American Academy of Pediatrics

TABLE 1

Potential Indicators of Commercial Sexual Exploitation of Children¹⁰^,¹³^,²⁰^,³¹^,⁴⁷

Initial Presentation	Historical Factors	Physical Findings
Child accompanied by domineering adult who does not allow child to answer questions	Multiple sexually transmitted infections (STIs)	Evidence suggestive of inflicted injury
Child accompanied by unrelated adult	Previous pregnancy/abortion	Tattoos (sexually explicit, of man’s name, gang affiliation)
Child accompanied by other children and only one adult	Frequent visits for emergency contraception	Child withdrawn, fearful
Child provides changing information regarding demographics	Chronic runaway behavior	Signs of substance misuse
Chief complaint is acute sexual assault or acute physical assault	Chronic truancy or problems in school	Expensive items, clothing, hotel keys
Chief complaint is suicide attempt	History of sexual abuse/physical abuse/neglect	Large amounts of cash
Child is poor historian or disoriented from sleep deprivation or drug intoxication	Involvement of child protective services (especially foster care/group home)	Poor dentition or obvious chronic lack of care
	Involvement with department of juvenile justice
	Significantly older boyfriend
	Frequent substance use/misuse
	Lack of medical home and/or frequent emergency department visits

Initial Presentation	Historical Factors	Physical Findings
Child accompanied by domineering adult who does not allow child to answer questions	Multiple sexually transmitted infections (STIs)	Evidence suggestive of inflicted injury
Child accompanied by unrelated adult	Previous pregnancy/abortion	Tattoos (sexually explicit, of man’s name, gang affiliation)
Child accompanied by other children and only one adult	Frequent visits for emergency contraception	Child withdrawn, fearful
Child provides changing information regarding demographics	Chronic runaway behavior	Signs of substance misuse
Chief complaint is acute sexual assault or acute physical assault	Chronic truancy or problems in school	Expensive items, clothing, hotel keys
Chief complaint is suicide attempt	History of sexual abuse/physical abuse/neglect	Large amounts of cash
Child is poor historian or disoriented from sleep deprivation or drug intoxication	Involvement of child protective services (especially foster care/group home)	Poor dentition or obvious chronic lack of care
	Involvement with department of juvenile justice
	Significantly older boyfriend
	Frequent substance use/misuse
	Lack of medical home and/or frequent emergency department visits