of days, sending parents into my office concerned about cold sores or infection after they have forgotten about the dental visit.
Fortunately, the mucosal (moist) areas of the mouth heal rapidly because of a rich blood supply which brings nutrients to the area quickly. However, before it heals, the area on and around the lip where the suction sat looks ugly, white and heaped up the by the third or fourth day after the dental visit. Keep the area clean with soap and water and put on a barrier protection such as petroleum jelly based product (eg Vaseline, aquaphor) so that any drool will not further irritate the area. Apply barrier protection the next time your child visits the dentist.
Naline Lai, MD with Julie Kardos, MD
©2012 Two Peds in a Pod®
There is a saying we heard in medical school, “Half of what you learn now will change in ten years… you just don’t know which half.” In pediatrics, where we specialize in change, the saying certainly holds true. We ring in the New Year by picking the top 2011 changes in pediatrics all parents should be aware of:
Car seats– keep children rear facing in car seats until two years old (or until they physically cannot fit rear-facing any more) and keep your child in a booster seat until a seat belt fits properly– across his chest and not his neck, and low on the waist across the hip bones, not across his belly. Sitting in the back seat is the safest spot for those 12 years and under. For more information check out our post Buckle up: the latest in car seat safety.
Meningitis Vaccine– A booster dose for older teens is now recommended for the vaccine against the germ Neisserria meningitidis in addition to the dose routinely given to tweens.
Flu vaccine– Having an egg allergy is no longer an absolute contraindication to getting the flu vaccine. Turns out there is so little egg in the vaccine, most kids with egg allergies can safely receive the injectable form, though they still should not receive the spray-up-the-nose form. Ask your child’s pediatrician or allergist if your egg-allergic child is a candidate.
Bye-bye food pyramid– The difficult to understand food pyramid finally bit the dust and is replaced by My Plate .
SIDS prevention and safe sleep– keep soft bedding away from baby’s face- no crib bumpers! And continue to place your baby on his back to sleep. AAP Expands Guidelines for Infant Sleep Safety and SIDS Risk Reduction and Sleep Safety: How to decrease your baby’s risk of Sudden Infant Death Syndrome (SIDS)
An old recommendation gets reinforced: in 2011, Dr Wakefield’s paper suggesting a link between the Measles, Mumps and Rubella (MMR) vaccine and autism is reaffirmed as fraudulent. MMR vaccine schedule does not change.
Genital Wart and cancer from HPV prevention in males– HPV vaccine is now not only approved for boys, but recommended for boys, as well as girls, by the ACIP (vaccine branch of the CDC). With over 35 million people having received this vaccine, evidence supporting its safety has become well established.
All liquid acetaminophen products (Tylenol) are now the same strength. Watch out if you have the old formulation in your medicine cabinet, double check the dosing.
Changes in when and how to start solids foods: For about the last fifteen years, pediatricians advised delaying the start of solid foods and the start of commonly allergenic foods such as eggs or wheat to prevent food allergies. Unfortunately, food allergies have risen during this time. Current advice is back to the old advice. According to the National Institute of Allergy and Infectious Diseases sponsored guidelines (November 2011 Pediatrics), solid foods should be introduced by 4-6 months of age and any potentially allergenic foods may be introduced at this time as well.
We look forward to more advances in pediatrics for 2012. Please keep reading and tell parents about us.
Best wishes for a healthy New Year.
Your Two Peds,
Naline Lai, MD and Julie Kardos, MD
©2011 Two Peds in a Pod®
As a new year rolls around and our pockets start to feel empty after the holidays, we look back at an older post for ways to penny-pinch without short-changing your kids: Save money: How to penny pinch without hurting your children. And whether your children receive gift cards, gelt, or cash gifts this season, we direct you to the popular post Teaching kids money smarts for ideas on how to help them manage their new stash.
Best wishes from your Two Peds,
Drs. Kardos and Lai
©2011 Two Peds in a Pod®
In case you missed the live internet radio show- hit the arrow to tune in here:
Pertussis is “whooping cough,” also known as the “100 day cough.” In children and adults, the disease starts out looking like a garden-variety cold, complete with runny nose, runny eyes, and mild cough. Sometimes fever is present, sometimes not. However, after a few days, coughing spasms emerge – severe, persistent coughing spasms that go on and on and on. In between coughing fits, children may appear okay.
There is no treatment except to “ride it out” and the cough can last up to three months. Doctors prescribe antibiotics to a child with pertussis because antibiotics can decrease how much a person with whooping cough will spread it to others. Close contacts of kids with pertussis may also receive antibiotics to reduce their chance of getting pertussis.
Whooping cough gets its name from the “whoop” noise kids make after a coughing fit. The fits leave them so breathless that it’s difficult to take a breath in again after the coughing spell. To hear the “whoop” with coughing fit, visit www.whoopingcough.net.
Teens and adults with whooping cough don’t tend to make the whoop sound because their airways are bigger, but the coughing spasms can leave them feeling like they might throw up or pass out. Some in fact do end a coughing fit with vomiting or fainting.
Babies don’t make the whoop either. Instead, babies with pertussis simply cannot catch their breath and stop breathing. That is why babies are the ones who tend to die from this illness. Dr. Lai and I both have watched over hospitalized infants blue from pertussis.
Thankfully, we have a vaccine that is effective at preventing pertussis. The “P” in pertussis is the “P” in the DtaP vaccine that children receive as babies, usually at two, four, and six months of age. The DtaP vaccine is then next given after the first birthday, another between ages four and six years old, and another at age eleven years. Teens who have not received the pertussis vaccine since they were in preschool, and adults who care for infants also should also get the vaccine. For more specific up-to-date recommendations: www.vaccineinformation.org/pertuss/.
As we enter the season for catching snowflakes and coughs, we hope none of your children catch whooping cough.
Julie Kardos, MD with Naline Lai, MD
©2011 Two Peds in a Pod®
revised Nov 16, 2011 to reflect the indications for antibiotic prophylaxis
Dr. Lai and her husband had a running debate about when to replace kitchen sponges. Today we thank guest blogger Dr. Karina Martino, Food Safety Engineer, for exposing the germs in our kitchens. We certainly learned a lot, and Dr. Lai’s husband lost a bet.
Naline Lai, MD and Julie Kardos, MD
WHO’S THE WORST OFFENDER IN THE KITCHEN???
The winner is…….the kitchen sponge (and dishcloth)! The next worst offender is your kitchen sink. This is where vegetarians have a definite advantage since they don’t bring raw meat into their homes. There’s less chance of E. coli and Salmonella spreading, but vegetarians still have to be on the lookout for viruses and parasites.
What are the kitchen’s hot germ zones?
In descending order by highest bacterial count, these are:
1. Sponges and dishcloths
2. Sink drain area
3. Faucet handles
4. Cutting boards
5. Refrigerator handles
Here are simple steps that you can follow to create a healthier kitchen environment:
Dip sponges after every use in dilute sanitizer water (1 teaspoon bleach per quart of water); boil them for 3 minutes on a weekly basis.
• Change dish cloths daily, especially after wiping up raw meat juices.
• Wash sinks with hot soapy water prior to food preparation and before washing dishes.
• Wipe down refrigerator handles daily with dilute sanitizer water.
• Choose non-porous cutting boards that are easy to clean.
• Avoid rinsing raw meats. It contaminates the sink. If you cook meat at the correct temperature for enough time, bacteria on raw meat will be killed.
When we are handling food products everything in the kitchen must be clean, especially ourselves. It is vital to wash our hands with soap and hot water for at least 20 seconds before handling any food product. Each time you re-enter the kitchen from outdoors or any other place in the house where you might have contaminated your hands, you should wash your hands again.
Clean clothing, including aprons, is also an important part of personal hygiene. Dirty clothes and dish towels are a good place for bacteria to hide and grow. Sneezing and coughing spreads germs from our lungs, throats, and noses. When handling food, we must control the spread of germs from these natural occurrences by covering our mouths with disposable tissues and then rewashing our hands.
While the Centers for Disease Control (CDC) provides information about illness from food in homes, it does not yet offer statistics about how many people become ill from their kitchen sponges. However, here are some facts for you to keep in mind:
• The kitchen environment can be more heavily contaminated with fecal bacteria (those bacterial species associated with feces) than the bathroom, suggesting that the risk of spreading infection in the home may be highest in the kitchen-the area in the home where food is prepared.
• Microbiological surveys of domestic kitchens have found significant contamination from a variety of bacterial contaminants, including E. coli, Campylobacter, and Salmonella.
• Pathogenic organisms (germs that cause disease) have been shown to be introduced in the home by people, food, water, pets and insects.
• The domestic kitchen is not used only for food preparation, but may serve as a laundry, a workroom, and a living area for family pets. Each of these functions can serve to introduce bacterial contamination into the kitchen environment.
Moreover, research focusing specifically on the kitchen environment has found:
• 67% of kitchen sponges may be contaminated with fecal bacteria
• Contaminated cloth towels serve to transfer bacteria to dishes during drying
• 82% of sink faucet handles are contaminated during food preparation
• 60% of people do not wash the cutting board after cutting raw meat or poultry and before cutting fresh vegetables for salads
• 9% do not wash the work surface at all after cutting raw chicken
So, please don’t duplicate these mistakes! The next time that you get ready to do your dishes with your six-month-old sponge… think again!… either toss it or get your Clorox immediately!
Karina G. Martino, PhD
Dr. Martino received her Masters degree and her PhD in Food Safety Engineering from Michigan State University. A former professor at University of Georgia, she now has her own consulting business (www.kgminnovations.com) and is the mom of two children.
©2011 Two Peds in a Pod®