August 2021 – Purple and Green and the Life in Between

From Baby to Toddler: The End of Bottle Feeding

WHY BOTTLE FEEDING?

If you’ve been following along with our journey, you’ll know that we have been bottle feeding our baby since they were two weeks old. This is because of issues with lactation and dysphoria. As soon as we tried bottles, it was night and day. It just worked so much better for us.

Generally, bottle feeding is treated as a stand-in or substitute for the more preferred nursing/body-feeding. I don’t think this is fair. In our case, I was able to be much more present and engaged in the activity of feeding my baby when feeding from a bottle than feeding from my body. I actually enjoyed holding them close and snuggling as they ate. So as far as I’m concerned, whatever feeding method allows your baby to be fed the calories they need in a safe way and allows you to connect with them as much as possible is the best way to feed your baby.

So, because we’ve been bottle feeding since two weeks old, we’ve had a pretty solid routine of mixing formula, heating bottles, feeding and cuddling our baby 3-4 times per day, and steralizing/washing the bottles and nipples. Even after we started giving solid foods, they continued to drink the majority of their bottles. This started to change around ten months.

THE END IS NIGH

As our baby got better at eating solid foods, we started offering solids more often. We started with only at lunch time, then added dinner time, then added breakfast, and now have 3-5 times they will eat depending on what is happening. At about ten months, they started to drink less and less of the formula in the bottles. So we cut down from four bottles a day to three. We had to try this a few times before it actually worked without them getting too hungry.

Then, as we increased the number of solid food meals we were offering, we just ran out of time in the day to offer as many bottles. Our baby was also too interested in playing and cruising to want to sit still to drink from the bottle. So, for a little while, we offered formula in a sippy-cup style bottle with a straw. They drank way more from that than when they were forced to sit still and drink from a baby bottle. It worked great as a transition from three bottles to two.

Then the bottle at the end of the day, after dinner, was becoming more and more of a struggle. Our baby would either be too tired, too full from dinner, or too active to want to sit still and drink. So we did the same thing – put some formula in a sippy cup that they could drink from on the go if they wanted, or not, as they chose. And more often than not, was left mostly untouched. So, rather suddenly, we were down to only one bottle per day – first thing in the morning.

As they turn one year old, this is where we’re at. They are doing great getting calories from solid foods and cows milk during the day, and have one bottle of formula, and the cuddles that go with it, first thing in the morning. How long will this last? Who knows. But getting here from a solid four bottles a day was a pretty smooth and steady process.

FOLLOWING MY BABY’S LEAD

The biggest thing throughout this transition from bottle feeding to eating primarily solids was following my baby’s lead. Some of the signs we noticed along the way that told us they were ready for the next step were:

Eating less from each bottle
Getting antsy while drinking from a bottle and giving up on it in favour of playing
Preferring to drink from the bottle while on the go instead of while cuddling
Doing well drinking water independently from a straw cup with handles
Doing well consuming solid foods multiples times a day

Some of the signs that we were progressing too fast for them were:

Being too hungry to focus on the newer skill of eating solid foods
Getting cranky in the later afternoon before it was time for dinner despite having good sleep
Drinking everything from every bottle we offered when they had not been finishing bottles for a while before we made the latest change

Most of the signs they were ready to progress were around skill acquisition and independence. Most of the signs that we were going too fast were aroung hunger. We never really noticed signs related to needing more cuddle time to make up for the loss of cuddle time as they were having fewer bottles. Maybe this is because we were still spending the majority of the time with them (as I was still on parental leave). Perhaps if they had been starting daycare at the same time this would have been a factor.

WHY DOES IT MATTER?

Just because my baby didn’t seem to be concerned by the decrease in cuddle time as they had fewer bottles didn’t mean it didn’t matter to me. I noticed it. Each time I feed them a bottle in the morning and they snuggle in my lap and hold onto my finger or touch my face, it resonates with all the memories of the other times we have done this. The late night times, the right-before-nap times, the out-at-the-park times. These memories around feeding my baby are visceral and strong and one of the main threads through the first year of their life – our entire existence together so far.

What will it be like when we no longer have that first bottle in the morning to bring those memories and emotions to the surface? What will we find as a substitute? I don’t know yet because we’re not quite there but I can tell you that, as much as I try to stay in the moment and not grieve in advance, I am already grieving the end of those feeding time cuddles.

On the other side, seeing them independently use a toddler cup and be in control of when they want some, how much they have, and hand it back to us when they’re done is so rewarding. This type of independence is a big part of feeling like my baby is becoming a toddler.

So, we will keep giving our baby a bottle first thing in the morning for as long as they want to have it. When we finish the formula we have, we will offer warm cows milk instead. Because sometimes it’s not what you’re feeding your baby that’s important, but the time you spend with them while you feed them.

Maybe by the time they give up that last bottle, family meal times will feel just as special as those cuddles in the rocking chair.

Where are you at in your feeding journey? What was your transition from nursing/body/bottle feeding to solids like? What emotions did it bring up along the way? Share your experiences in the comments!

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From Baby to Toddler: Motor Milestones and Ableism

FROM BABY TO TODDLER: FIRST STEPS

Technically, a baby becomes a toddler on their first birthday. There is so much development in so many different areas around this time but the one that gets the most attention is walking. A baby’s first steps are often much celebrated and, emotionally, mark the shift into toddlerhood. The name ‘toddler’ even comes from the unsteady, wide based gait quintessential to new, young ambulators.

With walking comes more independence and the end of crawling, bum scooting, rolling, or other forms of baby locomotion. From then on into adulthood, they’ll be walking (or so we assume and hope – more on the ableism of this perspective below). Though they aren’t yet talking (for the most part), potty trained, or really all that independent, it feels like a sudden shift away from baby behaviours and into the next phase of their life.

Babies (or toddlers) learn many other motor skills before taking their first steps. There’s rolling, sitting, and crawling but even once they start working towards walking there are many skills still to learn. There’s pulling up to stand (and learning how to safely return to the ground), weight shifting, cruising, letting go in standing, taking a reaching step while cruising, and then, eventually, a free standing step. And even then, it’s a while longer before walking becomes their main mode of locomotion.

As with all types of development, babies practice each of the smaller steps constantly. They are trying new things, seeing what works, and getting excited when they figure out how to consistently replicate an action. Especially when it helps them gain access to new areas and perspectives. And we get excited right along with them. We encourage them, get excited with them, protect them, and console them.

But why focus on first steps? Why aren’t a baby’s first words or some other milestone the most celebrated aspect of becoming a toddler?

THE PROCCUPATION WITH MOTOR MILESTONES

Motor milestones and a baby’s growth are the two main indicators of whether a baby is developing as expected during their first year of life. There are standards of when babies are expected to start holding up their head, rolling, crawling, pulling up to stand, and walking. It is so easy to get hung up on these expectations, comparing your baby to others or to the ‘standard’.

This comparison can cause a ton of anxiety and pressure that we can inadvertantly pass on to our babies. We teach them that their actions and physical development will make us more excited than other areas and that is what they should focus on. We are encouraged to have our babies play on their tummies on the floor, even if they hate it (‘They’ll get used to it, you just have to keep trying!’) rather than trying alternative positions that encourage the same types of development.

Yes, motor development is an important part of a baby’s development because, as I understand it, it encourages, allows for, or results in development in many other areas such as spatial awareness, differentiation of self from others, depth perception, emotional development, etc. But what we’re not told is that there is a range of ways and timelines a baby can develop motor skills that still result in developing all these other areas, especially if the parent(s) are engaged and play with them in meaningful ways.

The most important part is that we are excited for whatever aspect of development our baby is focused on in the moment and is able to achieve. When we’re in community with others, I think it’s important to be excited and curious about all the different ways babies develop and try not to compare, shame, or judge based on differences.

MOTOR MILESTONES AND ABLEISM

The concept that there is a ‘right way’ for a baby to develop is extremely ableist. It is so easy to fall into this way of thinking when everything we are told is about when our baby ‘should’ be able to do certain things. This has become especially evident for me around the ‘first steps’ milestone.

Here are some of the thoughts that have been spinning around my head and how I’ve been trying to address them from an anti-ableism perspective:

Using ‘taking their first steps’ as the indicator for becoming a toddler

This is inherently abelist. Not all children take steps. If they do, they may take significantly longer than 12-16 months to get there. Just the idea that a human that isn’t walking is considered a baby makes me cringe. So no, a baby does not need to take their first steps to be considered a toddler. I think I’ll stick with the first birthday as the marker of that threshold.

Getting excited when my baby learns new motor skills

It’s always exciting when your child learns new things, no matter what type of skill it is. But motor skills seem easier to identify as an observer. We can see all the little progressions and attempts as they work up to being able to do something. And of course we get excited when they are able to do something new.

But does that mean we’re putting unnecessary emphasis on motor skills due to an ingrained ablist perspective? Not necessarily. If we’re excited because our baby is excited and because they learned something new, that seems fine to me. Just because we’re excited to see them roll for the first time, doesn’t mean we’d be any less excited if, at the same age, our baby had just learned how to open and close their fist. Being excited for any development at any age, whatever stage your child is at, is one of the joys of being a parent.

Using motor milestones as the main indicator of development

Again, I think this is ableist. Motor milestones should get no more weight than social development, language development, play engagement and activities, sleeping skills, eating skills, and overall growth. Sure, some of those others are harder to observe and measure and may have a wider range of ages when they appear and develop. But focusing on motor milestones simply because they are easiest to track puts undue focus on physical ability, stressing that that is somehow more important than all the other areas. This is not true and highly ableist.

Identifying motor ‘delays’ and accessing support services

As a rehab professional, this is where I get stuck. I don’t like the focus on motor skills to the exclusion of other types of development but I recognize that if there are motor delays, this can be the earliest and most easily identifiable indicator that there may be delays in other areas as well. I also know that the sooner a child, parents, and family has access to interdisciplinary support, the easier it is for the family to learn how to create a supportive environment for a child who’s needs might be different from the mainstream experience.

I think it becomes ableist when motor delays (or other delays) and accessing support services comes with negative judgement. Anything along the lines of ‘your child isn’t normal’, ‘you have failed as a parent’, ‘you did this to your child’, ‘you should be able to support your child on your own’, or ‘you are weak for needing help’ is pure ableism. Even the more subtle aspects of needing to prevent as much future disability as possible so they can have a good life is ableist. Preventing disability for the sake of enduring less pain, stigma, or struggle is one thing. Assuming that they won’t have a good life if they are born with or develop a disability or delay is a whole other and very ableist thing.

FINAL THOUGHTS

First steps are very exciting and are a culmination of many smaller skills and hours of practice.
First steps and the beginning of walking (or being fitted for and learning to use their first wheelchair) marks the end of ‘baby’ locomotion skills and can trigger a grieving process around the end of the ‘baby phase’.
Babies become toddlers on their first birthday, not when they take their first steps.
Focusing on motor milestones to the exclusion of other areas of development is ableist.
Stressing about and pressuring your child to perform motor skills they are not yet ready for is unnecessary and comes from internalized ableism.
Comparing to others or the ‘standardized norm’ can cause unnecessary stress and focus on motor development.
Following your child’s lead and being excited for whatever skill they are working on is one of the joys of parenting and not inherently ableist.
Accessing support for yourself and your child should you feel you need to help provide a positive and supportive environment for your child is important.
Negative judgement around motor delays (or any type of delay or disability), accessing supports, or perceived future quality of life is extremely ableist.

Have you had similar thoughts and experiences? Do you agree or disagree with what I said here? Leave a comment below with your thoughts or share your story!

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From Baby to Toddler: Developmental Thresholds and Complex Emotions

DEVELOPMENTAL THRESHOLDS

Babies are constantly changing. Even before birth, their development during pregnancy is rapid and constant. And yet, we perceive this development as occurring in stages. Some of these stages seem arbitrary – like the trimesters of pregnancy – and some seem practical – like the motor milestones. The change from one stage to the next requires adaptation and often comes with excitement, pride, mourning, and anxiety.

Often, these thresholds feel sudden because we mark them with a discrete event – conception, birth, first time our baby sleeps through the night, first time they eat solid foods, first tooth, first step, first word. But really, these are indicators of progress that is slow and constant.

This focus on a discrete event is where we get into trouble. The more sudden a change from one stage to the next feels, the more trouble we have adapting and the more our emotions around this change can feel overwhelming.

Motor development especially can seem to happen in sudden leaps. If that is our focus, we can fall into the pattern of waiting for the next leap to happen, trying to help our baby get there faster, and even becoming anxious if the space between leaps is taking ‘too long’. But if we pay attention to other areas of development, we see them progressing more quickly during that space between gross motor leaps – fine motor control, perceptual abilities, social interaction, language ability, sleeping skills, and eating skills.

So when we take a holistic global view, development doesn’t happen in chunks with discrete moments marking one section to the next but gradually and globally. We can define our child’s ‘stages’ in whatever way is most meaningful to us. And the thresholds between stages are more like the changing of seasons than the flip of a switch.

COMPLEX AND CONFLICTING EMOTIONS

Often, thresholds or transitions from one stage to the next cause lots of complex and conflicting emotions. We are excited to see our baby learn new things and delight in their excitement and wonder (such as learning how to turn pages in a book). We are proud of how far they’ve come and how our bond with them is manifesting. But we also mourn the loss of the things we enjoyed about the previous stage that we will never get back (such as being able to cuddle and read a book without them grabbing it, chewing it, or tearing it). And we can feel anxious about adapting to, managing, or guiding them through the next stage of development (such as how to stop them from damaging books while still encouraging their interest in them and promoting literacy).

Sometimes, the mourning especially feels big and overwhelming to the point that you wonder if there’s something wrong with you (such as yearning for the days when your baby was soft and tiny and squishy and stayed where you put them). In these moments, I have tried to identify what it was about the previous stage that I feel I am losing and look for how that same experience or form of connection is showing up in my baby’s new way of being or interacting (such as encouraging my baby to come to me when they need me or getting down on the floor to play with them on their level).

As with all endings of one stage and beginnings of the next, the closer you look at them and pay attention to the details of the experience, the more they seem to overlap. The ‘moment’ when one thing ends and another begins starts to look more like a process. This zooming in helps me smooth out the emotional experience as well.

It means I am not mourning everything at once but in small pieces as the changes occur. I can then more easily stay focused on the exciting new aspects of my baby’s development and our life together. I can be proud of the small victories as well as the big ones.

I can also see the smaller pieces of the change as they occur and adapt in real time instead of feeling like something has suddenly shifted that I wasn’t ready for. In this way, I avoid a lot of the anxiety that comes from a sudden loss of feeling competent, a loss of control, and the feeling of my baby growing up too fast for me to keep up. There will definitely be times when things do shift suddenly – an illness or injury for example. And maybe I will have to learn a completely different way of dealing with those. But for the more predictable shifts that happen as my baby grows into a toddler, I have found this ‘focus on the details’ approach to work well.

WHEN DOES MY BABY BECOME A TODDLER?

The standardized moment when a baby becomes a toddler is their first birthday. This is an example of an arbitrary and sudden way to mark this threshold. For us, this time corresponds with the end of my parental leave and the start of daycare. Their first birthday is also the first anniversary of their birth and all the emotional memories that come with that. We are also in the process of weaning bottle feeding and our baby is rapidly working their way to taking their first steps.

These related yet varied developmental and life changes all feel like part of the process of my baby becoming a toddler. So while their first birthday may be the definitive moment that the label flips over, the emotional processing of this developmental change incorporates so much more.

PROCESSING THE THRESHOLD FROM BABY TO TODDLER

The threshold between baby and toddler isn’t the first time in parenting that I’ve experienced complex and conflicting emotions, and it definitely won’t be the last, but it feels particularly big.

Some of the changes around this threshold involve the ending of something that has been a constant for us since their birth a year ago or very close thereafter (bottle feeding, parental leave and full time caregiving). These aspects have been core elements that defined our existence up until now. Progressing past them to move on to the next phase feels like we’re giving up parts of what defines us as a family. Or what has defined our experience as a family up until now.

The end of parental leave is like pushing our way out of our family cocoon (reinforced by the pandemic-induced isolation) and re-entering the world, now as a family of three. It feels vulnerable and shaky. It feels like there will be monumental distance between us after spending almost every day together.

Their first birthday is an opportunity to reflect on all our memories and experiences, growth and change from this first year. It will also bring back a lot of emotional memories from our experiences of labour, birth, and immediate postpartum.

The end of bottle feeding feels like the end of early morning cuddles and a clear step from the baby-drinking-from-a-baby-bottle phase into the toddler-drinking-from-their-own-cup phase.

There is so much development in so many different areas around this time but the one that gets the most attention is walking. A baby’s first steps are often much celebrated and, emotionally, mark the shift into toddlerhood. The name ‘toddler’ even comes from the unsteady, wide based gait quintessential to new, young ambulators. But this ‘milestone’ especially feels like a long slow process as I’ve watched my baby go from sitting to pulling up to stand, crawling, cruising, kneeling, bear-crawling, standing, balancing, reaching, and soon, taking steps, then walking. And even then, it will be a while before they give up crawling altogether.

So overall, there is a shift towards my child becoming more independent, spending more time away from me, and a re-defining of our experience as a family from one that exists in isolation to one that exists integrated with the wider world. Clearly, my baby is not the only one making a shift to a new stage. We all will be shifting together.

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How to be a Trans Inclusive Health Care Professional

THIS IS IMPORTANT AND YOU CAN HELP!

Trans people experience a wide range of barriers to health care including overt discrimination, uninformed health care professionals, systemic discrimination, and personal biases. As a result, trans people frequently have negative experiences in health care settings and often avoid accessing health care services even when it is necessary. Ultimately, this leads to significant health disparity. This is compounded by having intersectional identities and experiences that also experience health care bias (fatness, racial minorities, disabilities, neurodivergence, sex workers, previous incarceration, current or past drug use, etc.)

Trans people have a significantly higher risk of suicide, especially youth. The single biggest protective factor against this increased risk is having supportive people in their life that respect their name and pronouns. That’s all it takes (though the more support the better of course).

So as a health care professional, what can you do to help? Here are some suggestions.

DON’T ASSUME

Don’t assume you know someone’s gender. Not based on their legal gender marker, their presentation, their body shape, their voice, their experiences, or the clinical service they are accessing. Trans men can be pregnant, birth, and body feed their children. Trans women can have a low voice. Nonbinary people come in all shapes, sizes, and presentations. Not every trans person is able to or cares to change their gender marker.

Don’t assume someone’s pronouns or the language they prefer based on their gender (or any of the other above information). People can use any pronoun regardless of their global gender identity. Pronoun preference can shift day to day, depending on context, or depending on the people they’re with. Other gendered terms are separate from pronouns. People can prefer seemingly conflicting terms (such as preferring Mx., sir, guy, sister, and Mom) and this is perfectly fine.

Don’t assume a trans person’s transition trajectory. Don’t assume every trans person wants to transition in any way, what components they will want to include in their transition, or what order or length of time they will take to access and engage with the options available to them. There are not only two pathways for transitioning. There is no set end point to transitioning. It is a highly variable and individual process that spans many many years if not the rest of their life.

So if you’re not supposed to assume any of these things, how do you find them out so you can interact respectfully and provide the appropriate care? You use neutral language for everyone (not just the people you suspect of being trans) until they specify or until you confirm by asking specific questions. Knowing what questions to ask and how to ask them in a specific and respectful way comes with practice. It is your choice whether you want to practice on your own time (via accessing formal training opportunities or informally interacting with trans people on a personal level) or over the course of your professional career.

RESPECT NAMES, PRONOUNS, AND GENDER IDENTITIES

You don’t have to understand every gender identity in order to respect them.

When you get someone’s name or pronouns wrong (which you will, we all slip up sometimes), correct yourself and move on. Do not apologize, especially not repeatedly or profusely. By apologizing, you are putting the focus on you and the mistake you made and forcing the trans person into the socially conventional role of either thanking you for the apology or excusing the original mistake, neither of which is acceptable.

Repeating what you said with the correct pronouns, name, or other language is necessary to cement the correct version in your brain. The more you de-emphasize the mistake and emphasize the correct version, the faster your brain will adapt and stop making mistakes in the first place.

If someone else corrects you, say ‘thank you’ (not ‘sorry’), repeat it correctly, and move on.

If people around you are making mistakes, make sure to correct them if you feel it is safe to do so. It is often easier to hear when other people make mistakes than when we do it ourselves. The more you correct someone else, the more you are emphasizing the correct version to yourself and others. You can correct others by interrupting them and stating the correct pronoun/name/language, by repeating what they said but using the correct pronoun/name/language, or by continuing on with the conversation, ensuring to use the correct pronoun/name/language with added emphasis.

This goes for documentation and patient records as well. Find a way to include preferred names, pronouns, and other important language in your patient demographics tracking system. Document using the patient’s preferred name and pronouns. If these don’t match their legal information, start with a note that states that you will be referring to [legal name] as [preferred name] and using [preferred pronouns] for the remainder of the patient’s chart. If you have to do this at the beginning of every chart note, then do it. It’s important.

IT IS YOUR JOB AS A PROFESSIONAL TO BE OR BECOME INFORMED

It is not your patient’s job to educate you on the basics of trans identities, trans health care, trans bodies, or how to respectfully interact with them.

It is your job to know what aspects of trans experiences and medical care relate to your scope of practice. If you are a medical doctor and do not understand that trans men do not need prostate exams and trans women do not need pap smears, you have a significant amount of learning to do to be considered a competent medical professional (for anyone, not just trans people).

‘I was never taught that in school’ is never a good reason not to know something. All regulated medical professions have an expectation of continued learning and keeping up with medical advances and new research. Would you prescribe someone the same medication now that you did twenty years ago even if it was no longer recommended and newer medications that are cheaper, more effective, and with fewer side effects had since been developed? No? Then don’t treat a trans person according to twenty year old ‘best practice’ guidelines. Those are no longer best practice. The world of trans care is changing rapidly. It is your job as a professional to stay up to date.

YOU DON’T NEED TO KNOW EVERYTHING TO BE A GOOD HEALTH CARE PROFESSIONAL

Even if you are doing your best to stay informed, there will be times when you’re not sure whether you’re missing something or whether their experiences as a trans person simply aren’t relevant. You don’t need to know everything. But…

You need to be willing to admit when you don’t know something.

You need to do the work to learn what you need to know when you identify a gap in your understanding or knowledge.

And you need to be able to find the information you need and assess whether the source is reputable, scientifically based, and whether it holds bias (hint: there is always some bias if it is a scientific source so it’s important to be aware of it).

TRUST THE PATIENT

Trans people’s experiences are incredibly nuanced, intersectional, and often very internal. You cannot judge what a trans person (or anyone, really) is struggling with internally by looking at them. Therefore, you cannot judge what care would be best without first understanding and accepting what they are telling you about their experiences, struggles, joys, and desires.

It is your patient’s job to be as honest with you as they think is safe and necessary in order access the care they need. Sometimes this involves misrepresenting their identity or hiding parts of their medical history. The more informed you are and the more respectful you are, the more likely your patient will trust you, the more honest they are likely to be with you, and the better the care you can provide.

Don’t question their lived experience because it is outside your area of experience or expectation. Trans people are not exaggerating when they describe the systemic barriers they face such as long wait times, repetitive updates and submissions of forms, lack of appropriate processes for changing legal documentation, etc. You can be shocked and disgusted that that is the way the system is but unless you have your own lived experience of navigating these barriers with a trans person and have found a way around or through them, you have no right to argue against them, suggest that they are doing something wrong, or simply haven’t tried hard enough.

TRANS PATIENTS ARE STILL PATIENTS

At the end of the day, trans patients are still patients. If you’re not sure how to proceed, draw on your clinical knowledge and treat the patient in front of you, not the trans patient you are assuming they are.

Don’t know whether the testosterone that a trans patient is taking may be relevant to the reason you are seeing them? Go back to the basics. What affects does testosterone have on a human body? What body systems might it affect? Are these relevant to your patient’s current concerns? You can follow a similar thought process for any component of trans experience or medical care.

If you think something might be relevant, explain your reasoning to the patient in terms they would understand and ask some clarifying questions. If you’re still not sure, make a note of it and move on to the next part of your assessment. Then, before you see the patient for their next visit, learn more about it.

As with any patient, consider the whole health of the patient, mental health included. If there is a component of their trans identity or trans specific medical care that you are worried is causing concern for other aspects of their health, consider ALL the consequences of interrupting that behaviour or medical care before making a recommendation.

Often, trans people have to compromise their physical health and wellbeing in order to protect or maintain their mental health and wellbeing enough to function in society. If you then suggest that they change their behaviour in order to protect or improve their physical health, that change could cause significant damage to their mental and emotional health (which is much harder to get help with and recover from). So, before making any recommendations, ensure that you understand the patient’s reasons for engaging in that behaviour or pursuing that avenue of medical care. You may not be seeing the big picture, or your version of the big picture might be different from your patient’s.

WHERE TO GO FROM HERE

I hope this has helped clarify a few things and point you in the right direction. Simply by reading this, you are already showing you are a better health professional to trans people than the majority. That is how low the bar is. Please help raise it.

Below you will find recommended resources. These are a place to start, not a sum total of what you need to know. If these links are outdated or broken, please let me know. I will try to keep it up to date. But again, if you are a health professional, you have the skills to find these resources on your own.

Beyond these links, how are you supposed to learn more about trans people (or other minority groups that differ from your experience)? Here are a few options:

Talk to a trusted friend or family member who is trans (or other minority) outside of a professional-patient relationship
Read descriptions of trans experiences written by trans people (such as this blog)
Attend a lecture or other learning opportunity presented by a trans person
Pay a trans person to provide education to you and your staff or assess your clinic/practice on the basis of trans inclusion

Reach out if you are struggling to find specific resources. If you are a trans person and would like to add suggestions to this post for how health professionals can be trans inclusive, please leave a comment!! The more experiences and voices the better.

REFERENCES AND RECOMMENDED RESOURCES

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How to Find a Queer and Trans Inclusive Daycare

Parenting is hard at the best of times. When you have to trust your child’s care and guidance to a group of strangers at a daycare, you want to know that all the hard work you’ve put in will be supported, not contradicted.

As a queer and trans family, we believe in raising our child in a gender creative and expansive way. We believe in respecting and affirming their bodily autonomy and teaching and modeling consent. We believe that under no circumstances do body parts define a person’s gender and until a baby is old enough to vocalize their preferred gender, pronouns should be considered temporary. Gendered language should be used sparingly (using child instead of girl or boy) or expansively (using child, girl, and boy equally to refer to the child).

As a queer and trans family, we don’t feel constrained by traditional gender roles. We don’t necessarily use traditional, binary parental terms or binary pronouns. We don’t necessarily celebrate traditional binary parental days. Our families may include sperm donors and donor siblings, surrogate and bio parents, children of our close queer friends whom our kiddo thinks of as ‘cousins’, and many other varieties.

Having to interact with institutions that care for our child opens the door to discrimination, isolation, and othering. Finding an inclusive daycare, school, pediatrician, etc is a lot of work. Often, these don’t even exist or we choose to travel much further than we hoped in order to access them. When we do find one, we often still have to do significant work to explain our identities and family structure and recommend ways they can be even more inclusive.

This is because there is a difference between accepting, aware, inclusive, and affirming. For me, accepting is the bare minimum. This is the absence of overt discrimination. Awareness comes when they understand the unique needs and identities of the queer and trans families they may encounter but haven’t necessarily taken steps to make space or include these in their policies and programs. Once they create and act on these policies and programs and complete some LGBT diversity and inclusion training, I would consider them inclusive. If they actively include diverse gender identities and family structures in their representations, encourage the kids to engage in all kinds of play regardless of sex or gender, vocalize their pronouns and ask families and kids about their own (as age appropriate), and apply all kinds of adjectives to kids regardless of sex or gender, then I would consider them affirming. This, I have yet to find.

We are currently in the middle of searching for a daycare for our little one. I don’t yet have the experience of working with a daycare to understand and respect our family’s identities and our child’s gender presentation and personal boundaries. I’m sure I will share more on that when it comes. For now, here are a few ways I have used to search for a queer and trans inclusive daycare.

COMMUNITY RECOMMENDATIONS

This is the best option. Having a recommendation from another family with similar identities/structure to yours who already attends a daycare and has had a good experience not only gives you a first hand recommendation but also another family to back you up should you need to bring up issues around inclusivity.

However, this is also the hardest to find for most of us. I received one recommendation from a queer (but not trans) family for a daycare they attend and like and one recommendation from a queer and trans family for a daycare they attend and have had no problems with (but isn’t actively inclusive).

So I kept those daycares in mind and moved on to other options:

WEBSITES

I did a quick search for daycares within commutable range of our house and came up with about 13 options. I thought this was a pretty good number. I then looked at all their websites. Of the 13, only one mentioned gender in the types of diversity they were supportive of. A couple others mentioned being supportive of/welcoming all types of families, family structures, and cultures.

This was not super encouraging. Clearly, I would have to ask specific questions to see if any of the others were inclusive even though they didn’t mention anything on their websites.

CONTACT WITH QUESTIONS

So I sent out emails to my top eight choices in our area based on their policies and programs listed on their websites. The more emails I sent, the more brave I got and the more specific and direct my questions became. Because really, what is a daycare going to do to me if they’re transphobic and I’m asking about inclusivity? The worst that could happen is I get a negative response which would give me a very clear answer about whether to send my child there or not.

Here are some questions that I asked:

Do you have any policies regarding interactions with trans and queer families and children?
Has your staff done any LGBT specific diversity and inclusion training?
What is your knowledge of and perspective on gender development in children?
What is your approach to children’s toys, clothing, pronouns, and other language?
Do you have any LGBT inclusive children’s books?
Do you have any LGBT identifying staff?
Have you had/do you currently have any other LGBTQ families attending your daycare?

The majority of responses ignored all of my specific questions and used a blanket statement such as ‘we are supportive of all cultures and families’. What this says to me is ‘I don’t understand why these questions are necessary and have no idea how I would answer them in a way that would satisfy you so I will reassure you as best I can and hope that’s good enough’. This falls into the category of ‘accepting’ but not even ‘aware’.

The couple that responded with more specific answers to my questions had decent answers and freely admitted when my question was not something they had ever considered before. One even went so far as to say they would put that at the top of their list for training opportunities for their staff, resources to add to their library, and further learning for themselves. While I would consider that falling in the ‘aware’ to ‘inclusive’ categories, they show potential for being ‘affirming’ in the future and open to corrections and suggestions.

The ones that had good responses and the ones that were recommended by other LGBT people became the list of places we wanted to tour.

TOURING SITES

This is the stage we are currently in. Here is a list of things we are paying attention to when we go on site tours.

What to look for

Books with LGBT characters, families, and gender creative representations and stories
Gender neutral toys and play spaces (red flags for anything divided into boys/girls or pink/blue)
Pronouns included on staff ID badges/name tags or kids’ cubby areas

Interactions with staff

Do they respectfully ask about your family structure, identities, and pronouns?
Do they introduce themselves with their pronouns?
Do they gender your child before asking what pronouns you are using for your child?
How do they react if you correct their use of language for your child or family?
If you observe them interacting with other children, do they interact in a way you are comfortable with?

HOW TO BE A QUEER AND TRANS INCLUSIVE DAYCARE

If you are someone who works in childcare, here are some suggestions for ways you can be queer and trans affirming in your business structure and programming. This is by no means an exhaustive list.

Mandatory 2SLGBTQ inclusion and diversity training for current staff
- Include this in new staff training or repeat after a period of staff turnover
Familiarity and competence using a variety of pronouns
Knowledge of how gender develops in children
Actively counteract your biases around gendered clothing, toys, behaviours, and types of play
Use a variety of adjectives and forms of encouragement for all children
Books that depict families of all structures, children and parents of various gender experiences and presentations, and a variety of pronouns.
Ask for and offer your pronouns when interacting with kids and adults

If you are a queer or trans parent and looking for childcare, I hope this helps give you ideas or makes you feel less alone in the struggle. If you have other questions you would ask, other things you would look for during tours, or other recommendations to childcare businesses, please leave them in a comment or send me an email! I’d love to hear your experiences with your hunt for inclusive and affirming childcare.

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