Authors: Mallory Johnson, Mackenzie Ostlie, Meghan Etsey, Dr. Divya Krishnan on behalf of the Gender Equity Task Force
Eight year-old Lila had been complaining of frequent fatigue, trouble concentrating in school, and occasional dizziness. Her teacher noted that she was quieter in class and her mother noticed she stopped playing outside. When Lila’s parents brought her to the pediatrician, the doctor conducted a quick physical exam but dismissed their concerns. “She’s probably just sensitive. Girls at this age tend to be anxious, especially if things are changing at home or school.” No tests were ordered. A few days later, Lila passed out at school and was rushed to the emergency department, where bloodwork revealed she had severe iron-deficiency anemia. After receiving an iron infusion, her symptoms began to improve, but the delay in diagnosis had already taken a toll on her health and confidence.
Lila’s story highlights how gender bias in pediatric care can shape outcomes. Socially constructed stereotypes influence not only how children see themselves, but also how they are perceived and treated (Upchurch, 2018). In healthcare, these biases affect both diagnosis—how histories are taken, exams performed, and tests ordered—and treatment, where communication and provider-patient dynamics often vary by gender (Carrilero et al., 2023). In pediatrics, the complexity deepens: the patient is a child, the parents interpret symptoms and advocate for care, and their relationship with the provider shapes decisions (Carrilero et al., 2023). Childhood is a formative stage where medical experiences can have lasting effects. When subtle gender biases influence how symptoms are interpreted or concerns addressed, the consequences extend far beyond childhood. Rather than fading, these early disparities reinforce inequities across a lifetime of health experiences and outcomes along with creating a barrier to seeking care due to lack of trust. Additionally,when families hear stories of negative healthcare experiences from others, it can create profound mistrust and lead them to avoid seeking care.
Although pediatric care is often viewed as gender-neutral, subtle biases persist. Western medicine has historically treated the male body as the default, shaping diagnostic criteria, clinical trials, and medical education around male physiology. This legacy leaves systemic gaps in understanding how diseases present in female bodies. In pediatrics, these gaps are compounded by cultural expectations: girls’ symptoms are frequently attributed to emotional sensitivity, while boys are encouraged to “tough it out,” leading to dismissal of their emotional distress (Carrilero et al., 2023). Parents play a pivotal role in perpetuating these narratives. Their responses to children’s health concerns often mirror broader cultural double standards, shaping how children learn to interpret and express their symptoms (Carrilero et al., 2023). These parental influences establish expectations long before a child enters the clinic, reinforcing biases across generations.
Providers also contribute to the persistence of gender bias in pediatric care. Despite seeking medical attention, women and girls frequently struggle to have their pain acknowledged, as longstanding cultural narratives about the female body often lead professionals to minimize or question their symptoms (eClinicalMedicine, 2024). In pediatrics, these same patterns emerge when providers undervalue parental reports, even though parents are among the most accurate in assessing their child’s pain (Ruben, Blanch-Hartigan, & Shipherd, 2018). When these assessments are disregarded, the consequences for children can be profound—missed school, restricted participation in recreational activities, disturbed sleep, and increased strain on family dynamics (Cozzi et al., 2017).
Despite seeking care, women and girls frequently struggle to have their pain acknowledged by healthcare professionals. Gender bias and long-standing cultural narratives about the female body and illnesses often lead providers to question or minimize the seriousness of their symptoms (eClinicalMedicine, 2024). These same biases can extend into pediatric care, particularly when providers overlook or undervalue parental input. Notably, research shows that parents, more than any other type of caregiver, are the most accurate in assessing their child’s pain, with their evaluations closely aligning with the child’s own reports (Ruben, Blanch-Hartigan, & Shipherd, 2018). Yet, provider-child and provider-parent dynamics are often shaped by assumptions that may lead to these assessments being disregarded. The consequences of underestimating or dismissing pediatric pain are substantial. Children’s quality of life is lowered by limiting their chances to socialize and learn due to school absences, restricting participation in recreational activities like sports, disturbing sleep, and creating added challenges within family dynamics (Cozzi et al., 2017).
Gendered stereotypes also contribute to the underdiagnosis of neurodevelopmental conditions in girls. While boys are often identified earlier, girls’ symptoms are more likely to be overlooked or misinterpreted. For example, girls with autism—sometimes called “lost girls” or described as “hiding in plain sight”—may display fewer repetitive behaviors and stronger social imitation skills, masking their challenges (Arky, 2019). Likewise, girls with ADHD often present with emotional struggles rather than external behaviors, leading to misdiagnoses of anxiety or depression or delayed recognition of ADHD altogether (Mowlem et al., 2019). In contrast, boys’ more overt behaviors tend to fit traditional diagnostic criteria, resulting in earlier intervention.
In an emergency setting, gender disparities in clinical decision-making can significantly impact patient outcomes–even when boys and girls present with similar symptoms. For instance, an observational study examining febrile children with respiratory symptoms in the emergency department found that girls were consistently less likely to receive inhalation medication, despite a higher proportion presenting with increased work of breathing (Tan et al., 2022). These discrepancies are not limited to pediatric respiratory cases. Broader emergency care data show that a larger proportion of severely injured male patients are more likely to be triaged and transferred to a trauma center compared to females (Alspach, 2012). Severely injured boys and men tend to receive more aggressive and specialized care, reflecting a long-standing pattern in which male symptoms are taken more seriously and responded to more urgently. This systemic imbalance in treatment not only influences immediate clinical outcomes, but also contributes to long-term disparities in recovery, trust in the healthcare system, and health equity.
Lila’s story illustrates a troubling truth: invisible gender biases in pediatric care can delay diagnoses, distort treatment, and cause lasting harm. From misattributed symptoms to overlooked pain and delayed recognition of neurodevelopmental conditions, gendered assumptions often disadvantage girls. These patterns are reinforced by research gaps, implicit provider bias, and culturally shaped caregiver expectations, embedding inequities across the healthcare experience. The consequences extend well beyond childhood. Early dismissal of symptoms not only worsens long-term health outcomes, but also shapes children’s self-perception leading to girls often doubting the legitimacy of their pain. Together, these dynamics fuel persistent disparities across the lifespan.
Addressing these dynamics requires more than awareness. Pediatric research must disaggregate data by sex and gender to uncover hidden patterns of bias (Carrilero et al., 2023). Clinicians need training on implicit bias, supported by standardized protocols to reduce subjective assumptions in diagnosis and treatment. Families should also be empowered to advocate for their children, ensuring their concerns are heard and taken seriously. Pediatric care sets the tone for a lifetime of interactions with the health system. Ensuring equity in childhood is not only a medical necessity—it is a moral imperative.
References
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About the Authors
Mallory Johnson, MS4
Mallory Johnson is a fourth-year medical student from St. George’s University. She holds a Bachelor of Science in Forensic Science and a Bachelor of Science in Chemistry from Tiffin University. She worked as an Analytical Chemist at P&G and KAO before medical school. She is passionate about giving back to vulnerable communities and providing equal access and opportunity to medical care. She is a member of the Domestic Violence and Music in Medicine Committees within the American Medical Women’s Association. When she’s not doing schoolwork, you can find her playing her cello, reading cozy mysteries, and playing with her poodles, Gertie and Maple.
Mackenzie Ostlie, MS4
Mackenzie Ostlie is a fourth-year medical student at St. George’s University. She holds a Bachelor of Science in Electrical Engineering from North Dakota State University in Fargo, ND. She served as Executive Director of Grenada Give Back; a student-led volunteer organization based in St. George’s, Grenada, that served to bridge gaps and meet needs in the community. Growing up in rural Minnesota, she is passionate about reaching the underserved and providing equal access to healthcare for all communities. Beyond her academic and clinical training, Mackenzie enjoys spending time with family and friends, especially when it involves being outdoors on her mountain bike or on the lake.
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Divya Krishnan, MD
Dr. Divya Krishnan obtained a medical degree with honours at the University of Medicine and Health Sciences, St. Kitts. She is passionate about preventative medicine and community medicine. She believes that we can only begin to move towards good health for all patients, with health equity and consistent community education led by healthcare workers. When not working in the medical world, she spends her spare time learning outdoors (hiking, rock climbing, gardening), learning indoors through reading books, and studying to brainstorm creative ideas for how to improve her practice as a whole- for her patients and for her co-workers.