Transgender children: 'I first realised Jackie was different when she was 18 months old'

With more and more children seeking medical treatment for gender identity issues on the NHS, can a child be too young to know who they really are and what can nurseries do to help?

Figures from Tavistock and Portman NHS Trust, the only UK clinic to provide medical treatment to transgender children, reveals the number of referrals have risen steadily over the past five years and are up five-fold from 139 in 2010/11 to 697 in 2014/15.

In 2014/15, seven five-year-olds were referred to the clinic and five four-year-olds.

Jackie’s Story

Jack Green was diagnosed with Gender Identity Disorder (GID) at the age of six at the Tavistock clinic and now lives as Jackie. Her desire to be seen as a young woman, led her to become a semi-finalist in a beauty contest as Miss England.

“I first realised Jackie was different when she was 18 months old,” says her mum Susie Green.

"Although she was my first child, I had lots of nephews and nieces and Jackie just didn’t seem to behave like them.

“She’d go into my wardrobe, put on dresses and she even put my bra on at 18 months.

“The nursery staff were telling me Jackie was different when she went there at two and a half years old.”

Cross-dressing in the dressing up box

At nursery Jackie never played with the boys, always took a female role in the games played and would treat the soft toys like babies or pretend to have tea with them.

“She couldn’t wait to get into the dressing up box. She’d come out as Snow White with a jumper on her head and the arms trailing down to make it look like she had long hair.”

Young children expressing themselves at nursery as different genders is not as uncommon as some might think.

Jenny Buckley, head teacher at Chichester Nursery and Children’s centre believes: “In every nursery there are boys who like to put on the frilly tutu and go around in high heels and there are girls who like to wear trousers.

“It’s really up to the child to explore every area. Adults shouldn’t try to narrow those choices down simply because of a mindset they might have.

“We would deal with this on an individual basis.”

Recalling how she felt at the time, Ms Green says: “I thought she was gay or very sensitive.

“Her dad didn’t like it and wanted to make her be a boy and tell her off when she played with girls stuff.

“The staff asked me if I wanted them to encourage her to play with the boys.

“I said to the staff, let her play with whoever she wants and with whatever she wants.

"They’d never dealt with this before and they followed my lead."

When Jackie was four-years-old, she told her mother that “God had made a mistake” and she should have been a girl. She was still at nursery.

Lack of information

“I was absolutely desperate for information about what to do.

“I wanted people to tell me it was okay.”

Susie Green is now the chair of Mermaids, a support group for young people with gender identity issues and their families. It has more than 500 parents in the UK with children who are non-conforming.

“I found Mermaids when she was six. Between the age of two and a half years old and six, I was completely lost.

“No one thought let’s make her more comfortable, their view was she had to change what she likes."

The Government in 2011 pledged greater equality for transgender people, including early years education.

Some believe nurseries could do more to help parents and their children by opening people’s minds up to the ways in which people can be different.

Rainbow Teaching provides free support and guidance to teachers and staff including non-gender conformist lesson plans for younger children.

Gender non-conformist books such as '10,000 dresses' by Marcus Ewart tells the story of a little boy who dreams of wearing pretty dresses but when the young transgender child tells her parents they become angry and she seeks the help of a dressmaker to fulfil her dream.

Parents with nursery children who approach Mermaids are encouraged to speak to nurseries to see if they are willing to source non-gender conformist books or have parents supply them.

Ms Green says: “Most nurseries and schools only do something like this if they are faced with a pupil with gender identity issues."

About one in 20 families joining the support group have a child who is of nursery age. At least three families have children who transitioned (dressed as a different gender) at nursery.

Ms Green says it is still the parents educating professionals, when it should be the other way round.

So, should there be more literature for parents provided by nurseries? Should Ofsted be inspecting whether or not gender-neutral material is given in nurseries?

Polly Carmichael, director of the NHS Trust’s gender identity development services says: “The reality is the number of very young children being referred is very low.

“Across Europe, numbers are increasing rapidly. It is likely that this is linked to greater awareness and tolerance of gender variance and young people are using social media to explore their gender."

Dr Carmichael says evidence suggests that the majority of people experiencing distress as a result of gender identity issues (known as gender dysphoria) before puberty don’t ultimately go on to seek physical treatments to change their body. Sometimes it can indeed be just a phase.

While other young people experience gender dysphoria from a very young age, she says many do not until they are post puberty.

Dr Carmichael does admit there is “a big gap in terms of available information for parents” wondering should they or shouldn’t they worry or how they should best support a young person who does not conform to gender stereotypes.

Not reinforcing the binary

“We have to support people to manage uncertainty and their understandable distress”, she says.

Even if society may put girls and boys in different boxes from birth: pink for a girl, blue for a boy, nurseries are expected to be more forward-thinking.

“Nurseries should acknowledge that a binary culture does not fit everyone. In early years, if there was less reinforcement of the binary, there would be less of an issue if a child felt they didn’t fit.

"Boys and girls outfits, lining up according to gender, books depicting genders in a stereotypical way."

But she says it is also “unhelpful" to create a third box and say male, female, trans. Trans is an umbrella term covering a range of experiences of gender, including for example, non-binary.

“We need to break down assumptions that certain ways of dressing and behaving go along with set genders.”

Taking gender out of the equation in early years means children have more space to express themselves.

This could even be as simple as splitting children into two groups according to a specific animal or cartoon character.

Dr Carmichael says it is important that “nursery staff don’t jump to conclusions”.

“We don’t want to assume that children are trans or have a different sexuality. Children are developing and their understanding of themselves and what feels right for them can change over time.”

Dr Carmichael supports the idea of nurseries exploring gender neutral material more to help all children express themselves and thinks nursery managers could provide literature to parents.

"When asked whether information can be disseminated by Tavistock to nurseries, Dr Carmichael said: “It is a good idea. I would be happy to develop a handout for nurseries to give to parents.”

Miseducation

In the quest for knowledge, parents of children with gender identity issues have shared personal experiences with each other.

This includes how they felt when a nursery phoned social services claiming a parent was forcing their boy to dress as a girl. After meeting the parents, social services went back to the nursery and told them to revise their policies concerning gender and diversity values.

Another little girl tried to throw herself out of the window because she wanted to be a different gender. She was four.

After suicide attempts, 13-year-old Jackie Green went to the US with her mum to take puberty blocking injections and on her sixteenth birthday to Thailand for gender reassignment surgery.

Her mum said: “Nobody would choose to change gender it’s a biological not psychological condition.

“It’s about a balance of what makes them less miserable – being bullied or having to disguise who they really are.”