“ I know who I am ”: Gender-creative children Draw-and-Tell their social and healthcare experiences

Gender-creative children have an elevated risk of healthcare avoidance and adverse health outcomes related to stigma and discrimination. Despite evidence that family affirmation is protective and pediatric providers influence care outcomes, young children's perspectives related to their social support and clinical experiences remain underrepresented in health research. Indeed, children's agency has been historically restricted in healthcare and health research. This community-engaged, artsbased, qualitative study used Draw-and-Tell Conversations-a participatory approach combining drawing, storytelling, and writing-with 12 U.S.-based gender-creative children (ages 5-10). Although children's caregivers completed surveys to contextualize findings, the project highlighted children's capacity to report on their own experiences. Data were analyzed using reflexive thematic analysis and poetic inquiry. Participants expressed discomfort in clinical settings but identified trusted adults with whom they could discuss gender. Drawing facilitated confidence and clarity in communication. Findings reveal missed opportunities in pediatric care and research to engage directly with gender-creative children. This study contributes child-centered, empirically grounded recommendations for gender-affirming care and highlights the value of arts-based methods in health research with children.