ONE night after dinner in the middle of last year, Jo was sitting on the couch giving her six-year-old, Sophie*, a cuddle.

Sophie seemed incredibly nervous; there was something she desperately wanted to ask her mother. Finally, she said it.

“Could the doctors have made a mistake? Could I have accidentally been born a girl? I should’ve been born a boy. Can that happen?”

Jo describes this pivotal moment as “terrifying.”

“‘I have to be honest. I can’t lie.’ That’s what went through my head,” she tells me.

Jo’s reply to her child’s pressing question was simple: “Yes, that can happen.”

Her emotions were not so simple.

“That was the hardest part, trying to be supportive to your child and act like it’s no big deal and inside you’re exploding,” she says.

There’s a lengthy pause and then Jo says: “I’m sorry. I’m trying not to cry just talking about it now.”

Reflecting on that crucial conversation with Sophie, Jo says she was both “terrified for my child” and “very sad.”

“Back then I knew nothing about having a transgender child.

“I didn’t know where I was going to go from here, what was going to happen, what sort of life my child would have.

“Also, the idea of losing my only daughter, as well, was quite sad. I really wanted a daughter and all of a sudden I was going to have two sons,” Jo explains.

Sophie got in to see the multidisciplinary team the Royal Children’s Hospital’s (RCH) Gender Service in Melbourne earlier this year and doctors confirmed what her parents already knew. She had gender dysphoria.

A person is transgender when their sex (physical appearance) and gender (a person’s inner sense of who they are) do not match. When it causes severe distress, it is referred to as “gender dysphoria.”

Based on a New Zealand study of secondary students, 1.2 per cent of the population identifies as transgender. Extrapolating from this finding, it’s likely that more than 44,000 Australian school-age children are transgender. It’s a huge figure. Taking into account the variation in school sizes, that’s an average of almost 5 kids in every typical school.

RCH’s Dr Michelle Telfer is one of Australia’s leading paediatricians in the field of gender dysphoria. She says people often ask the question: “These kids are so young, how can they know what gender they are?,” but to her it makes perfect sense.

“If you think about other children who don’t have gender dysphoria, they’re very clear at age two and three whether they’re a boy or a girl. “They know and they choose particular clothes and games and friends,” Dr Telfer says.

“[But] When we have a transgender kid who is just as sure about their gender but that doesn’t fit with our ideas of what is usual then we question them.

“Whether they identify with the gender that matches their physical body or not, I still think they can know,” she says.

RCH’s Gender Service had only one referral when it opened in 2003. Last year it received 104 new referrals and staff expect that number to double in the coming year.

Once Sophie understood it was possible that she was born into the wrong body, “his heart just became lighter … and I could see the change in him,” Jo says.

She uses the pronoun “he” because Sophie socially transitioned into a boy in October last year and now wishes to be called Max*.

“Max was just dragging us into social transition, which means he’s just wanting to live his life as a boy … wanting to change his name and have everyone know he’s a boy,” she recalls, explaining how rapidly things unfolded.

And suddenly, all the pieces fell into place.

“I knew this was what had been wrong all the time,” Jo says.

Before the transition, Max always requested to be called by boys’ names. He rejected girls’ clothes and toys from the time he was 18 months old.

“He wouldn’t just say, ‘No.’ He would violently throw them away,” Jo says.

More troubling was the sleeplessness and anxiety. Max’s insomnia reached such a fever pitch that a paediatrician prescribed him melatonin.

He’d also wake in the night screaming, trying to remove his girl’s pyjamas and would not sleep in a room alone.

When he school started last year, another set of problems arose.

“School is very gendered, so when he went to school … the anxiety sort of seemed to go through the roof,” Jo says.

Max would not play with other kids but instead sat “by himself, isolated, on the floor in the classroom,” his mother says.

With full support from Max’s school, Safe Schools Coalition Victoria (SSCV) was brought in to help both teachers and students understand his social transition into a boy. This included talking to Max’s prep class “in an age appropriate way” and answering all the kids’ questions.

While this happened, Jo took Max down the street.

“We came back to the prep class they all welcomed Max as a boy with his new name and they had this little celebration cake, which was really sweet and lovely,” she says.

These days Max still feels unhappy with his girl’s body, Jo says, but “he’s definitely a happy little boy in comparison.”

In Australia, medical interventions for children with gender dysphoria only commence in early puberty. Initial treatments are fully reversible. Surgical options are only considered once a young person turns 18.

“It was such a dramatic change,” Jo says, adding that Max “started sleeping that week in the room by himself with the door shut. It was like a miracle.”

Jo largely attributes Max’s relatively smooth social transition to his school.

“They couldn’t be more supportive, and so were the parents.

“I feel like the whole community has got our back,” she says.

But navigating the school system with a transgender child isn’t always easy. Emma* and her six-year-old daughter Matilda* had a vastly different experience to Jo and Max, despite Victorian Department of Education and Training guidelines stating schools must support transgender students.

Emma describes the approach of her daughter’s public school to Matilda’s social transition from a boy into a girl as a “go slow” and says this involved “putting road blocks” in the way.

Teachers resisted using Matilda’s chosen female name or using female pronouns. When she tried to insist, Emma says she found herself in the principal’s office along with the prep co-ordinator and Matilda’s teacher.

Emma says the principal told her: “We can’t do anything until we see a birth certificate. We really can’t use the female pronoun because it doesn’t say female on the birth certificate.”

In Victoria, you must be over the age of 18 and have undergone sex affirmation surgery to change gender on your birth certificate.

However Emma says the principal insisted it was “Department policy to see a birth certificate.”

“It’s misinterpreting the policy,” Emma says.

In that same meeting Emma says school staff questioned whether Matilda’s desire to affirm her true gender “was just a phase.”

When SSCV suggested to her daughter’s school that Matilda could use the girls’ toilets, Emma says staff responded with a “look of horror on their faces.”

In the end, Emma was worried she couldn’t trust the school to look out for Matilda’s wellbeing. She constantly worried about her being “embarrassed or humiliated” and decided to start her at a new school at the beginning of next term.

“I don’t want Matilda in that environment anymore,” she says.

As for Jo, she still worries about her son’s future. She knows “he’ll always have gender issues and he’ll have to work on that his whole life.”

However Jo believes Max’s transition was “a life and death choice.”

“If you look at the statistics, a child who is not supported with this sort of gender dysphoria is at huge risk of suicide and self harm.

“The main thing is that he’s alive,” she says.

*Names have been changed at the request of the families.

Ginger Gorman is a multi-award winning print and radio journalist, and a 2006 World Press Institute Fellow. Follow her on twitter: @freshchilli