Weiselberg Eric C, Shadianloo Shervin, Fisher Martin
Division of Adolescent Medicine, Department of Pediatrics, Cohen Children's Medical Center, Northwell Health System, 410 Lakeville Road, Suite 108, New Hyde Park, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, United States.
Curr Probl Pediatr Adolesc Health Care. 2019 Sep;49(9):100682. doi: 10.1016/j.cppeds.2019.100682. Epub 2019 Nov 7.
Over the past decade, more and more children and adolescents are identifying as transgender and gender diverse (TGD). Often, they and their parents first turn to their primary care pediatrician for guidance and support. Therefore, in 2018, the American Academy of Pediatrics (AAP) released a policy statement focusing on the health care of TGD youth. The AAP acknowledges that many pediatricians have a lack of training in this area and therefore need to increase their knowledge base and expertise in order to provide culturally competent care. While most sexual and gender minority individuals are healthy and well adjusted, some TGD youth are at an increased risk of mental health concerns, including anxiety, depression, substance abuse, eating disorders and suicidality. This is theorized to be due to the experienced or internalized marginalization, stigmatization, victimization, harassment or rejection and not inherent in having gender dysphoria or being transgender. The pediatrician therefore needs to be knowledgeable of, and skilled to screen for, the health disparities that may exist, as well as to be able to support the individual who may disclose their gender identity status during treatment. Parents and guardians may also turn to the pediatrician for guidance when faced with their child who presents with gender non-conforming behaviors or gender dysphoria. Therefore the pediatrician needs to be able to guide the parents as well, as their acceptance and support of their child's journey to gender identity is probably the most important protective factor against health disparities encountered. To deliver optimum care for TGD children and youth, the pediatrician needs to establish an office setting that is inclusive, gender-neutral and TGD friendly. By becoming familiar with the diversity of gender expression and identities, use of gender-appropriate terminology, health disparities often encountered and the importance of providing a safe and welcoming environment, issues that are all covered in this article, the primary care pediatrician will be in position to provide comprehensive health care to this often marginalized population.
在过去十年中，越来越多的儿童和青少年认同自己为跨性别者及性别多样化者（TGD）。通常，他们及其父母首先会向初级保健儿科医生寻求指导和支持。因此，2018年，美国儿科学会（AAP）发布了一项关于TGD青少年医疗保健的政策声明。AAP承认，许多儿科医生在这一领域缺乏培训，因此需要增加他们的知识储备和专业技能，以便提供具有文化胜任力的医疗服务。虽然大多数性少数群体个体健康且适应良好，但一些TGD青少年面临心理健康问题的风险增加，包括焦虑、抑郁、药物滥用、饮食失调和自杀倾向。理论上，这是由于经历或内化的边缘化、污名化、受害、骚扰或排斥，而不是性别焦虑或跨性别本身所固有的。因此，儿科医生需要了解并熟练筛查可能存在的健康差异，并且能够支持在治疗过程中可能披露其性别认同状况的个体。当父母和监护人面对表现出性别不符合行为或性别焦虑的孩子时，也可能会向儿科医生寻求指导。因此，儿科医生也需要能够指导父母，因为他们对孩子性别认同之旅的接受和支持可能是预防所遇到的健康差异的最重要保护因素。为了为TGD儿童和青少年提供最佳护理，儿科医生需要建立一个包容、性别中立且对TGD友好的诊室环境。通过熟悉性别表达和身份的多样性、使用合适的性别术语、经常遇到的健康差异以及提供安全和友好环境的重要性（本文涵盖了所有这些问题），初级保健儿科医生将能够为这一经常被边缘化的人群提供全面的医疗保健。
