These guidelines were created to help parents and other caregivers of young children better understand gender identity and expression in early childhood. Throughout the guidelines, we use the term "parent" broadly, to refer to any primary caregiver or guardian of a child. These guidelines are designed to be useful to all types of primary caregivers.

We use the term “transgender and/or gender nonconforming (TGN)” throughout the guidelines. This was the preferred term during the process of creating these guidelines in 2018-2020. We recognize that terminology changes and that other terms may be used. We intend TGN to be used as an umbrella term, similar to terms such as “transgender and/or nonbinary (TNB)” or “transgender and gender diverse (TGD).”

When we refer to experts in the guidelines, we are referring to the following three groups who participated in expert panels to develop these guidelines: (1) parents of transgender and/or gender nonconforming (TGN) children, (2) individuals with TGN lived experiences, and (3) individuals with clinical and/or research experience with TGN populations. Experts who identified as belonging to more than one of these groups chose one group to represent for this study.

These guidelines were developed using the Delphi expert consensus method. Three groups of panelists completed a series of surveys. In the surveys, the experts rated items about navigating early childhood gender identity and expression. The experts received reports on the items’ ratings between each survey round. The Delphi research team drafted the items into prose.

The Delphi process ensures a high level of consensus between each expert in the panel and between all three panels. These guidelines are based on statements about early childhood gender identity and expression that were widely endorsed by all three panels.

In addition, some statements in the surveys achieved a high level of consensus between two panels (individuals with TGN lived experience and individuals with clinical/research experience) but not the third panel (parents). These “partial-consensus” recommendations are noted at the end of each section of the guidelines in dark blue to give parents and caregivers access to a range of information agreed upon by experts with diverse perspectives.

The consensus-based guidelines were developed by 93 expert panelists including TGN adults, parents and caregivers of TGN children, and clinical and/or academic leaders in the field. The following researchers facilitated the process with the panelists to develop these guidelines: Sabra L. Katz-Wise, PhD, Allegra R. Gordon, ScD, MPH, Kendall J. Sharp, MPH, Natalie Penhale Johnson, MPH, and Laura M. Hart, PhD.