Despite high-profile advocates like Caitlyn Jenner and reality shows like "I Am Jazz," it can still be difficult for many parents to know what to do when a child identifies as trans.

We talked with Dr. Johanna Olson-Kennedy, an adolescent medicine physician specializing in the care of gender non-conforming children and transgender youth at Children’s Hospital Los Angeles, and Devi Borton, mother of a nine-year-old transgender girl, who lives in Santa Fe, New Mexico.

How can parents best support their child? What conversations should parents have with school officials? With other parents? How can parents prepare their children for a world that isn't always welcoming?

If you are a parent of a child who identifies as trans, let us know how you've handled these issues.

Interview Highlights

Have you seen growth in the number of families who have gone into your practice to talk about this?

Olson-Kennedy: I have seen a huge growth, especially over the last five years. Particularly in kids who are presenting concerns around their gender at younger and younger ages.

What are some of challenges you help parents navigate?

Olson-Kennedy: There are a lot of decisions parent have to make, especially if their child is younger. And there are very different responses that our society has towards children who appear to be little boys doing little girls things, versus little girls who are doing little boys things.

You think there’s more acceptance of the so-called tomboy?

Olson-Kennedy: I think it’s so socially acceptable, that sometimes young people are not identified in childhood as having a gender different from their assigned sex.

How do parents work through trying to figure what’s going on?

Olson-Kennedy: I think that’s a great question, and certainly, different parents approach this in very different ways. Some of it is cultural and some of it is geographical. I think the best, most important change that’s happened over the last decade is that parents are listening and having conversations about how to figure this out. I think prior to 15 or even 10 years ago, parents might have shut this down and said, “This is what you are because of these body parts and we’re not going to talk about it anymore.” But now people are spending more time having conversations with their child to listen to what they're telling them about their gender and their experience of their gender.

Devi, how did your then-son approach you about this?

Borton: When I get asked this question, I have to answer that it was really a puzzle that took a long time to put together; it didn’t just happen one day. It really happened gradually over time. Our child was never attracted to typical girl toys; she was always attracted to her sister’s clothes — and my clothes — and would dress up in them. Also, she never wanted to pee standing up, she always wanted to pee, sitting. Things like that just started to emerge and they were consistent. My child was persistent about her preferences in the way she expressed herself, and she was insistent. I suppose I'm very lucky that I have a child that’s so fiery that she would not let us ignore it.

How old was she when she started verbalizing this?

Borton: I would say 3-and-a-half was really the age I first heard her talk about it. Around that time, she had a very intense fear of death, which I thought was really unusual for a 3-year-old. Our Montessori teacher gave us a Buddhist book about death called, “Mountains of Tibet.” It’s about reincarnation. The wood cutter, who dies, is given an opportunity to have another life and has to make choices about which universe he wants to live in and who his parents will be, and the last question is, “Would you like to be a girl or a boy?” The wood cutter responds, “I’ve enjoyed being a boy in my last life, but I’d like to see what it’s like to be a girl.” My child turned to me with a really intense look in her eyes and said, “Momma, I wish I was a girl.” That’s really the moment where I stopped being in denial about what’s going on.

Given the fluidity of sexuality, for example, was this something you thought was a phase, or did you feel pretty convinced this was foundational for your then-son, now daughter?

Borton: That’s a great question. When you talked about sexuality earlier, I thought, I got a lot of feedback from our society at age 2 saying, “Your son is going to be gay.” I thought, that’s the weirdest thing I’ve ever heard, how could you know that? But i think that’s the box that a lot of us grow up in. we don’t really have a box for thinking in a more mature way about gender and the fluidity and spectrum of that. Most of us are privileged to not have to think about gender for most of our lives. I think that I did fall into, “Oh ok, I have a feminine son and he’ll probably be gay.” But something really nagged at me because this was an expression of self that came from really deep inside. And when she became old enough to start talking about it, it was these three important things you hear about: insistent, consistent and persistent. She eventually said, “I am a girl. Why are you making me wear boy clothes? Why are you calling me by this name?” We finally got hit over the head and paid attention, thank goodness.

Caller Tanya in Westwood: I’d just like to know if there are resources we can discuss with our child to help them figure out if they’re confused about their gender or where they belong. How can you help a child know they’re not alone?

Olson-Kennedy: : Luckily in Los Angeles, we have some really great resources. Certainly people are welcome to contact us. Another really good contact is the Los Angeles Gender Center, a collection of therapists who work with a lot of gender non-conforming children and transgender youth, but they’re also good places to bring young people and have a forum to talk about their gender. They do this professionally all day, every day, and know the kinds of conversations to have to help people move forward and get clarity. I do want to add that in many situations, it’s usually the people around the young person who are confused about the young person’s gender. I think when you’ve been told your entire life, whether it’s the first 3 years, fifteen years, or forty years, that you are one gender based on everybody else’s impression , it’s difficult to assert that you might have a gender that’s different than that.

Isn’t there also potential confusion for the child because they see their own anatomy, but feel so different than what is considered typical for someone with that anatomy. Would there not be some confusion in that?

Olson-Kennedy: I think so. I think a lot of young people, especially once they've passed that early age of 3 to 5, go through a process of trying to figure that out. And quite honestly, most of the time it’s done online. Young people who use the internet and find their community or other people with a similar experience, do a lot of what I call the “coming in” process. They’re coming in before they coming out. They’re trying to explore and figure out what’s happening for them with those feelings.

Caller Glenn from Pasadena: I’m a parent of a trans child. When our child first started dressing up in girl clothes and playing with girl toys, we were worried it would reflect badly on us because we’re both gay and people would think it’s because of our parenting. But once we got over that and decided it’s not about us, it’s about our kid, we embraced it.

Our child did not choose to transition or identify as girl for a couple of years, she was happy to identify as transgender but wanted to keep the male pronouns and a male name. She’s 6 now and it’s really only been a few months that she’s decided she’s a girl and we’re going with that. She’s transgender because she says she is, if that changes in the future, then we’ll go with that.

This interview has been edited for clarity.