AAP Voices Blog

Imagine pulling up your next patient's chart in the emergency department – a 16-year-old girl with dysuria. You look back at her previous visits which include chlamydia, emergency contraception, and intentional overdose. In the room, you find a thin girl, alone, looking down at her manicured fingernails. Without lifting her head she says, “it’s been hurting down there,” and under her gown you notice bruising on the inside of her thighs. You immediately think to yourself, “is this girl being trafficked?”

Sadly, that story is a real-life account. Child sex trafficking is more prevalent than many medical providers realize, and children and teens often present to emergency departments and outpatient settings for care. Prior studies have shown up to 82.5% of young adult trafficked people were seen at a local children’s hospital within the year prior to identification. A third of child sex trafficking victims are minors, with most entering between 12 to 15 years of age.

It is imperative that we, as pediatricians, recognize the signs and understand how to provide trauma-informed care to patients being trafficked. As detailed in the AAP Clinical Report on Child Sex Trafficking and Commercial Sexual Exploitation, they are at increased risk of physical and mental health problems like infectious diseases, substance use, malnourishment, depression, suicide, and abuse, including physical violence, sexual assault, and homicide. Additionally, there is a higher prevalence of involvement in sex trafficking for the following groups:

• Youth experiencing homelessness
• Youth with a history of child abuse and neglect
• Youth with mental health diagnoses
• Youth identifying as LGBTQIA+
• Youth living in areas with high community violence
• Youth living in war zones, near military bases/truck stops and on tribal lands

“Patients should be separated from any person they came in with, and clinicians should state this is part of typical medical care.”

A thorough history can elicit warning signs such as multiple sexually transmitted infections, a previous pregnancy or abortion, frequent visits for emergency contraception, chronic problems in school, an older boyfriend, and lack of a medical home or frequent emergency department visits. Physical exams can be telling as well. Minors possibly being trafficked may have evidence of an inflicted injury, tattoos, poor dental hygiene, or be withdrawn and fearful. These patients may also be resistant to medical care and have a history of leaving against medical advice.

It’s essential that pediatricians remember these young patients may be afraid, ashamed, depressed, or have been told to lie, and therefore may not be forthcoming about their circumstances. Patients should be separated from any person they came in with, and clinicians should state this is part of typical medical care. The following questions may help guide the pediatrician in eliciting information regarding the patient’s involvement in sex trafficking:

• Has anyone ever asked you to have sex or do anything physically you did not want to do in exchange for something you wanted or needed, like money or food?
• Has anyone ever asked you to have sex with someone else?
• Has anyone ever taken pictures of you without your clothes and showed them to other people?

Regardless of responses to the above questions, if there is suspicion for sex trafficking, the following interventions should be facilitated by the pediatrician:

• Assessing and treating acute and chronic medical diagnoses, including access to medical and dental care
•  Referral to the appropriate sexual assault response team in correlation to local law enforcement policy
• Close documentation of injury (genital, cutaneous, thoracoabdominal)
• Pregnancy, STI testing and prophylaxis with contraceptive options
• Social work involvement if available

Finally, it often falls on pediatricians to provide resources to persons who may be experiencing child sex trafficking. The following resources may be given directly and discreetly to patients:

• National Human Trafficking Hotline
• National Runaway Safeline
• National Domestic Violence Hotline
• National Survivor Network
• National Center for Missing and Exploited Children

For those pediatricians needing guidance in supporting and educating minors about child sex trafficking, try the National Human Trafficking Hotline, Polaris Project, Shared Hope, and the National Center for Missing and Exploited Children. 

No matter the health care setting, whether it be in an outpatient clinic or emergency department, it is vital we as pediatricians stay vigilant to recognize potential victims of trafficking and be educated on how to help them.