How to Recognize Child Trafficking

Human trafficking is modern-day slavery.

Attorney General of Texas (2020)
  • Global trafficking
    • 72 percent of trafficking victims are female, mostly trafficked for sex (UN Women, 2019).
    • Most labor trafficking victims are male (American Academy of Pediatrics [AAP], 2017).
  • Texas trafficking
    • 313,000 victims of sex and labor trafficking (University of Texas Institute on Domestic Violence and Sexual Assault, 2016).
    • 79,000 of those are children and youth victims of sex trafficking (Ibid.).
    • Ranked number one among the states for most active criminal cases of human trafficking in 2018: 74 cases (The Human Trafficking Institute, 2018).

Health-care providers have a unique opportunity to be the first point of contact in identifying male or female youth who have been trafficked.

“The people who most commonly interact with victims of trafficking, apart from traffickers and sex buyers, are health care providers” (Hopkins Bloomberg Public Health, 2020). “A 2014 study published in the Annals of Health Law found that 88% of nearly a hundred trafficking victims had contact with a health care provider at some point while being trafficked.” (Ibid.)

In order to help victims of human trafficking, primary care providers must be aware of the wide variety of situations or jobs that may involve trafficking.

“There are many forms of exploitation into which people can be trafficked and held in slavery. These crimes are happening in every corner of the world and can include any person, regardless of age, socio-economic background or location” (Stop the Traffik, 2020).

Victims are male and female. They live in cities and unincorporated communities. Their families come from all walks of life.

“Victims can be any age and are trafficked by anyone, including family members, extended relatives, friends, spouses and partners, as well as acquaintances and strangers” (Texas Health and Human Services Commission, 2020).

Youth are particularly vulnerable to manipulation and exploitation (AAP, 2015) because they have:

  • Limited life experiences.
  • An immature prefrontal cortex that limits their ability to control impulses, think critically and analyze risks and benefits of situations.
  • Limited options for action.


“In the United States, traffickers prey upon children in the foster care system. Recent reports have consistently indicated that a large number of victims of child sex trafficking were at one time in the foster care system” (U.S. State Department, 2019).

Test Your Trafficking Knowledge

Child trafficking victims can be hidden in plain sight. Check the box beside each patient who shows risk signs of child trafficking.

Pearl, age 11, is in your office for treatment of her third urinary tract infection in the past year. Her mother says Pearl doesn’t drink enough water. Pearl appears on the verge of tears and avoids eye contact with you and her mother.

Eddie, age 16, presents with a poison ivy rash so severe his eyes are nearly swollen shut. His neck and arms are inflamed as well. Eddie is accompanied by his “boss” from a landscaping crew, who says, “We have to hurry up here. This boy needs to get back to the job. He can’t afford to miss work.”

Kim, age 17, arrives alone for her annual Texas Health Steps preventive medical checkup, but she keeps looking at the door as if expecting to see someone. She works in a busy nail salon down the street but her own fingernails are ragged. Kim admits she bites her nails. “I guess it’s a bad habit,” she says. “I need to practice on my own nails.”

Airika, age 15, is pregnant. She is in your office with her foster mother. Airika picks at her long hair braid as you take her medical history. She won’t discuss the expectant father except to say, “just some dudes, I mean dude.” Her foster mother sits tight-lipped and focuses on her smartphone.

Johnnie, age 12, is found to be underweight at his annual Texas Health Steps preventive medical checkup. In the course of the checkup, you ask Johnnie whether there is enough food to eat in his home. “Yes,” he says quietly, looking at his father, “but I never feel hungry.”

Adele, age 19, works as an au pair for a single parent who owns a local small business. She attends classes at night to improve her English. She tells you she can’t keep up and asks for a prescription that will “help me do all the work.” You notice bruises of various sizes on her arms. Adele explains them by saying she is clumsy.

The Office of the Texas Governor Child Sex Trafficking Team provides links to resources for health-care providers, including the Child Sexual Exploitation-Identification Tool (CSE-IT) to identify trafficking victims.


To get help or report trafficking, call the National Human Trafficking Resource Center at 888-373-7888 or chat online at

Why It Matters

Pediatricians and other primary care providers should be on the lookout for signs that children and adolescents are being exploited or trafficked for sex or labor. Your position means you may be the first professional to identify human trafficking victims. You serve an essential role by recognizing trafficking of children and adolescents and responding appropriately to help victims and to stop perpetrators.

Related Courses


American Academy of Pediatrics. (2017). Policy Statement: Global Human Trafficking and Child Victimization. Pediatrics, 140(6):e20173138.

American Academy of Pediatrics. (2015). Clinical Report: Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims.

Attorney General of Texas. (2020). Human Trafficking.

Busch-Armendariz, N., Nale, N .L., Kammer-Kerwick, M., Kellison, B., Maldonado Torres, M. I., Cook Heffron, L., & Nehme, J. (2016). Human Trafficking by the Numbers: The Initial Benchmark of Prevalence and Economic Impact for Texas. The University of Texas at Austin, School of Social Work, Institute on Domestic Violence and Sexual Assault.

Gomes, I. (2020). Health Care Providers Are Missing Chances to Help Victims of Sex Trafficking. Hopkins Bloomberg Public Health, Spring 2020.

National Human Trafficking Hotline.

Office of the Texas Governor (2020). Child Sex Trafficking – Recognize.

Stop the Traffik. (2020). Types of Exploitation.

Texas Health and Human Services Commission. (2020). Texas Human Trafficking Resource Center.

The Human Trafficking Institute. (2018). Federal Human Trafficking Report 2018: State Summary, Texas.

U.S. State Department. (2019). Trafficking in Persons Report.

UN Women. (2019). Facts and figures: Ending violence against women.