A 15-year-old male presents to a community clinic for treatment of a minor injury associated with his work at a local factory. He recently immigrated to the U.S. and is accompanied by his sponsor, an uncle. The pediatrician has vague concerns about possible child labor exploitation but is unsure what local resources are available to assist the patient.
Pediatric clinicians have an essential role in providing patient-centered, high-quality care to children and adolescents experiencing or at increased risk for child trafficking and exploitation of human beings (child THB/E). Yet many feel ill-prepared to recognize potential signs of exploitation or respond with appropriate clinical management and community resources. In one study, 63% of pediatric clinicians at an academic children’s hospital reported they had never received education on THB/E.
Child THB/E occurs when a person involves individuals younger than 18 years in commercial sex acts (sex THB/E) or uses force, fraud or coercion to compel them to work (labor THB/E). Child THB/E is a major human rights violation and is associated with significant physical and mental health adversity, with the potential to significantly harm a child’s psychosocial development and long-term health.
An updated AAP policy statement outlines major issues regarding public policy, medical education, research and collaboration, and provides recommendations for future work.
The statement Human Trafficking and Exploitation of Children and Adolescents, from the Council on Child Abuse and Neglect and the Section on Global Health, is available at https://doi.org/10.1542/peds.2025-072214 and will be published in the July issue of Pediatrics.
Research needs
Research on THB/E is expanding rapidly but remains relatively limited in major areas, such as the effectiveness of assessment tools and intervention strategies.
The updated policy statement advocates for research on screening tools, universal education resources and harm reduction strategies. This research should use an equity lens, rigorous designs including implementation science, and community-based strategies informed by individuals who have experienced THB/E. Screening tools and universal education resources should be validated in a variety of high-risk populations and address the risk of both labor and sexual exploitation.
Prevention, collaboration
The policy statement encourages clinicians to facilitate evidence-based primary prevention of THB/E, which may include providing information on safe and healthy relationships, trafficking and harm reduction strategies, internet safety and/or labor rights.
Collaboration with other health care providers, as well as professionals from legal, child welfare, education, law enforcement, immigration and victim/survivor services, will help ensure children who experience TBH/E are offered appropriate services. Pediatric clinicians seeking to report cases and obtain services for patients should have knowledge of community partners or the National Human Trafficking Resource Center (1-888-373-7888).
The 2022 AAP clinical report Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients provides detailed guidance for pediatric clinicians in recognizing previously unidentified TBH/E and providing a basic initial response to suspected and confirmed cases of exploitation.
Key recommendations
The policy statement contains many recommendations addressing the need for victim/survivor advocacy and services, training for health professionals and research on THB/E. Following are among the recommendations pertinent to primary care providers:
- Advocate for increased and equitable services, including health care and continuous financial coverage for physical and mental health expenses, for all children and adolescents impacted by THB/E (online and offline), regardless of immigration status, race/ethnicity, abilities, gender identity, etc.
- Facilitate a public health approach to THB/E that embraces culturally responsive, rights-based, trauma-informed and child-centered care.
- Advocate for standardized pediatric clinician training on:
- THB/E prevention, assessment, treatment and referral for community services, using trauma-informed and culturally responsive strategies;
- education on patient-informed and appropriate documentation of sensitive health information and use of THB/E International Classification of Diseases-Tenth Revision codes in ways that protect the safety and privacy of patients; and
- education on mitigating implicit/explicit bias and discrimination at individual and systemic levels.
- Advocate for pediatric clinicians to join community multidisciplinary teams combating THB/E, educating team members about survivors’ health needs and facilitating services to enhance their well-being.
Dr. Greenbaum is a lead author of the policy statement and an affiliate member of the AAP Council on Child Abuse and Neglect and Section on Global Health. Lead author Nia Bodrick, M.D., M.P.H., FAAP, contributed to this article. She is a member of COCAN and SOGH.
