A 5-year-old boy is brought to the office by his parents for a well-child visit. His mother says, "My son is doing very well. He is able to read at a first-grade level and knows his name and address. He loves to sing, dance, and play house with his older sisters. Everything seems fine with him; we just want to make sure his vaccinations are up to date before our family trip overseas." The physician administers the appropriate vaccinations. Just before leaving, the father says, "I think you should know that my son is playing with his sister's dolls and doesn't seem to like cars or trucks like most other boys. Is that normal?" Which of the following is the most appropriate response to the father's concerns?

Question

A 5-year-old boy is brought to the office by his parents for a well-child visit.  His mother says, "My son is doing very well.  He is able to read at a first-grade level and knows his name and address.  He loves to sing, dance, and play house with his older sisters.  Everything seems fine with him; we just want to make sure his vaccinations are up to date before our family trip overseas."  The physician administers the appropriate vaccinations.  Just before leaving, the father says, "I think you should know that my son is playing with his sister's dolls and doesn't seem to like cars or trucks like most other boys.  Is that normal?"  Which of the following is the most appropriate response to the father's concerns?

Quizplus · Accepted Answer

Gender is the innate feeling someone has of being male, female, or a combination of both. Children develop an understanding of the concept of gender by age 3-4 and have a sense of the permanence of gender around age 5-6. It is developmentally normal for them to explore the world by engaging in activities that may be culturally associated with the opposite gender. It is important to follow a child's lead and allow this exploration to occur. In contrast to occasional play and exploration, if there is a prolonged and intense feeling that a person's gender does not match one's assigned birth sex, it is more likely to continue into puberty. When this feeling is associated with significant distress it is diagnosed as gender dysphoria. Patients with this condition have increased rates of psychiatric illness, including depression and anxiety, and need monitoring and support. (Choice B) Although it is important to allow the child to play freely, this response does not answer the father's question and is unlikely to decrease his concern. The father should be educated that his child's type of play is part of normal exploration. (Choice C) It is normal for a child to explore gender activities. There is no evidence that boys need increased exposure to male figures to understand their own gender. (Choice D) Playing with dolls is consistent with normal explorative play, not gender dysphoria. Further evaluation and professional support might be warranted in this child if he had a more persistent desire to be the opposite sex or disliked his own genitalia. (Choice E) Children usually know their gender by age 4 and understand that it is permanent by age 5-6. Educational objective: Although children understand the concept of gender by age 4, it is normal for them to explore activities culturally associated with the opposite gender. In contrast, gender dysphoria is diagnosed when there is marked distress associated with a prolonged and intense feeling that one is a different gender from one's birth sex. __________ References: Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. (http://www.ncbi.nlm.nih.gov/pubmed/21216800) Gender variance and dysphoria in children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/26210629)

A 5-Year-Old Boy Is Brought to the Office by His