Physicians recommend a public health approach that includes training, research, collaboration with non-medical professionals and advocacy.

Children are trafficked for labor and sexual exploitation in communities across the U.S., but the devastating global scope and consequences for children's health are often difficult to detect and underreported.

To combat these basic violations of human rights, the American Academy of Pediatrics (AAP) calls for a public health approach that incorporates rigorous research, medical education, collaboration and advocacy in its policy statement titled, "Global Human Trafficking and Child Victimization."

The policy statement, which was published online November 27, in the journal Pediatrics recommends that health care workers undergo training to recognize signs of possible child exploitation and collaborate with nonmedical professionals in the community to assist victims.

"Social ills such as poverty, family violence and homelessness are just a few factors that leave children vulnerable to human trafficking," said Jordan Greenbaum, MD, an author of the statement and member of the AAP Council on Child Abuse and Neglect. "Children who are smuggled internationally are especially at risk, and may be reluctant to report abuses out of fear."

There are no reliable estimates of how many children are trafficked for sex or labor, and efforts to track the numbers are hampered by the lack of a centralized database or uniform definitions among those collecting data.

According to U.S. federal law, child sex trafficking involves engaging a person younger than 18 in a commercial sex act, which may include exploitation for prostitution, pornography or performance in sexual venues. Federal law defines labor trafficking as using force, fraud or coercion to subject someone to involuntary servitude, debt bondage or slavery.

In U.S. cities with federally funded task forces on human trafficking, data collected between January 2008 and June 2010 found that 94% of sex trafficking victims were female, and that 55% of them were younger than 18. Other studies have shown a predominance of males in labor trafficking, but the numbers are believed to be vastly underreported.

"As pediatricians, we have the opportunity to identify children at risk of exploitation and connect them to essential services," said Nia Bodrick MD, MPH, co-author of the statement and member of the AAP Section on International Child Health.

"As child advocates, we must work together to develop policies and programs to prevent human trafficking and support survivors."

Child labor trafficking in the United States may occur in a wide variety of industries, including domestic servitude, construction, janitorial/cleaning services, door-to-door magazine sales and other businesses.

The AAP recommends:

• Training health care professionals to recognize possible signs of exploitation and how to intervene appropriately
• Working with nonmedical professionals in the community to assist victims
• Supporting state, national and international antitrafficking legislation and policies that promote child rights and victim services
• Advocating for rigorous, evidence-based research on child trafficking
• Supporting the development of clinic and hospital protocols to help recognize and respond to child trafficking of all types.

"In some cases, the parents or caregivers are victims of human trafficking," Dr. Greenbaum said. "Our goal is prevention, and to provide medical services that are culturally appropriate and victim-centered."