The American Academy of Pediatrics (AAP) has issued a compelling new policy statement addressing one of the gravest but often hidden violations of children's rights in the United States: human trafficking and the exploitation of minors for labor and sex. Published in the July 2025 issue of Pediatrics, this statement does more than raise an alarm—it advocates for a decisive shift in the way healthcare professionals, community stakeholders, and policymakers approach the identification, care, and long-term support of children and adolescents caught in the web of exploitation. By emphasizing a public health framework and acknowledging the multifaceted vulnerability that trafficked children face, the AAP aims to reshape both awareness and response mechanisms nationwide.
Human trafficking and child exploitation are not distant global issues—they are happening within American neighborhoods, often hidden in plain sight. From suburban homes to rural backroads, children and teenagers are being forced or coerced into exploitative labor arrangements or commercial sex work. While it is easy to assume this population exists far from mainstream communities, the reality is far more disturbing. These children live and work alongside us, frequently in invisible roles such as domestic help, agricultural laborers, restaurant staff, construction assistants, or participants in door-to-door sales operations. Many are also pulled into criminal enterprises or the commercial sex industry. Despite the widespread prevalence of these cases, systemic gaps in training, reporting, and intervention continue to hamper efforts to protect these children—especially in under-resourced rural areas where professionals may be undertrained or unsupported when facing such complex cases.
The AAP’s new policy is the result of a collaborative effort between its Council on Child Abuse and Neglect and the Section on Global Health. It is intended to be a companion document to the clinical recommendations issued in 2023, which outlined best practices for pediatricians and other health professionals in identifying and treating children who have experienced trafficking. The current policy statement builds on that foundation and underscores the urgent need for a coordinated, culturally competent, trauma-informed, and rights-based approach to child welfare in the context of trafficking. This requires more than just clinical intervention; it calls for systemic reform and robust partnerships across healthcare, law enforcement, education, social services, and the broader community.
Children who have been trafficked for either labor or sex endure deeply traumatic and often prolonged experiences that inflict lasting physical, emotional, and psychological harm. The array of health consequences they face is vast and devastating. Physical injuries may be sustained on dangerous job sites or as a result of physical abuse. They may suffer from malnutrition, dehydration, and chronic exhaustion. Many face repeated exposure to sexually transmitted infections, the risk of unwanted pregnancies, and the complications that may follow. Mental health conditions such as post-traumatic stress disorder, anxiety disorders, depression, and substance use disorders are pervasive among these children, often exacerbated by the absence of any consistent support system or access to trustworthy adults. In many cases, trafficked children are deliberately isolated from friends, family, and services to reduce the risk of disclosure and escape.
The AAP notes that recognition of the signs of trafficking is the first step toward effective intervention. However, identifying victims remains profoundly challenging. Many children, particularly those who are undocumented, mistrustful of authorities, or psychologically conditioned through manipulation and coercion, do not self-identify as victims. They may present with vague or seemingly unrelated symptoms during medical visits, making it essential that healthcare providers are adequately trained to detect red flags, including inconsistent personal histories, signs of physical restraint, avoidance of eye contact, or reluctance to speak in the presence of others. Providers must adopt a patient-centered approach that accounts for cultural context, respects the dignity of the child, and ensures safety at every stage of the interaction.
Data compiled over the past several years paints a sobering picture of the scope of child trafficking. Globally, the International Labour Organization estimated that over 3 million children and adolescents were engaged in forced labor, including commercial sex, as recently as 2021. Within the United States, the numbers are equally alarming. Among runaway and homeless youth—a population especially susceptible to predation—sex trafficking rates range from 7% to 26%, while labor trafficking rates span from 5% to a staggering 54%. These statistics reveal the structural and social vulnerabilities that traffickers exploit, including poverty, family instability, homelessness, immigration status, limited educational opportunities, and social marginalization.
It is important to understand the legal distinctions between forms of exploitation. Child labor exploitation can occur when a child is treated unfairly or unsafely in a work environment, often involving long hours, low or no pay, and conditions that are harmful to their development or wellbeing. Labor trafficking, on the other hand, is defined under U.S. law as the use of force, fraud, or coercion to compel an individual into labor or services. Child sex trafficking involves commercial sex acts with individuals under 18 and does not require proof of force, fraud, or coercion under federal law. This includes not only physical acts but also the production and distribution of child sexual abuse material, a crime that has exploded in scale with the increasing reach of the internet and digital technology.
Technology, while providing essential connectivity, has become a potent tool for traffickers to groom, recruit, exploit, and control children. Online platforms, including social media, gaming forums, and encrypted messaging apps, are frequently used to make contact with vulnerable youths, especially those expressing signs of distress, alienation, or need. The virtual world offers traffickers anonymity, reach, and speed—factors that make digital environments particularly difficult to regulate or police effectively. In some cases, victims are enticed through promises of modeling jobs, romantic relationships, or financial support, only to find themselves trapped in abusive and exploitative arrangements.
Several overarching risk factors contribute to a child’s susceptibility to trafficking and exploitation. At the individual level, prior abuse, neglect, disability, or a history of placement in foster care can create psychological and practical vulnerabilities. At the family level, poverty, intimate partner violence, and parental substance abuse frequently correlate with higher risk. On a community level, the lack of accessible services, inadequate housing, failing school systems, and neighborhood crime contribute to an environment where exploitation can thrive. At the societal level, systemic inequalities, weak enforcement of labor laws, insufficient immigration protections, and lack of public education further entrench vulnerability.
Events of global and national significance can amplify these risk factors. The COVID-19 pandemic disrupted social support systems, isolated children, and placed enormous strain on families, making many youths more susceptible to exploitation. Climate change and environmental disasters have also displaced communities, strained resources, and heightened family instability—factors that traffickers capitalize on. Similarly, an increase in migration, particularly involving unaccompanied minors fleeing violence or economic deprivation, has created additional opportunities for traffickers to exploit children who lack legal protections or fear deportation if they come forward.
One especially concerning group identified by the AAP includes undocumented children and teens. Often fleeing poverty, violence, or persecution, many arrive in the United States without adult caregivers or clear pathways to legal residency. These children may be recruited by traffickers who exploit their desperation and lack of alternatives. Because of their undocumented status, they are often unwilling to report abuse or exploitation, fearing legal consequences, deportation, or retaliation. This group is frequently excluded from social services, education systems, and healthcare—systems that could otherwise offer a lifeline.
The solution, the AAP argues, must be multifaceted and sustained. At its core, the effort must begin with awareness and professional training. Physicians, nurses, educators, law enforcement officers, and social workers must be educated on the complexities of trafficking and equipped with the tools to intervene appropriately. Training must emphasize trauma-informed care, culturally competent communication, and awareness of legal reporting requirements and victim services. Education should not only be targeted at professionals but also offered to parents, community leaders, and young people themselves. Prevention efforts must address the root causes of vulnerability by investing in housing stability, education, youth empowerment, and family support services.
Furthermore, policies must be created or reformed to prioritize the rights and recovery of child victims. Legal frameworks should ensure that children who are trafficked are not treated as criminals but as victims of abuse. Diversion programs, access to legal counsel, protection from detention or deportation, and inclusion in social welfare programs are essential components of a humane and effective response. Health systems must develop protocols for screening, referral, and treatment that recognize the often-invisible nature of trafficking. Inter-agency collaboration must be institutionalized, with clear referral pathways and data-sharing agreements that protect confidentiality while promoting comprehensive care.
The AAP’s policy statement underwent multiple levels of expert review and reflects the consensus of leading professionals in pediatric and global health. It is both a clinical document and a call to action—a declaration that society cannot continue to ignore the suffering of its most vulnerable members. The fact that trafficking persists in a country with the resources, legal infrastructure, and public awareness of the United States is not just a moral failing—it is a policy failure.
Dr. Jordan Greenbaum, a lead author of the statement, emphasized that the solution must go beyond medical treatment. “What we know is that besides more research and advocacy, there is a need for community members to work collaboratively to provide safety, medical attention and other basic services to these vulnerable kids.” His co-author, Dr. Dana Kaplan, noted the particular risks faced by undocumented youth. “Many may be too fearful or uncertain to disclose, seek help, or engage with authorities due to concerns about safety, mistrust, or potential legal consequences.” Both experts agree that the pathway to change lies in strengthening community networks, ensuring continuity of care, and creating environments in which children can feel safe enough to heal.
The message is clear: child trafficking is not only a crime—it is a public health emergency. The pediatric community must lead the charge in dismantling the systems of abuse and indifference that allow exploitation to flourish. But they cannot do it alone. Families, schools, local governments, national agencies, and even tech companies must play their part in defending childhood from commodification and abuse. Because no child—regardless of background, citizenship, or circumstance—should be invisible.