Postural Screening And Trans Gender Children

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Wondering how you all have handled this.  I have my screenings coming up and we have many students that use them.  I am fine with anyone that wants to wear a sports bra or bathing suit but I'm not sure how I would handle it if student who was born with female genitalia wanted to take their shirt off.  I really want to be supportive but I don't want to get into trouble either.  I thought of telling everyone to wear tank tops but it is much easier to see curves and bones with a bare back...

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Specializes in kids.

I think that as long as they have breast tissue, it should be covered. Talk to the kid and explain why you are asking them to be covered. Be honest, there is very little precedent for this and you need to be sure you are not in violation of their privacy and or any laws or statutes. That it is NOT about judgment. 

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Specializes in School Nursing.

Are you able to ask for a summary of their latest well visit and take their scoliosis results from that if they aren't comfortable with the screening? Healthcare provider assessment would trump my screening anyway. 

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Specializes in pediatrics, school nursing.

We always send a letter home prior to it taking place encouraging them to wear something because a good many girls are still at Tanner stage 1 and don't routinely wear anything under their t-shirts. This is the first year I have trans students and I'm hoping no one gets offended by me asking that "all girls should wear a bra, sports bra, or bathing suit top". I've been trying to rack my brain for alternative language, but I don't want students thinking they can wear loose tank tops....

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Specializes in ICU, travel.

No one is obligated to wear a bra because you think they should, and if I had a nurse tell me my child MUST wear a bra because they think it's necessary based on my child's sex, I not only would not allow the nurse to assess my child, I would talk to their supervisor because it's weird to sexualize female nipples as a nurse working in a professional capacity. Less nice people will just go to the BON and let them know about your underaged female nipple fixation. 

Do NOT talk to children about why they should cover their bodies when working as a nurse. We don't talk to minors in great detail about their breasts and presenting them in a way that is most palatable to you, the adult.  Just look at their spines and try not to get hypnotized by any female nipples. Give the patient a gown or drape. Standard practice is best here. What you're suggesting is flirting with sexual harassment.  (In NY, sexual harassment would cover things like demanding female patients wear bras because it's "correct" gendered behavior.) 

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Specializes in ER.

I agree. Always covering female breasts is actually A peculiar cultural phenomenon. In many parts of Europe it is acceptable to see a female breast, either for sunbathing and certainly for breastfeeding. In many many countries public breastfeeding is absolutely acceptable. Not so in the United States, especially in certain parts of the country.

I think the best way to handle it is to use standard practice as was suggested. Get some patient gowns.

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Specializes in pediatrics, school nursing.

I completely agree with you that we should not be telling kids what they should and shouldn't be wearing, but if you think not giving guidance and having them change into a hospital gown is the answer, then you have clearly never worked with adolescents in a school. During a postural screening, we are not looking at just the back, we need to visualize the hips and shoulders from the front and side as well, which would make a hospital gown useless, since they would just have to take it off. If you think that we should have them change into one and then strip when it's time for that part, I don't think you understand is the amount of time it would take to have each and every child in the grades we are MANDATED to screen changing in and out of a gown, not to mention the cost of purchasing enough gowns to get through a days worth of screenings plus the cost laundering these gowns (and then storage of them for the remainder of the year). As it is, a large school district may have over 1000 students that need this screening on a yearly basis. Usually, there is one, maybe two, nurses that still have to run a health office during these screenings. Plus we also have other screenings - heights and weights, vision and hearing, and in the upper grades SBIRT. You do whatever you need to to get these things done. Not to mention, the guidelines for these screenings, which come from the Department of Public Health in my state, recommends initial screenings be done BY THE GYM TEACHER, not a nurse, and it suggests coverings such as a bra or bathing suit top and does not mention a hospital gown. This is old-school, assembly line-style, screenings. Students who are uncomfortable with the prospect are encouraged to have their parents opt them out. 

Here is the language I have settled on for my letter home thus far, but I plan on running it by some friends who are an authority on gender affirming language: " On that day, we ask that all students who identify as female and any others who have concerns for modesty please wear an undergarment that will allow easy visualization of the hips, spine, clavicle, and shoulders/shoulder blades. This can be a bra, sports bra, bathing suit top, or a tight-fitting tank top that may be rolled up to reveal the spine and hips."

 

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Specializes in kids.
On 3/18/2022 at 10:36 AM, k1p1ssk said:

Here is the language I have settled on for my letter home thus far, but I plan on running it by some friends who are an authority on gender affirming language: " On that day, we ask that all students who identify as female and any others who have concerns for modesty please wear an undergarment that will allow easy visualization of the hips, spine, clavicle, and shoulders/shoulder blades. This can be a bra, sports bra, bathing suit top, or a tight-fitting tank top that may be rolled up to reveal the spine and hips."

That is awesome! Some parents in my town would  even object to the addressing of the issue...?

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4 hours ago, k1p1ssk said:

" On that day, we ask that all students who identify as female and any others who have concerns for modesty please wear an undergarment that will allow easy visualization of the hips, spine, clavicle, and shoulders/shoulder blades. This can be a bra, sports bra, bathing suit top, or a tight-fitting tank top that may be rolled up to reveal the spine and hips."

This is a really nice write up.  Thanks for sharing.

 

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Specializes in retired LTC.

I just had a terrible repressed flashback to Catholic grammar school circa 1958 for some screening at the time.

I was a chubbbbby kid, and we has to strip down to our undies. It was with all  girls, but I vividly remember feeling the fat-shaming embarrassment then.

After all those years ...

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Specializes in ICU, travel.

I'No. Targeting a group of students based on the genitals they were born with and telling them they must dress a certain way is misogynistic. If you want to say all students must wear a form fitting shirt, that's fine. Remember, OP said she is not comfortable with people with female genitals having uncovered breasts. Execution of saying this is bigotry, and yes, it's sexual harassment.  It is reportable where I live. And people do not have to tolerate it.  

On 3/17/2022 at 8:10 AM, arlingtonnurse said:

I am fine with anyone that wants to wear a sports bra or bathing suit but I'm not sure how I would handle it if student who was born with female genetalia wanted to take their shirt off.  I really want to be supportive but I don't want to get into trouble either.

Many trans-masculine people don't own bras or bathing suit tops because that would trigger dysphoria. Binders can be expensive or obscure views. Does a kid who's had breast removal but has a vulva have to wear a bra?  Or what about a AFAB boy who is totally masculine in appearance to wear you don't know he has female breasts until his shirt is off?  What about AMAB fat kids with large amounts of breast tissue?  What about AMAB girls with male genitals and breast tissue? According to what you posted, if a girl says, "Oh, it's okay. I have a member and testicles, XY chromosomes, and an inactive SRY gene," you should be okay with no bra. See how absolutely crazy that is?  

What's wrong with an egalitarian position that everyone must wear a bra, swimsuit top, or form-fitting shirt?  

You're allowed to have internalized misogyny and think if someone appears female, they should cover their nipples. No one is demanding you educate yourself on trans people or do any degree of navel gazing, but in turn, you shouldn't discriminate and try to dictate gendered behavior for your own comfort. It would be like an ICU nurse saying she doesn't run drips; it's roughly analogous to a school nurse saying because of misgendering children and sex stereotypes, children must dress in a way for the psychological comfort of the nurse, even if it's psychologically harmful to them. 

Are you okay with triggering such dysphoria a kid hangs themselves and blames you in the note?  Seriously. You're playing with fire and getting bad legal and ethical advice from people who are largely unfamiliar with trans issues. Do no harm.

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Specializes in ER.

Maybe just don't mention gender and inform all students that they may wear a bra if they are concerned about modesty. I always favored simplicity. That will avoid the whole 'identify as female' lingo, which some people will interpret as the school pushing gender agendas.

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