How to get help or report child trafficking
Those in need of help can call the National Human Trafficking Resource Center Hotline at 1-888-373-7888 or text "Help" to 233733 (BeFree).
Pediatricians who say they have never seen a victim of child trafficking probably haven't been looking.
"If it's never on your radar screen, you're never going to see it," said Dr. Lori Frasier, chief of the Division of Child Abuse Pediatrics at Penn State Hershey Children's Hospital, who is also board certified in child abuse pediatrics. "Especially in central Pennsylvania, we feel insulated."
We're not. Just last month, a Lower Paxton Township man was sentenced to 10 years in prison for running a "suburban brothel" that included child sex trafficking.
While the words "human trafficking" were little heard or understood even five years ago, the issue has come to the forefront with awareness campaigns and news stories, most notably the 300 Nigerian girls who were kidnapped from their boarding school in 2014.
Still, in the average pediatrician's office in the average American town, trafficking isn't on the list of things to check for next to height, weight and BMI.
Healthcare workers need to raise their awareness of clues that a child may be sexually exploited said Dr. Pat Bruno, medical director of the Child Advocacy Center of Central Susquehanna Valley, a part of the Geisinger Health System. Bruno is one of the state's few pediatricians who is board certified in child abuse pediatrics.
"We lack the tools to identify victims of child trafficking and we don't know what to do when we encounter a victim,'' Bruno said. "We don't ask the right questions and we don't look below the surface."
Local connections
"We're like a thoroughfare. Washington, D.C. and New York both have a high incidence of trafficking and we're the state in between. Lots of these kids are passing through our state," said Bruno, who gives presentations on the topic to area medical groups.
Frasier said people tend to think of sex rings or girls smuggled across borders when they hear "child trafficking," but it more commonly happens anytime a girl is forced to exchange sex for something, such as food or a place to stay. In fact, when the victim is under age 18, force or deception don't need to be present; their age is enough to label it as sexual exploitation.
"In the past, teenagers were seen not as much as victims but as prostitutes," she said.
Bruno agreed, saying it's important to remember that these are "just kids who are being manipulated and deluded by adults who are far savvier than they are."
Training needed
A recent study by the Medical College of Wisconsin in Milwaukee, published in the journal "Pediatrics," found that only half of medical providers could correctly identify possible victims in scenarios containing clues to potential child sex trafficking.
Of those surveyed, 63 percent said they had never received training on child trafficking awareness.
While some child victims may be seen for regular well-child visits, they are more often seen in emergency departments, urgent care centers or regional health clinics, Frasier said.
Regardless of where doctors or nursing staff are working, there are clues they should be looking for that might flag children who are being trafficked, Bruno and Frasier said.
The American Academy of Pediatrics recently published its first guidelines for clinicians to help identify victims of sexual exploitation, a clear message to pediatricians that they need to become more aware of the issue, Frasier said.
"Multiple runaway attempts, signs of substance abuse, frequently asking for emergency contraception - these are red flags," Frasier said. "But even subtle things like a child who is with a domineering adult who won't let the child answer for herself or a child who is not with their parents or who is wearing expensive jewelry or clothing - these are also clues that the medical community is not used to picking up on."
Doctors should make sure that they talk to the children alone, apart from the parent or adult who accompanied them.
"Talking about sexual safety in the pediatrician's office has been a bit forbidden; it's a dicey topic but a necessary one," Frasier said.
Bruno said questions should include "Is anyone forcing you to do anything you don't want to do?" and "Has anyone ever touched you or hurt you in any way?"
Pediatricians should look for obvious clues like bruising in the genital area or sexually-transmitted infections but also things that a pediatrician might not automatically connect to sexual exploitation, such as lack of attention to personal appearance, rib fractures and even tattoos that a perpetrator may have branded onto the child's skin, he said.
Large web of deception
Parents also need to be aware of clues that their child is being trafficked. Believe it or not, peer trafficking happens, the doctors said.
"New friends, losing interest in age-appropriate activities, multiple cell phones, inordinate time online, a change in physical appearance, a disconnect from the family - these can all be clues," Bruno said.
Some 200,000 to 300,000 children in the U.S. are trafficked and the average age is 12 to 14, Bruno said. It's a $32 billion industry nationwide, he said.
The traffickers lure these children with tangible things - like a food or place to stay - and with emotional lures like affection and statements of love, Bruno said.
How do they make contact? Social media is a major connector. Twitter, Facebook and - in news that should run a chill down any parent's back - apps that show who is tweeting within a neighborhood and their address.
Once perpetrators make contact, they shower the victims with affection and gifts and eventually condition them into sexual exploitation.
People may wonder why an exploited girl doesn't just run away or tell someone.
"Fear, that's why. Fear of arrest, fear of losing the only home they have, fear of placement in social services," Bruno said.
It's very hard to break free, Bruno said. Statistics show it takes an average of 18 months to two years and only 1 to 2 percent of victims ever get out - statistics that he hopes will change as more medical professionals become aware of the clues that could lead to help.
"It involves individuals from all walks of life," he said. "Who are the perpetrators? Some are family members, friends or strangers; 75 percent are pimps - traffickers - who intentionally recruit vulnerable children with low self-esteem, difficulties at home, family conflict, a history of drug and alcohol abuse, children who are runaways or in foster care."