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Trafficking of children for labor and sexual exploitation violates basic human abstract
rights and constitutes a major global public health problem. Pediatricians
and other health care professionals may encounter victims who present with
infections, injuries, posttraumatic stress disorder, suicidality, or a variety of
other physical or behavioral health conditions. Preventing child trafficking,
recognizing victimization, and intervening appropriately require a public aStephanie V. Blank Center for Safe and Healthy Children at Children’s
Healthcare of Atlanta, Atlanta, Georgia; bInternational Centre for
health approach that incorporates rigorous research on the risk factors, Missing and Exploited Children, Alexandria, Virginia; and cUnity Health
health impact, and effective treatment options for child exploitation as well Care, Inc, Washington, District of Columbia
as implementation and evaluation of primary prevention programs. Health Both authors contributed to the writing and editing of the document
and approved the final manuscript as submitted.
care professionals need training to recognize possible signs of exploitation
and to intervene appropriately. They need to adopt a multidisciplinary, This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors have
outward-focused approach to service provision, working with nonmedical filed conflict of interest statements with the American Academy
of Pediatrics. Any conflicts have been resolved through a process
professionals in the community to assist victims. Pediatricians also need to approved by the Board of Directors. The American Academy of
advocate for legislation and policies that promote child rights and victim Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
services as well as those that address the social determinants of health,
Policy statements from the American Academy of Pediatrics benefit
which influence the vulnerability to human trafficking. This policy statement from expertise and resources of liaisons and internal (AAP) and
outlines major issues regarding public policy, medical education, research, external reviewers. However, policy statements from the American
Academy of Pediatrics may not reflect the views of the liaisons or the
and collaboration in the area of child labor and sex trafficking and provides organizations or government agencies that they represent.
recommendations for future work. The guidance in this statement does not indicate an exclusive course
of treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.
A critical role of the pediatric health care professional is to advocate for All policy statements from the American Academy of Pediatrics
automatically expire 5 years after publication unless reaffirmed,
the health and well-being of children and adolescents. Central to this role revised, or retired at or before that time.
is the conviction that health and well-being depend on a guarantee of DOI: https://doi.org/10.1542/peds.2017-3138
fundamental human rights. Victims* of trafficking routinely are deprived of
Address correspondence to Jordan Greenbaum, MD. E-mail: jordan.
greenbaum@choa.org
contribute to human trafficking of the host language and culture, attention at some point during their
vulnerability in the United States and and precarious legal status.11 These period of exploitation,44,45
around the globe (Table 2). Children children are particularly vulnerable if trafficked immigrant children
and youth who identify as lesbian, they lack the necessary authorization detained at the United States border
gay, bisexual, transgender, or queer or documents required under may receive insufficient care,43
(LGBTQ); those who are American immigration regulations and have and those trafficked abroad may
Indian girls; and boys and girls with a been smuggled across an international receive little or no care at all.46,47
history of abuse or neglect, substance border; traffickers may subsequently However, it is important for health
misuse, or homelessness may lure them into situations of severe care professionals all over the world
constitute a significant proportion of exploitation or circumstances of debt, to be alert to possible indicators
– 34
trafficked youth.23,31 Statistics reveal bondage, or other abuses and maintain of sex trafficking, and these are
high rates of child protective service control over them through violence, described in detail elsewhere.31
involvement among sex-trafficked threats, or economic or psychological With respect to labor trafficking,
young people: 78% of 1 group in manipulation. Unaccompanied children potential indicators may include
California reported a history with are likely to be reluctant to report a recent history of immigration,
child protective services, and 53% of abuses to authorities because of unfamiliarity with the city or town
another group reported residing in 1 concerns of corruption among officials where the clinic or hospital is located,
or more foster care group homes.35 (law enforcement, immigration, or apparent control and intimidation
Families experiencing financial crises, consular), highly stressful conditions by an accompanying adult. Additional
unemployment, or intrafamilial in Customs and Border Protection potential indicators are listed in
violence are particularly vulnerable to processing centers,43 and the child’s Table 3. It is important to remember
human trafficking.12,13,
17,36
fear of arrest and/or deportation. that the parents of the child may be
Finally, gender-based violence and victims of labor or sex trafficking,
Community or governmental tolerance discrimination, a cultural assumption with or without victimization of the
of labor or sexual exploitation, that boys cannot be victims, cultural child.
demand for cheap labor, or the beliefs that children must support
occurrence of a natural disaster the family in crisis, the sexualization The adverse health effects associated
or major social upheaval may and objectification of girls, and weak with child sex and labor trafficking
render children at risk.12,36
Massive recognition of children’s rights are are numerous and include traumatic
population migrations often involve societal factors that contribute to injury from sexual and physical
large numbers of unaccompanied 38– 40
vulnerability.4,36, assault or work-related injury,
minors.17,41
Unaccompanied children sexually transmitted infections,
are at significant risk for labor and sex Although researchers suggest that nonsexually transmitted infections,
trafficking,42 given their young age, lack victims of sex trafficking in the United chronic untreated medical conditions,
of adult supervision, lack of knowledge States are likely to seek medical pregnancy and related complications,
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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Updated Information & including high resolution figures, can be found at:
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References This article cites 34 articles, 6 of which you can access for free at:
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