Commercial Sexual Exploitation and Sex Trafficking of Children in the United States

Child commercial sexual exploitation and sex trafficking are global health problems requiring a multidisciplinary approach by individuals, organizations, communities, and national governments. The adverse emotional, physical, and social consequences for victims are legion and in many areas of the United States and the rest of the world, victim resources are scarce. Since violence, deprivation, abuse, and infection are so integral to the exploitation experience, victims may present for care to community and academic pediatric and adolescent health care providers. It is essential that medical professionals have the knowledge, skills, and resources to recognize victims, assess their needs, and treat them appropriately, including making key referrals for community services. However, to date medical information and resources regarding commercial sexual exploitation and sex trafficking has been sparse. There are no clinically validated screening tools specifically designed to identify victims in the health care setting and since victims seldom self-identify, it is likely that the majority of victims are unrecognized. The opportunity for comprehensive assessment and intervention is lost. Further, professionals receive little training on appropriate interview techniques for this special population, and many are ill equipped to ensure safety and optimal medical evaluation during the visit. This article provides a general overview of child sex trafficking and commercial sexual exploitation (CSEC), describing the epidemiology of international and domestic exploitation, and reviewing the challenges of conducting research on this population. The five stages of trafficking are explained, as are typical physical and emotional consequences of exploitation. The medical evaluation is described, including potential indicators of CSEC and sex trafficking, common medical presentations by victims, approaches to the comprehensive medical interview, and the appropriate medical exam with diagnostic testing and treatment. Finally, a discussion of common victim needs is provided, with a description of resources and referrals.