Paeds · child-safety-and-social-paediatrics
Online sexual exploitation and image-based abuse
Also known as Technology-facilitated child sexual abuse · Online grooming and sextortion · Image-based abuse and non-consensual intimate image sharing · Child sexual abuse material and online solicitation · Digital sexual exploitation of youth · Revenge porn involving minors
Fellowship-level guide to online sexual exploitation and image-based abuse: online grooming, sextortion, non-consensual intimate image sharing, self-generated sexual content and child sexual abuse material. Covers recognition of behavioural cues, trauma-informed assessment, evidence preservation, the mandatory-reporting and platform-reporting pathway, and the regional safeguarding architecture across ANZ, the UK, the US and Canada.
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Target exams
Red flags
- Sudden behavioural change in an adolescent — withdrawal, secrecy, anxiety, sleep disruption or school refusal — without another explanation
- A young person terrified of losing access to their device, or panic when a parent reaches for their phone
- Disclosed or discovered intimate images of a minor shared without consent, or an image being used as a lever for threats
- Financial sextortion — demands for money or payment alongside threats to expose an image
- A gift, money, gaming currency or phone credit from an unknown online contact that preceded distress
- Acute suicidal ideation or self-harm in the context of an online sexual threat
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Adolescent medicine and safeguarding
- Child protection: technology-facilitated sexual abuse
- Current 2026 PREP curriculum — Learning goal 9: Clinical assessment and management — child safety and maltreatment
- Renewed curriculum for first-year trainees from 2027 — Learning goal 13: Caring for adolescents and youth
- Professional practice: online sexual exploitation, image-based abuse and mandatory reporting
- Adolescent health
- Ethics and law in paediatric practice
- Child protection: recognising and responding to online sexual exploitation
- Long Cases
- Short Cases
- Communication stations
- 9. Safeguarding vulnerable children
- 10. Young people's health
- 8. Safeguarding: statutory duties and inter-agency working
- 2. Professional skills and knowledge: Communication
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Safeguarding, child protection and the law
- Communication
- History
- Clinical
- General Pediatrics Content Outline — Domain 4: Child Abuse and Neglect
- General Pediatrics Content Outline — Domain 10: Adolescent medicine
- General Pediatrics Content Outline — Domain 23: Ethics
- Technology-facilitated child sexual abuse and mandatory reporting obligations
- Professionalism 1: Professional Behavior and Ethical Principles
- Systems-Based Practice 1: Legal and regulatory requirements including mandated reporting
- Systems-Based Practice 2: Coordination of care across systems
- Interpersonal and Communication Skills 1: Patient- and family-centered communication
- Professional
- Health Advocate
- Pediatrics: online sexual exploitation and safeguarding obligations
- Collaborator: working with child-protection agencies and online-safety authorities
Overview & Definition
Picture a fifteen-year-old brought to your emergency department at midnight after taking an overdose. The overdose is the presenting complaint, but the engine behind it is a string of messages on her phone: a man she met on a gaming platform convinced her to send an image, then threatened to send it to her school unless she paid. Your job is to see past the paracetamol level to the technology-facilitated sexual abuse driving it. [14]
Online sexual exploitation is the umbrella term for child sexual abuse that is enabled, amplified or sustained by digital technology. Henry and Powell defined the broader field of technology-facilitated sexual violence as any sexual violence perpetrated in part or wholly through communication technologies, and it spans harassment, grooming, coercion, image-based abuse and threats. [6]
The clinical subtypes that matter at the bedside are these. Online grooming is the process by which an offender builds trust and emotional connection with a child online to manipulate them into sexual activity or sexual content. Sextortion is the coercion of a young person — using a sexual image or information as leverage — to produce more content, meet in person, or pay money. Image-based abuse (often called non-consensual intimate image sharing, or colloquially "revenge porn") is the sharing, or threat of sharing, of a sexual image without the subject's consent. [6] [7]
Self-generated sexual content (sexting) ranges from developmentally normative consensual exchange between peers to coerced or illegal material; the same image can shift from consensual to abusive the moment it is shared beyond the intended recipient. Child sexual abuse material is the recorded depiction of a child being sexually abused, now overwhelmingly produced and distributed online. Kloess and colleagues' review established the prevalence, process and offender characteristics that frame all of these. [1]
A child in this domain is anyone under the age of majority in your jurisdiction, and the clinical approach is identical whether the young person is nine or seventeen: recognise, assess, safeguard, report, and support. The age changes the legal framework (consent, criminal responsibility, image-abuse statutes) but not your duty to protect. [7]
[1] [6]References16ShowHide
- [1]Kloess JA, Beech AR, Harkins L Online child sexual exploitation: prevalence, process, and offender characteristics Trauma Violence Abuse, 2014.PMID 24608540
- [2]Madigan S, Ly A, Rash CL, Van Ouytsel J, Temple JR Prevalence of Multiple Forms of Sexting Behavior Among Youth: A Systematic Review and Meta-analysis JAMA Pediatr, 2018.PMID 29482215
- [3]Patel U, Roesch R The Prevalence of Technology-Facilitated Sexual Violence: A Meta-Analysis and Systematic Review Trauma Violence Abuse, 2022.PMID 32930064
- [4]Patchin JW, Hinduja S Sextortion Among Adolescents: Results From a National Survey of U.S. Youth Sex Abuse, 2020.PMID 30264657
- [5]Kloess JA, Hamilton-Giachritsis CE, Beech AR Offense Processes of Online Sexual Grooming and Abuse of Children Via Internet Communication Platforms Sex Abuse, 2019.PMID 28715937
- [6]Henry N, Powell A Technology-Facilitated Sexual Violence: A Literature Review of Empirical Research Trauma Violence Abuse, 2018.PMID 27311818
- [7]Gottfried ED, Shier EK, Mulay AL Child Pornography and Online Sexual Solicitation Curr Psychiatry Rep, 2020.PMID 32025821
- [8]Mitchell KJ, Finkelhor D, Wolak J The internet and family and acquaintance sexual abuse Child Maltreat, 2005.PMID 15611326
- [9]Ringenberg TR, Seigfried-Spellar KC, Rayz JM, Rogers MK A scoping review of child grooming strategies: pre- and post-internet Child Abuse Negl, 2022.PMID 34801848
- [10]O'Malley RL Short-Term and Long-Term Impacts of Financial Sextortion on Victim's Mental Well-Being J Interpers Violence, 2023.PMID 36866591
- [11]Turner HA, Finkelhor D, Mitchell K, Colburn D Prevalence of Technology-Facilitated Abuse Among Sexual and Gender Minority Youths JAMA Netw Open, 2024.PMID 38306097
- [12]Henry N, Flynn A, Powell A Technology-Facilitated Domestic and Sexual Violence: A Review Violence Against Women, 2020.PMID 32998673
- [13]Thomas K, Hamilton-Giachritsis C, Branigan P, Hanson E Offenders' approaches to overcoming victim resistance in technology-assisted child sexual abuse Child Abuse Negl, 2023.PMID 37182413
- [14]Hong S, Lu N, Wu D, Jimenez DE, Milanaik RL Digital sextortion: Internet predators and pediatric interventions Curr Opin Pediatr, 2020.PMID 31789977
- [15]Mori C, Cooke JE, Temple JR, Ly A, Lu Y, Anderson N, Rash C, Madigan S The Prevalence of Sexting Behaviors Among Emerging Adults: A Meta-Analysis Arch Sex Behav, 2020.PMID 32072397
- [16]Katz C, Piller S, Glucklich T, Matty DE Stop Waking the Dead: Internet Child Sexual Abuse and Perspectives on Its Disclosure J Interpers Violence, 2021.PMID 30160592