Potential Indicators of Commercial Sexual Exploitation of Children10,13,20,31,47

Initial PresentationHistorical FactorsPhysical Findings
Child accompanied by domineering adult who does not allow child to answer questionsMultiple sexually transmitted infections (STIs)Evidence suggestive of inflicted injury
Child accompanied by unrelated adultPrevious pregnancy/abortionTattoos (sexually explicit, of man’s name, gang affiliation)
Child accompanied by other children and only one adultFrequent visits for emergency contraceptionChild withdrawn, fearful
Child provides changing information regarding demographicsChronic runaway behaviorSigns of substance misuse
Chief complaint is acute sexual assault or acute physical assaultChronic truancy or problems in schoolExpensive items, clothing, hotel keys
Chief complaint is suicide attemptHistory of sexual abuse/physical abuse/neglectLarge amounts of cash
Child is poor historian or disoriented from sleep deprivation or drug intoxicationInvolvement of child protective services (especially foster care/group home)Poor dentition or obvious chronic lack of care
Involvement with department of juvenile justice
Significantly older boyfriend
Frequent substance use/misuse
Lack of medical home and/or frequent emergency department visits