Re-Thinking Rooming Practices in Pediatric Hospitals: Another Approach to Gender-Affirming Care

ACLP Bulletin | Spring 2023 | Vol. 41, No. 2

Ruthie Charendoff, CCLS

In pediatric hospitals with shared rooms, room assignments are often determined by infection control, age, and sex. While NICUs often have large bays or rooms with infants of all sexes, other pediatric units group children and their families based on their sex assigned at birth. However, families of transgender and gender non-conforming (TGNC) youth may prefer a different arrangement if given a choice, and child life specialists can advocate within health care systems to question and change traditional room assignment policies.

The number of TGNC young people is growing rapidly, and as child life specialists, we must be ready to provide inclusive care for them. There are 300,000 transgender teens in the United States (Ghorayshi, 2022). Transgender teens make up 1.4 percent of the teen population, but more notably, trans teens make up a disproportionately large percentage of the entire transgender population. While teens ages 13 -17 make up 7.6 percent of the U.S. population, they make up 18 percent of the transgender population (Ghorayshi, 2022). The TGNC community is also growing among younger children, with triple the amount of children identifying as gender diverse in 2021 compared with 2017 (Respaut & Terhune, 2022).

Transgender and gender non-conforming youth can and do live happy and healthy lives, but some of them experience gender dysphoria. Gender dysphoria is “the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sexrelated physical characteristics” (Mayo Clinic, n.d.). Gender dysphoria puts teens at a substantially higher risk for poor health, including depression, anxiety, and suicide (Kimberly et al., 2018). Medical care that is designed to affirm individuals’ gender identities mitigates the negative effects of gender dysphoria. It is crucial, therefore, that medical teams provide gender-affirming care to these teens who can be at higher risk for negative health outcomes.

Gender-affirming care has many facets. Some of them are more medical, including puberty blockers, hormone therapy, and gender-affirming surgeries, which need to be prescribed by medical providers. There is another side to gender affirming care, though, that can be performed by anyone in the hospital, and that is social affirmation. This includes affirming a young person’s hairstyle, dress, name, pronouns, and restroom of choice. Many hospitals are making it easier for medical professionals to engage in social affirmation by providing pronoun stickers to staff and utilizing features in electronic medical records to highlight a patient’s preferred name and pronouns when you pull up their chart. When it comes to shared rooming, however, many hospitals have not shifted to a gender-affirming model and continue to room patients based on sex assigned at birth, rather than patient gender or preference (Appel, 2011).

Many hospitals in the United States assume that patients want to share a room with someone of the same sex, and therefore don’t provide them with any other options. Many Canadian hospitals, however, are allowing mixed gender rooms in all hospital departments to get patients out of the emergency room and into rooms faster (Appel, 2011). These hospitals don’t require patients to room with someone of a different gender but ask them their preference to find them a bed more quickly. By asking patients whether they have a gender preference for a roommate, these hospitals are providing the potential for gender affirming care in not making an assumption about gender based on sex assigned at birth, while also optimizing the use of space in the hospital by filling as many open beds as possible. Rogers
(2002) conducted a study that supports this decision. He found that patients generally would accept a mixed-gender room if it meant they got faster admission.

In camp and school settings, the research has found that mixed-gender room assignments benefit many participants. One study found “gender identity and birth sex to not be drivers of friendship development among the LGBTQ campers in this context, while campers’ assigned cabin was a significant predictor of friendship development” (Gillig & Bighash, 2019). All-gender cabins have also been shown to help increase self-esteem and decrease anxiety and depressive symptoms (Gillig & Bighash, 2021). Child life
specialists who work in a camp setting can and should help advocate for all-gender housing at retreats and camps. While not all families may want to opt into all-gender housing, gender affirming programs often create some gendered and some all-gender rooming options so that all families’ needs can be met.

Creating the option of mixed gender rooms (without requiring it) could be hugely beneficial, not only for TGNC patients, but for all patients in allowing them to have more control and autonomy over their stay while also speeding up the admission process. As child life specialists, we can help advocate to adapt hospital policies to allow for the choice of mixed-gender rooms. This supports not only our own set of child life ethical principles of autonomy, beneficence, justice, and nonmaleficence, but also many hospital policies that include non-discrimination statements based on gender identity. Pronoun stickers and pride flags are a great start, but they are not enough. Gender affirming care requires us to think not only of individual interactions with patients and families, but of hospital design that promotes the development and autonomy of each patient and family.

REFERENCES

Appel, J. (2011, May 25). Are we ready for coed hospital rooms? Huffpost. https://www.huffpost.com/entry/are-we-readyfor-coed-hos_b_618028

Beemyn, G. (2022, January 1). Colleges and universities that provide gender-inclusive housing. Campus Pride. https://www.campuspride.org/tpc/gender-inclusive-housing/

Ghorayshi, A. (2022, June 10). Report Reveals Sharp Rise in Transgender Young People in the U.S. The New York Times. https://www.nytimes.com/2022/06/10/science/transgenderteenagers-national-survey.html

Gillig, T., & Bighash, L. (2019). Gendered spaces, gendered friendship networks? Exploring the organizing patterns of LGBTQ youth. International Journal of Communication, 13, 22.

Gillig, T. K., & Bighash, L. (2021). Network and proximity effects on LGBTQ youth’s psychological outcomes during a camp intervention. Health Communication, 1-7.

Kimberly, L. L., Folkers, K. M., Friesen, P., Sultan, D., Quinn, G. P., Bateman- House, A., ... & Salas-Humara, C. (2018). Ethical issues in gender-affirming care for youth. Pediatrics, 142(6).

Malone, S. (2016, June 10). College dorms a new front in U.S. battle over transgender rights. Reuters. https://www.reuters.com/article/us-usa-lgbt-education/college-dorms-a-new-front-inu-s-battle-over-transgender-rights-idUSKCN0YW15P

Mayo Clinic. (n.d.). Gender Dysphoria. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/symptoms-causes/syc-20475255

Respaut, R. & Terhune, C. (2022, October 6). Putting Numbers on the Rise in Children Seeking Gender Care. Reuters. https://www.reuters.com/investigates/special-report/usa-transyouthdata/

Rogers S. (2001-2002, Winter). Mixed gender wards: What does the evidence indicate? Hospital Quarterly, 5(2), 77-84.

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