Trafficking and exploitation (T/E) of children and adolescents for sexual purposes and forced labor may have profound effects on their health and mental health.
An estimated 3.3 million children and adolescents globally experienced forced labor in 2021, of whom approximately 1.7 million were subjected to commercial sexual exploitation, according to a report from the International Labour Organization, Walk Free and International Organization for Migration (http://bit.ly/3tt68oB).
An updated AAP clinical report can assist health care professionals (HCPs) in preventing and recognizing T/E, and provide a basic initial response to suspected and confirmed cases of exploitation involving children of any age and national origin.
The report Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients, from the AAP Council on Child Abuse and Neglect and Council on Immigrant Child and Family Health, is available at https://doi.org/10.1542/peds.2022-060416 and will be published in the January issue of Pediatrics.
The guidance directs attention to child sex trafficking (e.g., involving a minor in a sex act in exchange for something of perceived value) as well as forced child labor and online sexual exploitation. Much of the focus involves use of a trauma-informed, culturally sensitive, rights-based approach to working with those who may have experienced T/E.
The report highlights the association of T/E with stigma and bias. HCPs must be aware of and manage their own biases and work to eliminate stigma/discrimination in the workplace. Fear of HCP judgment and discrimination are major barriers to children and adolescents seeking care and/or disclosing their T/E status to providers.
Making a commitment to care
Preventing, recognizing and responding to suspected T/E requires time, awareness and knowledge; skills in trauma-informed care; attention to cultural factors that may impact the care experience; and a willingness to work with external stakeholders to offer resources to the child and family.
Insurance companies may pay poorly, if at all, for the time involved in screening, rapport-building, obtaining details of a child’s living conditions and discussing safety plans. Crowded emergency departments and clinics place enormous pressure on HCPs to minimize time spent interacting with patients. However, this may lead to a failure to identify children at high risk for or experiencing T/E, and a missed opportunity to offer critical services and safety options.
Pediatricians routinely prioritize issues of child safety. They must extend this commitment by prioritizing identification of potential T/E and making the time to address these issues as they arise in routine practice.
Pediatric practices likely have patients with risk factors for T/E such as a history of sexual abuse; identifying as LGBTQ; children of color; immigrant children; living in poverty or with unstable housing; and being otherwise marginalized. Attention to risk factors and potential indicators and an open, nonjudgmental exploration of a child’s life and concerns are critical to the safety and well-being of children and adolescents, especially those at high risk for T/E.
Children experiencing T/E are unlikely to report their situation spontaneously, so HCPs should be alert and responsive to the possibility of exploitation. This requires training all staff and having a clinical protocol or guideline that summarizes staff roles and responsibilities.
The clinical report provides information and resources to assist HCPs in obtaining the knowledge and skills for an effective response to T/E and creating a clinical protocol tailored to their health facility’s needs.
The clinical report addresses key issues in the care of children/adolescents who experience or are at risk for T/E, including:
- risk factors, with discussion of marginalized populations;
- epidemiology and dynamics of offline and online T/E in the U.S. and globally;
- potential impact of the COVID-19 pandemic on T/E prevalence and dynamics;
- common health and mental health conditions associated with T/E;
- potential red flags for T/E that HCPs may encounter in the health care setting;
- obtaining a history using the trauma-informed approach;
- screening for T/E and/or provision of universal education with resources;
- trauma-informed, rights-based and culturally sensitive examination, with forensic evidence collection as appropriate;
- diagnostic testing and treatment;
- issues related to safe documentation of sensitive patient information;
- strategies for engaging the child and nonoffending caregiver in safety planning and provision of resources;
- issues related to mandatory reporting of T/E;
- holistic, culturally sensitive, multidisciplinary treatment approach that considers health, mental health, social, economic, educational and legal/immigration needs of the child/family;
- special needs of immigrant children and families, especially unaccompanied minors;
- importance of longitudinal preventive care in a medical home; and
- self-care for clinicians.
Dr. Greenbaum is a lead author of the clinical report.
- Table 3 in the report includes a list of red flags for labor or sex trafficking/exploitation.
- Table 4 offers strategies for a trauma-informed, rights-based approach to care.
- AAP’s Trafficking and Exploitation webpage