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Ages & Stages

Gender Identity Development in Children

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By: Jason Rafferty MD, MPH, EdM, FAAP

There are many ways parents can promote healthy gender development in children. It helps to understand gender identity and how it forms.

What's the difference between gender and sex?

Being a boy or a girl, for most children, is something that feels very natural. At birth, babies are assigned male or female based on physical characteristics. This refers to the "sex" or "assigned gender" of the child.

Meanwhile, "gender identity" refers to an internal sense people have of who they are that comes from an interaction of biological traits, developmental influences and environmental conditions. This may be male, female, somewhere in between, a combination of both or neither.

Self-recognition of gender identity develops over time, much the same way a child's physical body does. Most children's asserted gender identity aligns with their assigned gender (sex). However, for some children, the match between their assigned gender and gender identity is not so clear.

How does gender identity develop in children?

Gender identity typically develops in stages:

  • Around age two: Children become conscious of the physical differences between boys and girls.

  • Before their third birthday: Most children can easily label themselves as either a boy or a girl.

  • By age four: Most children have a stable sense of their gender identity.

During this same time of life, children learn gender role behavior—that is, do­ing "things that boys do" or "things that girls do." However, cross-gender preferences and play are a normal part of gender development and exploration regardless of their future gender identity. (See The Power of Play: How Fun and Games Help Children Thrive.)

The point is that all children tend to develop a clearer view of themselves and their gender over time. At any point, research suggests that children who assert a gender-diverse identity know their gender as clearly and consistently as their developmentally matched peers and benefit from the same level of support, love and social acceptance.

What parents can do:

All children need the opportunity to explore different gender roles and different styles of play. Parents can make sure their young child's environment reflects diversity in gender roles and encourages opportunities for everyone. Some ideas would be to offer:

  • Children's books or puzzles showing men and women in non-stereotypical and diverse gender roles (stay-at-home dads, working moms, male nurses and female police officers, for example).

  • A wide range of toys for your child to choose from, including baby dolls, toy vehicles, action figures, blocks, etc.

  • By age 6, most children spend most of their playtime with members of their own sex. They may also gravitate towards sports and other activities that are associated with their gender. It is important to allow children to make choices regarding friend groups, sports and other activities they get involved in. It is also a good idea to check in with your child to learn about their preferences and to make sure they feel included without teasing or bullying.

How do children typically express their gender identity?

In addition to their choices of toys, games, and sports, children typically express their gender identity in the following ways:

  • Clothing or hairstyle

  • Preferred name or nickname

  • Social behavior that reflects varying degrees of aggression, dominance, dependency and gentleness.

  • Manner and style of behavior and physical gestures and other nonverbal actions identified as masculine or feminine.

  • Social relationships, including the gender of friends, and the people they decide to imitate.

Gender expression & gender identity

A child's gender-specific behavior (gender expression) at any time seems to be influenced by exposure to stereotypes and their identification with the people in their lives. However, the internal sense of being a girl, boy, in between or something else (gender identity) cannot be changed.

How have gender stereotypes changed over time?

Our expectations of "what girls do" and "what boys do" have changed. Many female athletes excel at their sports. Girls increasingly pursue subjects traditionally thought of as "masculine." There are many famous male chefs, artists, and musicians―fields traditionally thought of as "feminine."

Over time, society has recognized that stereotypes of "masculine" and "feminine" activities and behaviors are inaccurate and limiting to a child's development. Such interests also do not determine or influence one's gender identity. Plus, our ability to predict who a child is based on early preferences is not very accurate—and may be harmful if it leads to shame or attempts to suppress their skills, talents and genuine self.

Still, when a child's interests and abilities are different from what society expects, they may face discrimination and bullying. It is natural for parents to have gender-based expectations for their children and to want to protect them from criticism and exclusion. Instead of pushing children to conform to these pressures and to limit themselves, parents can play an important role in advocating for safe spaces where their children can feel comfortable and good about themselves.

If your child doesn't excel in sports or even have an interest in them, for example, there will still be many other opportunities and areas in which they can thrive. Regardless of gender identity, each child has their own strengths that may not always conform to society's or your own expectations, but they will still be a source of current and future success.


Gender development is a normal process for all children. Some children will exhibit variations―similar to all areas of human health and behavior. However, all children need support, love and care from family, school and society, which fosters growth into happy and healthy adults.

More information

About Dr. Rafferty

Jason Rafferty Jason Rafferty, MD, MPH, EdM, FAAP, is pediatrician and child psychiatrist at Thundermist Health Centers, a Patient-Centered Medical Home in Rhode Island. He specializes in adolescent substance use disorders and gender and sexual development, and also practices in related specialty clinics at Hasbro Children's Hospital and Emma Pendleton Bradley Hospital. Dr. Rafferty is an advocate in his local community and on a national level through work with the American Academy of Pediatrics on issues including the emotional health of young men, access to care for LGBTQ youth, and prevention of childhood homelessness.

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American Academy of Pediatrics (Copyright © 2018)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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