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Gender identity has both a cognitive component and an affective
component. There is now considerable evidence that by the age of
2 to 4 years, children have a rudimentary cognitive understanding
of their gender identity. They are, for example, able to self-label
as a boy or as a girl. Although it is normative for children in
this age range to self-label correctly, a more sophisticated cognitive
understanding of gender is lacking. A girl, for example, who can
correctly self-label as a girl might readily declare that she will be
a daddy (or even a giraffe) when she grows up. With cognitive maturity,
however, children eventually master the notion that gender is an
invariant part of the self. Coinciding with a cognitive-developmental
understanding of gender, there is a corresponding affective pride
in gender identity self-labeling in that children appear to value
themselves as being a boy or being a girl, and there is a tendency
to overvalue other members of one’s sex and devalue members
of the other sex—a type of “in-group vs out-group
bias.”1,2
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Early in development, it is common for children to hold rather
stereotyped views about behaviors that are “appropriate” for boys
and for girls. Some theorists argue that this is related to the
tight connection that children make between subjective gender identity
and surface-related gender role behaviors. Thus, young children
will adhere to the notion that “only girls” can
wear dresses (dubbed the “pink frilly dresses” phase3)
or that “only boys” can become doctors. Over time,
greater cognitive flexibility in gender role attributions emerge,
although affective behavior preferences might remain strong for culturally
defined gender role behaviors.1
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The pediatrician is often the first professional that parents
might consult regarding the child whose behavior departs from conventional
patterns of sex-typed behavior. Developmentally related sexual behaviors emerge
at various ages in young boys and girls (Table
90-1). Issues surrounding gender often cause intense anxiety for parents. Are the behaviors
in question “only a phase” that the child will
outgrow? Or, are the behaviors in question prognostic of longer-term
developmental issues? Regarding gender development, parents often
want to know if the behaviors of their young child are prognostic
of a later homosexual sexual orientation or of transsexualism, the
desire to receive contrasex hormonal treatment and physical sex
change (eg, in males, penectomy/castration and the surgical
creation of a neovagina; in females, mastectomy and the surgical creation
of a neophallus). Parents also often worry about the stigma that
their child’s pervasive cross-gender behavior might elicit within
the peer group and in society at large.
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