Child Sexual Exploitation (CSE), Female Genital Mutilation (FGM), Grooming and Trafficking

These web resources briefly describe what is meant by Child Sexual exploitation (CSE), Female Genital Mutilation (FGM), Child Trafficking and Grooming. In the case of FGM we present below a set of approved diagrams of the different types of FGM to aid recognition. As with all types of abuse in children there is an associated and important legal framework associated with these offences, and it is important that all health professionals are familiar with this wherever they practice in the UK.

 

Child Sexual Exploitation (CSE)

What is CSE?
CSE describes the involvement of children and young people in sexual activity through persuasion, force or coercion, believing that they will receive something in return, such as money, drugs or status. Often victims of CSE do not recognise that they are being abused, therefore it is important that professionals are able to recognise warning signs that a child or young person may be subject to sexual exploitation.

The mnemonic safeguard can be a useful tool when considering those at risk:

  • sexual health and behaviour: evidence of sexually transmitted infections, pregnancy and termination; inappropriate sexualised behaviour
  • absent from school or repeatedly running away
  • familial abuse and/or problems at home
  • emotional and physical condition: deliberate self-harm, suicide attempts, unexplained injuries or changes in physical appearance
  • gang membership or association, older age groups and involvement in crime
  • use of technology and sexual bullying
  • alcohol and drug misuse at problematic levels
  • receipt of unexplained gifts or money
  • distrust of authority figures.

A key risk factor which might be picked up at a pre-operative assessment is a young person being accompanied by an unknown person that causes concern (e.g. acting in a controlling or coercive manner) 

If you suspect that a child or young person is being sexually exploited then discuss your concerns with a member of the local child safeguarding team. Significant concerns would warrant a referral to child social care. Detailed guidance from HM Government can be found here.

A report published by the Children's Commissioner looking to learn lessons from high profile failures to protect children and young people in the UK from CSE can be found here.

The Academy of Royal Colleges has recognised the need for better recognition of Child Sexual exploitation in a publication from 2014 which can be found here.

 

Child Sexual Abuse (CSA)

Please click here to view the CSA information available on our safeguarding pages, which also briefly discusses Institutional CSA.

 

Child Trafficking

What is Child Trafficking?
Child trafficking is defined by the UN as the 'recruitment, transportation, transfer, harbouring or receipt' of a child for the purpose of exploitation.  In adults, the definition of trafficking also requires the threat or use of force or other forms of coercion, but children are treated differently. Child trafficking recognises that a child cannot give informed consent to his or her own exploitation, so protection applies even if a child agrees to travel, or complies with their predicament.

Child Trafficking and the law
Child trafficking is child abuse and requires a child protection response. It is also a crime and an abuse of human rights. There is no single piece of legislation on child trafficking in the UK but clear guidance from the UK Government can be found here. If you suspect that a child or young person has been trafficked you must follow local child safeguarding procedures. This will mean contacting a member of the child safeguarding team or child social care. Further guidance from the NSPCC can be found here.

 

Child Grooming

What is Child Grooming?
Grooming is when someone builds an emotional connection with a child to gain their trust for the purposes of sexual abuse, sexual exploitation or trafficking. Children and young people can be groomed online or face-to-face, by a stranger or by someone they know – for example a family member, friend or professional. Groomers may be male or female. They could be any age. Many children and young people don't understand that they have been groomed or that what has happened is abuse. Further information from the NSPCC about child grooming can be found here.

 

Female Genital Mutilation (FGM)

PLEASE NOTE: the information below contains graphic content.

Please click here to expand the information

 

Further information on FGM, its worldwide prevalence and health effects can be found via the World Health Organization (WHO) website here.

 

FGM and the law
FGM has been illegal in the UK since 1985. In 2003 it also became illegal to take a British national or permanent resident overseas for FGM, or to help someone trying to do this. The crime carries a sentence of up to 14 years. Despite this, there have never been any successful convictions in the UK. To combat this, the UK Government amended the legislation regarding FGM in 2015. In England and Wales, but not in Scotland, a system of mandatory reporting has now been introduced. This means that it is now mandatory for all health professionals to notify the police when they are informed by a girl under 18 that an act of FGM has been carried out on her; or observe physical signs which appear to show that an act of FGM has been carried out on a girl under 18 and they have no reason to believe that the act was necessary for the girl’s physical or mental health or for purposes connected with labour or birth. 

The General Medical Council (GMC) duty of confidentiality does not therefore apply in this case. The duty to report is a personal duty, which requires the individual professional who becomes aware of the case to make a report; the responsibility cannot be transferred. FGM is the only form of child abuse for which mandatory reporting applies. Further information and advice can be found from HM Government here.

Advice on the law which applies in Scotland can be found here.

Identify and act
How can children or young people at risk or affected by FGM be identified? Some children or young people may disclose that they have been victims of FGM. Others may seek medical help for the consequences of FGM including complications affecting sexual intercourse, difficulties with menstruation, urinary infections or fertility problems.  Sometimes FGM may be diagnosed unexpectedly during intimate medical examinations. To identify a child at risk, consider the following:

  • do other family members have FGM?
  • does she have a parent from a practicing community?
  • do you think the family will be aware of UK law pertaining to FGM and be able to access information on FGM and its harmful effects?
  • has the young person been discussing FGM with other young people or referred to a ‘special procedure’?

Thorough risk assessment guidance can be found here.

What action should I take if I am concerned that a child may have had FGM or be at risk?
The flow chart below outlines the actions to take (please click on the image to see a larger, clearer version). Throughout the process, care must be taken to maintain a professional and supportive relationship with the child or young person:

  • ensure that a female professional is available to talk to the individual and make sure that they have access to a professional interpreter if required
  • ensure that there is sufficient time available in the consultation and be sensitive to the fact that the child or young person may be loyal to their parents 
  • make sure that the language used is simple and straightforward so that the individual will understand.

For further information on good practice regarding FGM in children refer to the following article:
Creighton SM, Hodes D Female genital mutilation: what every paediatrician should know. Archives of Disease in Childhood 2016;101:267-271.

or consult the Royal College of Paediatrics and Child Health website.

You may also find the following article useful on FGM, it is not open access but anyone with an OpenAthens account can view it for free:
Weston J Female genital mutilation: the law as it relates to children Archives of Disease in Childhood 2017;102:864-867.

Virtual Case – FGM (PowerPoint)

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