Paeds · child-safety-and-social-paediatrics
Trafficking, exploitation and forced marriage
Also known as Child trafficking and modern slavery · Commercial sexual exploitation of children · Child labour exploitation · Forced and child marriage · Modern slavery in children · Human trafficking in paediatric practice
Fellowship-level guide to trafficking, exploitation and forced marriage in children: recognising the hidden signs of labour and sexual exploitation and forced marriage, understanding vulnerability and control, the trauma-informed bedside response, mandatory reporting and National Referral Mechanism referral, and the long tail of physical, sexual and mental-health harm.
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Target exams
Red flags
- A child or adolescent accompanied by a controlling adult who speaks for them, refuses to leave, or holds their identity documents
- Inconsistent or scripted history, fear, deference to the accompanying adult, or avoidance of eye contact
- Recurrent or unexplained injuries, sexually transmitted infections, or pregnancies in a young person with no engagement with school or health
- Signs of labour or domestic exploitation — exhaustion, untreated injury, poor nutrition, no access to wages or identification
- Disclosure of a job, marriage, or 'friend' that does not match the child's circumstances, or movement that removed them from support
- Any child or adolescent in commercial sex is a victim of trafficking regardless of apparent force, fraud, coercion or consent
- A young person facing an impending marriage they do not freely consent to, or returned from overseas marriage against their will
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Child protection and mandatory reporting
- Ethics, law and professional practice
- 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 12: Communication with patients, families, and health professionals
- Professional practice: safeguarding children experiencing exploitation, trafficking and forced marriage
- Clinical Applications
- Child protection: recognition and response to child exploitation and modern slavery
- Ethics and law: mandatory reporting and the National Referral Mechanism
- Long Cases
- Short Cases
- Communication stations
- 9. Safeguarding vulnerable children
- 2. Professional skills and knowledge: Communication
- 1. Professional values and behaviours
- 8. Safeguarding: statutory duties and inter-agency working
- 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 23: Ethics
- Adolescent medicine: commercial sexual exploitation and trafficking
- Mandatory reporting obligations and state-specific child-protection statutes
- 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: Duty to report under provincial child-welfare legislation
- Collaborator: working with child-protection agencies, police and support services
Overview & Definition
Picture a fifteen-year-old who presents to your emergency department late at night with a sexually transmitted infection, brought in by an older man who answers every question for her and holds her passport. She is withdrawn, fearful, and cannot tell you where she goes to school. Nothing about her primary complaint is exotic — but the constellation should stop you. Trafficking, exploitation and forced marriage hide inside the everyday, and the clinician who recognises the pattern can change a child's trajectory. [5] [8]
The international legal anchor is the United Nations Palermo Protocol, which defines trafficking in persons as the recruitment, transportation, transfer, harbouring or receipt of a person by means of threat, force, coercion, abduction, fraud, deception, or abuse of power or of a position of vulnerability, for the purpose of exploitation. Exploitation includes the prostitution of others, sexual exploitation, forced labour or services, slavery, servitude, and the removal of organs. [10] [11]
For children the definition carries one crucial simplification. When the victim is under eighteen, the means element — force, fraud, or coercion — is not required. Any child recruited and moved for the purpose of exploitation is a victim of trafficking, and any child involved in commercial sex is a victim of trafficking regardless of how they got there or whether they say they consented. This is the single most testable principle, and it is the lens for every assessment that follows. [5] [7]
Forced marriage sits alongside trafficking as a related but distinct harm. A forced marriage is one in which one or both spouses do not, or cannot, consent, and coercion is involved; it differs from an arranged marriage, where the family takes the lead but both parties freely consent. Child marriage — any marriage before eighteen — is treated as a form of forced marriage and a form of child abuse, because a child is judged unable to give full, free and informed consent. [15] [16]
The work of Wood reframes the whole field for paediatricians: child modern slavery is a child-protection problem with a health front door, and the factors that make a child vulnerable are the same factors that surface in clinics every day. Poverty, displacement, family instability, disability, being in care, and being unaccompanied are not background noise — they are the mechanism of entry. [1]
[1] [5]References16ShowHide
- [1]Wood LCN Child modern slavery, trafficking and health: a practical review of factors contributing to children's vulnerability and the potential impacts of severe exploitation on health BMJ Paediatrics Open, 2020.PMID 32537521
- [2]Hemmings S, Jakobowitz S, Abas M, et al Responding to the health needs of survivors of human trafficking: a systematic review BMC Health Services Research, 2016.PMID 27473258
- [3]Cannon AC, Arcara J, Graham LM, et al Trafficking and Health: A Systematic Review of Research Methods Trauma, Violence, & Abuse, 2018.PMID 27189733
- [4]Wallace C, Greenbaum J, Albright K Global Perspectives on the Health and Social Impacts of Child Trafficking Pediatrics, 2022.PMID 36120743
- [5]Greenbaum J, Crawford-Jakubiak JE Child sex trafficking and commercial sexual exploitation: health care needs of victims Pediatrics, 2015.PMID 25713283
- [6]Greenbaum J Child Sex Trafficking and Commercial Sexual Exploitation Advances in Pediatrics, 2018.PMID 30053930
- [7]Greenbaum J, Kaplan D, Young J, et al Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients Pediatrics, 2023.PMID 36827522
- [8]Greenbaum J Child Labor and Sex Trafficking Pediatrics in Review, 2021.PMID 34850175
- [9]Le PD, Ryan N, Rosenstock Y, et al Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic Review Behavioral Medicine, 2018.PMID 30020867
- [10]Zimmerman C, Kiss L Human trafficking and exploitation: A global health concern PLoS Medicine, 2017.PMID 29166396
- [11]Kiss L, Zimmerman C Human trafficking and labor exploitation: Toward identifying, implementing, and evaluating effective responses PLoS Medicine, 2019.PMID 30695040
- [12]Chisolm-Straker M, Singer E, Strong D, et al Validation of a screening tool for labor and sex trafficking among emergency department patients Journal of the American College of Emergency Physicians Open, 2021.PMID 34667976
- [13]Wright N, Jordan M, Lazzarino R Interventions to support the mental health of survivors of modern slavery and human trafficking: A systematic review International Journal of Social Psychiatry, 2021.PMID 34431379
- [14]Coughlin CG, Greenbaum J, Titchen K Educating paediatric health-care providers about human trafficking Journal of Paediatrics and Child Health, 2020.PMID 32815607
- [15]Pettoello-Mantovani M, Cokugras H, Ferrara P, et al Child Brides and Forced Marriages: An Aspect of Child Abuse and Neglect The Journal of Pediatrics, 2022.PMID 35940291
- [16]McFarlane J, Nava A, Gilroy H, et al Child Brides, Forced Marriage, and Partner Violence in America: Tip of an Iceberg Revealed Obstetrics & Gynecology, 2016.PMID 26959211