to the editor: We read with great interest the commentary describing challenges associated with caring for unaccompanied minors from Central America. The considerations also inform the care of minors involved in human trafficking, specifically domestic minor sex trafficking (DMST), who may also seek care from family physicians.

According to the Office of Refugee Resettlement, unaccompanied minors are especially vulnerable to sexual violence, exploitation, and trafficking.¹ Defined by the Victims of Trafficking and Violence Protection Act of 2000 as a “severe form of trafficking in persons,”² DMST, in which minors are forced to participate in prostitution, pornography, or erotic entertainment, is one of the most common forms of human trafficking in the United States.³ A significant difference between the care of these patients and other unaccompanied minors is that the former requires an additional, crucial step: identification.

Minors who are exploited by DMST are not likely to disclose their status, especially while still being trafficked, which makes it difficult for clinicians to identify these patients when they present for care. Two studies found that 28% to 50% of trafficking survivors reported health care system encounters while they were being exploited.⁴ The National Center for Missing and Exploited Children conservatively estimates at least 100,000 children are exploited by DMST each year.⁵ Such numbers represent many missed opportunities to identify, care for, and potentially assist in freeing minors from this form of slavery.

Family physicians can prepare to recognize and care for this vulnerable, neglected population by utilizing suggested resources for general information and continuing education in Table 1. In doing so, to echo Drs. Bishop and Ramirez, we can help bring these patients “out of the shadows.”