O3273: Gender Identity in a Pediatric Orthopedic Clinic

Background: Increased attention has been called to the importance of recognizing gender identity (GI) but there is often resistance to asking about gender expression on medical intake forms. The National LGBT Health Education Center reports that including this data is essential to provide high quality, patient centered care. The literature has demonstrated GI questions to be acceptable in adult populations, but to our knowledge, no studies examined the acceptability of these questions in a pediatric subspecialty clinic.

Methods: An anonymous 11-question survey was distributed to every parent/caregiver (P/C) and patient in a clinical outpatient waiting room. A 5-point Likert survey was distributed in English and Spanish. Adolescent patients ages 11 and older were given a separate survey from P/C.

Results: A total of 110 responses (81 caregivers, 26 patients) were collected. Four caregivers omitted responses about their child’s sex and gender but answered questions towards attitude. Of the P/C survey, responses for their child’s gender identity included 38 male, 37 female, 1 transgender male, 1 does not know, and 1 that omitted. In the patient survey, 14 identified as male, 11 female, and 1 chose not to disclose. 97% of responses identified their gender identity with their sex at birth. With respect to pronoun preferences, 53 responses included he/him, 47 she/her, 3 they/them, and 3 specified that their child is not at the age where they are able to have preferred pronouns yet.

No differences were observed in responses between parents and patients as to whether the patient should be asked their pronouns at check in (p=0.92) or by their doctor (p=0.72), with the majority feeling indifferent. Similarly, no difference was observed for perspectives on including gender identity in medical records, with the majority agreeing GI should be included followed by indifference. A significant difference was noted between comfortability in correcting the doctor should the incorrect pronouns be used (p=0.0032), with 71.6% of caregivers that “strongly agree” and “agree” correcting the physician compared to the 36% of patients. In fact, 40% of patients felt “indifferent” towards correcting the doctor.

Conclusion: Questions about GI are important to provide the best care for patients. This is especially true in the pediatric population who are vulnerable to being overlooked due to the concern that some patients may be too young to be asked these questions. Our survey responses indicate that most of our patients and caregivers are in favor of including GI questions in the patient’s chart. The majority of caregivers felt comfortable correcting the doctor’s use of their child’s pronouns. The minority of responders felt that GI questions should not be included. Additionally, patients and caregivers in our clinic feel that GI questions are acceptable to ask in a pediatric orthopedic clinic.