By Maya Land and Dr. Hanni Stoklosa 

When most people hear the term “human trafficking,” they picture sex trafficking. Far fewer imagine a child cleaning industrial meatpacking equipment overnight, selling candy door-to-door for hours without food or water, or being pressured by family members into dangerous labor to help pay bills. 

But these situations are happening across the United States, and increasingly, the law is recognizing them for what they are: child abuse. 

A new paper from researchers at Tufts University School of Medicine and HEAL Trafficking argues that healthcare providers must begin recognizing child labor trafficking not simply as labor exploitation, but as a critical pediatric health and protection issue. 

The urgency is hard to overstate. 

In one recent federal case, more than 100 children were found working hazardous overnight shifts cleaning slaughterhouses and meatpacking facilities across multiple states. In another case, children and young adults were transported around Florida and forced to sell candy for long hours under abusive conditions. 

These children often present to healthcare settings with injuries, exhaustion, malnutrition, chronic pain, anxiety, depression, or developmental problems. Yet many clinicians still do not recognize labor trafficking when they see it. 

That gap matters because healthcare settings may be one of the few places where exploited children interact with adults outside the trafficking situation. 

A major legal shift that many still do not know about 

In 2023, the Trafficking Victims Protection Reauthorization Act (TVPRA) formally recognized child labor trafficking as child abuse under federal law. 

This was more than a technical legal update. It fundamentally changed how child labor trafficking should be understood. 

For years, child sex trafficking had clearer integration into child welfare and healthcare response systems. Labor trafficking often remained invisible, treated as a workplace issue, immigration issue, or criminal matter rather than a form of violence against children. 

But implementation remains uneven. 

Some states have expanded protections aggressively. Others still maintain major loopholes, including exemptions when labor is performed for a parent or guardian, despite evidence that family members are frequently involved in recruitment or exploitation. 

The result is what the authors describe as a “patchwork” response system, where whether a child is recognized as a victim can depend heavily on geography. 

Who is affected? 

One of the most persistent myths about labor trafficking is that it primarily affects undocumented immigrant children. 

In reality, research suggests that roughly 42% of identified child labor trafficking victims in the United States are U.S. citizens. 

Children may be exploited in agriculture, domestic work, restaurants, construction, hospitality, street vending, drug distribution, theft, and other industries. 

And coercion is often more subtle than people expect. 

Children are developmentally wired to trust adults and comply with authority figures. They may not identify themselves as victims. Some are manipulated through promises of financial stability or opportunities to help their families. Others are controlled through fear, dependency, threats, or trauma bonds. 

Why healthcare matters 

The paper emphasizes that healthcare professionals occupy a uniquely important position. 

A child experiencing labor trafficking may come to a clinic with dehydration, untreated injuries, chronic pain, exhaustion, anxiety, poor dentition, developmental concerns, or vague complaints that do not immediately “look” like trafficking. 

Yet healthcare systems often lack: 

• dedicated clinical pathways 
• workforce training 
• standardized screening approaches 
• referral systems 
• trauma-informed protocols specific to labor trafficking 

In one cited study, only about 12% of emergency department personnel felt confident recognizing child trafficking cases. 

The authors argue that awareness alone is not enough. Health systems need structured, trauma-informed responses that connect children not only to medical care, but also to social services, legal supports, shelters, and long-term protection. 

Moving from recognition to action 

Recognizing child labor trafficking as child abuse carries important implications for healthcare, child welfare, education, and policy systems. 

It means: 

1. expanding clinician training 
2. building coordinated referral networks 
3. strengthening child protection pathways 
4. harmonizing state laws with federal protections 
5. and recognizing that labor exploitation can cause profound lifelong health consequences 

Most importantly, it means changing how society sees these children. 

Not as “runaways.” 

Not as “troubled youth.” 

Not as “kids helping their families.” 

But as children experiencing abuse and exploitation who deserve protection, healthcare, and safety. 

As the paper argues, children exploited for labor have too often remained hidden in plain sight. The challenge now is whether healthcare systems, policymakers, and communities are willing to finally see them. 

 

Author Bios 

Maya Land holds a Master of Science in Public Health from Johns Hopkins Bloomberg School of Public Health. Her background includes conducting research at the intersection of public health and human rights, and in providing direct services to human trafficking survivors in her home state of New Mexico. 

Hanni  Stoklosa, MD, MPH, is co-founder and CMO of HEAL Trafficking, an emergency physician, and Associate Professor at Harvard Medical School. Dr. Stoklosa is an internationally-recognized expert, advocate, researcher, and speaker on the wellbeing of trafficking survivors in the U.S. and internationally through a public health lens. She has advised the United Nations, International Organization for Migration, U.S. Department of Health and Human Services, U.S. Department of Labor, U.S. Department of State, and the National Academy of Medicine on issues of human trafficking and testified as an expert witness multiple times before the U.S. Congress. Moreover, she has conducted research on trafficking and persons facing the most significant social, economic, and health challenges in a diversity of settings including Australia, Brazil, China, Egypt, Guatemala, India, Liberia, Nepal, Kazakhstan, the Philippines, South Sudan, Taiwan, Thailand, and Uganda. Among other accolades, Dr. Stoklosa has been honored with the U.S. Department of Health and Human Services Office of Women’s Health Emerging Leader award, the Harvard Medical School Dean’s Faculty Community Service award, has been named as an Aspen Health Innovator and National Academy of Medicine Emerging Leader. Her anti-trafficking work has been featured by CNN, the New York Times, National Public Radio, Fortune, Glamour, Canadian Broadcasting Corporation, STAT News, and Marketplace. Dr. Stoklosa published the first textbook addressing the public health response to trafficking, “Human Trafficking Is a Public Health Issue, A Paradigm Expansion in the United States.