Safeguarding in Gender Part 1: Parental Responses
From parental rejection to parental coercion, and the acceptable window in between
Introduction
The Cass Review1 placed a significant emphasis on the importance of safeguarding when working with children and young people with gender identity needs, with some of the clinicians that were consulted highlighting that “safeguarding issues can be overshadowed or confused when there is a focus on gender”2. However, the Review did not—understandably, given its remit—provide a comprehensive account of the safeguarding issues that may arise within this vulnerable population. This is not a criticism of the Review; rather, it is a recognition that further exploration is both necessary and overdue. The Safeguarding in Gender series aims to address that gap through an in-depth examination of the key safeguarding concerns that practitioners may encounter.
As Dr Cass observed in her foreword, “the toxicity of the debate [around gender identity] is exceptional”3. Within that debate, acknowledging risk has at times been misconstrued as pathologising all individuals with gender identity difficulties. This is a fallacy: recognising and responding to risk is not an act of prejudice but a fundamental aspect of safeguarding practice. While such cases are rare, the social worker’s duty is precisely to address the uncommon circumstances that place children at risk. Fabricated or induced illness, for example, is exceptionally rare, yet its rarity does not diminish our duty to protect the children affected.
Among children who experience gender identity issues, the rates of adverse childhood experiences4 and children who are looked after by local authorities4 are significantly higher than in the general population. Therefore, social workers must cut through the toxicity of the debate and ensure safeguarding needs are identified and addressed appropriately. Challenging conversations on controversial subjects are a necessary part of the profession, and this practice area is no exception.
With this context in mind, this first instalment of Safeguarding in Gender will focus on how parents respond to children’s gender identity difficulties. Children may encounter a spectrum of parental responses—from harmful forms of rejection to equally harmful forms of uncritical affirmation. Between these extremes lies a range of healthy parental responses. Drawing on the principles of the Children Act 19896, this article aims to define the boundaries of that range and identify where parental responses may cross the threshold into a safeguarding concern.
The Legal Parameters
The boundaries between acceptable and harmful parenting are ultimately a question of law. A substantial body of legislation and case law exists, granting rights and responsibilities to both parents and professionals, while placing clear limits on state intervention. As Justice Hedley famously observed, “society must be willing to tolerate very diverse standards of parenting, including the eccentric, the barely adequate, and the inconsistent.”7
Under the Children Act 1989, parents hold ‘parental responsibility’, conferring on them rights, duties, powers, responsibility and authority in relation to their child. Additionally, children and parents are granted protection under the Human Rights Act 19988, particularly Article 8, which guarantees the right to respect for private and family life. Together, these statutes establish parents as the primary decision-makers for their children, protected from state interference except where legally justified. Article 9 of the Human Rights Act—protecting freedom of thought, conscience, and religion—offers a further safeguard, affirming that parents may raise their children in accordance with their own beliefs and values, again subject to the requirement that any state intervention be legally justified.
There are several statutory routes through which these protections may be lawfully limited, all derived from the Children Act 1989. Section 47 of the Children Act confers a responsibility on the local authority to investigate concerns that a child is suffering, or is likely to suffer, significant harm; however, it does not grant powers to intervene. Only the courts and the police are granted powers to remove children without parental consent or prior judicial authorisation. Under section 46, the police may remove or accommodate a child they reasonably believe to be at risk of significant harm, for a period of up to 72 hours. The most extensive powers rest with the courts under section 31, which permits intervention only where “the child concerned is suffering, or is likely to suffer significant harm.” “Harm” is further defined in 31(9) as “ill-treatment or the impairment of health or development”.
While these provisions will be familiar to most social workers, there are several reasons for revisiting them here. The first is to distinguish between the duty of social workers to investigate and support—where parental consent is present—and the powers to intervene, which social workers themselves do not possess. The second is to emphasise that the thresholds between acceptable and harmful parenting, though informed by professional judgement, must be guided not by social norms or personal beliefs about parenting, but by evidence that a child is demonstrably at risk of significant harm.
Practical Parameters: Rejection and Boundaries
There are many reasons why a parent may reject their child, whether evicting them from the home, or through emotional distancing and abusive behaviours. The reasons given may relate to behaviour, lifestyle choices, values—the list is nearly endless—but typically reflect a mismatch between the expectations of the parent and the child’s reality. While it is uncommon for a parent to reject a child solely on the basis of gender identity difficulties when all other aspects of their relationship are secure, this may form part of the conflict and become a focal point. Among the safeguarding issues highlighted in the Cass Review was “breakdown in relationships with families” for this reason. It is important, however, to distinguish between a parent declining to affirm a child’s declared gender identity and parental rejection, as these are not the same.
According to Working Together to Safeguard Children9, emotional abuse is defined as “the persistent emotional maltreatment of a child so as to cause severe and persistent adverse effects on the child’s emotional development.” The specification of severe and persistent effects is important, because a child’s distress is not, in itself, evidence of emotional harm. Parents often cause short-term distress when setting appropriate limits. Consider the upset of a young child told it is bedtime, or a teenager forbidden from attending a party. Such boundaries, though upsetting, are essential to healthy development. In fact, research demonstrates that authoritative parenting—characterised by emotional warmth and clear, consistent boundaries—is associated with better outcomes than low-boundary or low-warmth styles,10 including higher emotional regulation and self-esteem.11
When a child declares an alternative gender identity, this is often accompanied by a request or demand that others adopt a new name, use different pronouns, or facilitate changes of appearance. This process is known as social transition. A meta-analysis of the research on social transition concluded that the quality of evidence is too low for firm conclusions and recommended that existing findings be treated with caution.12 While some studies reported modest reductions in anxiety or depression among those who socially transitioned13, 14 others found higher levels of suicidal ideation.15 Additionally, two studies found that children who undertook social transition were more likely to continue experiencing gender dysphoria,16,17 and a majority of those who did so later proceeded to medical interventions.18
The research therefore paints a mixed and uncertain picture. What it does not show, however, is that a parent’s decision not to socially transition their child constitutes emotional abuse in itself. Working Together to Safeguard Children specifies that emotional abuse “may involve conveying to a child that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person”. A parent can refuse to socially transition their child while maintaining warmth, empathy, and clear assurances of love and acceptance. Conversely, a parent could impose such boundaries in a cold or rejecting manner that may indeed amount to emotional abuse. Declining to socially transition a child therefore does not, on its own, meet the statutory threshold for significant harm. It is the manner in which a parent approaches the issue, rather than their views on social transition, that is the potential source of concern; any lawful and ethical intervention should therefore focus on promoting emotional warmth and secure attachment, not on compelling a change in parental belief.
Practical Parameters: Caution and Coercion
At the other end of the parenting spectrum are parents who decide to support social transition for their children. As discussed in the previous section, research on social transition is of insufficient quality to draw firm conclusions. While some studies indicate that social transition leads to persisting gender dysphoria, the evidence is not strong enough to consider social transition itself as a cause of significant harm. Parents are therefore entitled to exercise their parental responsibility in making decisions about social transition for their child. This does not mean, however, that social workers should actively undertake or encourage social transition, a point I have explored in earlier writing.19 As in the previous section, the manner in which a parental decision is implemented matters. While social transition may not automatically constitute significant harm, there are circumstances in which the approach taken by parents may cross safeguarding thresholds.
One such circumstance is fabricated or induced illness (FII), defined in to Safeguard Children as a rare but serious form of child abuse in which a parent or carer exaggerates or deliberately causes symptoms of illness in a child. Motivations vary widely and are often idiosyncratic, but several cultural and clinical factors surrounding gender identity may make it a conducive context for such behaviour. Factors that contribute to this context may include:
1. The medicalisation of gender identity can make it a route to accessing professional care.20
2. The long-term nature of medical transition can create dependency on the parent/caregiver.21
3. The surrounding social climate may reinforce compulsive or controlling dynamics between the parent and child.22
4. Public and online discourse can confer social validation or status on parents of gender-distressed children.23
Considering these dynamics, it is unsurprising that evidence of gender identity related FII has already begun to surface. In her investigation into the Tavistock Gender Identity Development Service, journalist Hannah Barnes reported clinicians’ accounts of parents who appeared to be more invested in the idea of their child transitioning than the child themselves.24 The Cass Review similarly heard concerns that in some cases a child’s gender identity appeared to be “consciously or unconsciously influenced by a parent”. Additionally, a 2024 government review reported a baby taken to a GP at just a few weeks old by a mother requesting a change of gender on official records.25
An even clearer example comes from Re J (A Minor) [2016]26, in which a mother was found to have caused her son significant emotional harm by compelling him to live as a girl. Following the court’s decision that he reside with his father—who showed no evidence of coercive behaviour—the child rapidly reverted to male-typical patterns of play and dress and expressed no further wish to be treated as a girl. Beyond speculation and anecdotal evidence, this case provides a clear example of gender identity based FII and its emotional impact on a child.
Although reliable prevalence data for FII are difficult to establish, it remains a thankfully rare phenomenon, with estimates ranging from 0.4 to 2.8 per 100,000 children in the UK.27 It would therefore be wrong to assume that most cases of parental facilitation of social transition arise from FII. Nevertheless, practitioners must remain alert to this possibility and exercise their professional curiousity to distinguish between parents who support social transition in a cautious and considered manner, and those who may be engaged in harmful influence or coercion.
Conclusion
Parents will understand and respond to matters of gender identity in many different ways, and the role of the social worker is not to determine how parents should respond, nor to enforce ideological conformity. Neutrality is important, and social workers are often required to support parents whose views differ markedly from their own. The role of the practitioner is to identify when parental behaviour, not belief, crosses the threshold of significant harm and when safeguarding is required.
In cases involving gender identity, this means distinguishing between healthy parental boundaries that limit or deny social transition, and emotionally abusive behaviours that may be disguised by those boundaries. It also means discerning when parents are facilitating social transition as a considered decision about their child’s welfare, and when they are harming the child by using them as a means to meet their own emotional needs.
These boundaries will often be blurred and difficult to interpret, and they may shift over time as more robust evidence emerges about the impacts of social transition. However, they can only be identified and clarified if practitioners are willing to recognise the risks, engage critically with developing research, and participate in open professional dialogues to ensure that the realities in front of us are properly understood.
References
1. Cass, H. (2024) The Cass Review: Independent Review of Gender Identity Services for Children and Young People, available at: https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf
2. Ibid., p. 142
3. Ibid., p. 13
4. Taylor, J.; Hall, R.; Langton, T.; Fraser, L.; Hewitt, C. (2024) Characteristics of Children and Adolescents Referred to Specialist Gender Services: A Systematic Review, Archives of Disease in Childhood, 109
5. Matthews, A., Davy, Z., & Garland, L. (2018) Gender Dysphoria in Looked After and Adopted Young People: A Retrospective Case Note Study, Clinical Child Psychology and Psychiatry, 23(2)
6. Children Act 1989 (UK), available at: https://www.legislation.gov.uk/ukpga/1989/41/contents
7. Re L (Care: Threshold Criteria) [2007] 1 FLR 2050, [50] (Hedley J).
8. Human Rights Act 1998(UK), available at: https://www.legislation.gov.uk/ukpga/1998/42/contents
9. Department for Education (2023) Working Together to Safeguard Child: A Guide to Inter-Agency Working to Safeguard and Promote the Welfare of Children, available at: https://assets.publishing.service.gov.uk/media/6849a7b67cba25f610c7db3f/Working_together_to_safeguard_children_2023_-_statutory_guidance.pdf
10. Bamring, D. (1966) Effects of Authoritative Parental Control on Child Behavior, Child Development, 37(4)
11. Awiszus, A.; Koenig, M. & Vaisarova, J. (2022) Parenting Styles and Their Effect on Child Development and Outcome, Journal of Student Research, 11(3)
12. Hall, R.; Taylor, J.; Hewitt, C.; Heathcote, C.; Jarvis, S.; Langton, T. & Fraser, L. (2024) Impact of Social Transition in Relation to Gender for Children and Adolescents: A Systematic Review, Archives of Disease in Childhood, 109
13. Fontanari, A.; Vilanova, F.; Schneider, M.; Chinazzo, I.; Soll, B.; Schwarz, K.; Lobato, M. & Costa, A. (2020) Gender Affirmation is Associated with Transgender and Gender Nonbinary Youth Mental Health Improvement, LGBT Health, 7
14. Russell, S.; Pollitt, A.; Li, G. & Grossman, A. (2018) Chosen Name Use is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behaviour Among Transgender Youth, Journal of Adolescent Health, 63(4)
15. Turban, J.; King, D.; Li, J. & Keuroghlian, A. (2021) Timing of Social Transition for Transgender and Gender Diverse Youth, K-12 Harassment, and Adult Mental Health Outcomes, Journal of Adolescent Health, 69(6)
16. Steensma, T.; McGuire, J.; Kreukels, B.; Beekman, A. & Cohen-Kettenis, P. (2013) Factors Associated with Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study, Journal of the American Academy of Child & Adolescent Psychiatry, 52(6)
17. Olson, K.; Durwood, L.; Horton, R. Gallagher, N. & Devor, A. (2022) Gender Identity 5 Years After Social Transition, American Academy of Pediatrics, 150(2)
18. Ibid.
19. Carling, R. (2025) The Cass Review for Social Work. Available at: https://substack.com/home/post/p-168475807
20. Capasso, E.; Costanza, C.; Roccella, M.; Gallai, B.; Sorrentino, M.; Carotenuto, M. (2025) When Care Becomes Abuse: A Forensic-Medical Perspective on Munchausen Syndrome by Proxy, Paediatric Reports, 17(3)
21. Adshead, G. & Bluglass, K. (2005) Attachment Representations in Mothers with Abnormal Illness Behaviour by Proxy, British Journal of Psychiatry, 187(4)
22. Ibid.
23. Brown, A.; Gonzalex, G.; Wiester, R.; Kelley, M. & Feldman, K. (2014) Care Taker Blogs in Caregiver Fabricated Illness in a Child: A Window on the Caretaker’s Thinking? Child Abuse & Neglect, 38(3)
24. Barnes, H. (2023) Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children, London: Swift
25. Cabinet Office (2024) Review of Sex and Gender Data: Final Report by Professor Alice Sullivan. London: Cabinet Office. Available at: https://sullivanreview.uk/documents.php
26. Re J (A Minor) [2016] EWHC 2430 (Fam)
27. Bass, C. & Glaser, D. (2014) Early Recognition and Management of Fabricated or Induced Illness in Children, Lancet, 383(9926)