The following article is a part of conference coverage from the National Association of Pediatric Nurse Practitioners (NAPNAP) 42nd National Conference on Pediatric Health Care, held virtually from March 24 to March 27, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurse practitioners in pediatrics. Check back for more from NAPNAP 2021.


Nurse practitioners (NPs) and other clinicians play a key role in the timely identification, intervention, and treatment of children involved in sex and labor trafficking in the United States, experts said in virtual presentations at the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2021).1,2

The COVID-19 pandemic increased vulnerability to child trafficking exposure; the National Center for Missing and Exploited Children (NCMEC) received 4.2 million reports of child online exploitation in April 2020 on the center’s CyberTipline, a 4-fold increase from April 2019. Approximately, 70% of these reports were from Facebook Messenger, explained NAPNAP President Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN.

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“One of the challenges with Facebook is that it is moving to a fully encrypted platform, meaning that Facebook will not be able to see or access messages posted by users, which removes the company’s obligation to report these messages,” said Dr Peck. Thus, these numbers are expected to artificially decrease in the future.

The number of online enticements (an individual communicating with someone believed to be a child with the intent to commit a sexual offense or abduction) increased nearly 100% from 2019 (19,174) to 2000 (37,872), according to NCMEC. In 2020 there were 365,348 entries in the National Crime Information Center for missing children, according to the FBI.

Some of the increased vulnerability stems from the economic pressure caused by the pandemic. Impoverished families may be more susceptible to labor trafficking or exploiting their own children in trafficking to put food on the table, said Dr. Peck, who is also clinical professor at the Baylor University Louise Herrington School of Nursing in Dallas, Texas.

“Child trafficking is an egregious human rights violation that has reached epidemic proportions and you need to know what to do about it,” Dr. Peck said. 

Nearly All Trafficked Children Access the Health Care System

Up to 88% of individuals who are trafficked report having contact with a health care provider during their captivity, Dr. Peck said. Unfortunately, identification of these individuals remains “remarkably low” in the health care setting, she noted.

Victims of human trafficking can present across the clinical continuum, commonly in emergent care but also in primary care and specialty care, she said. Children and adolescents who are trafficked may present for acute care of chronic, emergent conditions such as asthma or diabetes.

Dr. Peck relayed a case in her practice of an adolescent girl with type 1 diabetes who presented repeatedly with diabetic ketoacidosis.

“While it is not uncommon for teenagers with diabetes to be poorly controlled, what we realized is that she was being trafficked and traffickers don’t care about managing chronic illness. They only care if the child can make money right now,” she explained. Trafficked children and adolescents typically only present for care when the condition is so severe that they can no longer work.

Ask Open-Ended Questions

Gail Hornor, DNP, CPNP, SANE-P, a pediatric NP from the Center for Family Safety and Healing and Nationwide Children’s Hospital, presented red flags for child labor trafficking (Table 1).2 Open-ended assessment questions (Table 2) typically are more effective, sensitive, and specific in identifying potential risk of human trafficking than standardized screening tools, Dr Peck said.

Table 1. Child Trafficking Red Flags2

• Delay in seeking medical care
• Unwilling/hesitant to answer questions
• Inconsistent history of injury/illness
• Appears intimidated by person accompanying them
• Lacks basic work-related protective gear
• Unfamiliar with location (city or town)
• Accompanying person is overly dominant, does not let patient speak, refuses to leave bedside, or resistant to use an interpreter
• Lives with employer or housing provided by employer