Table 2

Example potential indicators of child MSHT—body systems (non-exhaustive)

Presenting concernPossible MSHT-related cause
Neurological system45 61 63 64
 Headaches, dizziness, confusion and/or memory problemsHead injury or systemic causes (ie, severe anaemia secondary to poor diet, environmental toxicity, ie, lead from poor accommodation or previous country of habitation).
 Body or limb pain, abnormal body postures, movement or sensation.Neurological damage secondary to repetitive or prolonged movements and positions.
Cardiovascular system65 66
 Chest pain, palpitations, shortness of breath, fainting, abnormally high or low blood pressure.Children (particularly of international origin) may have never received a medical examination or standard vaccinations. Congenital and infectious causes of cardiac presentations should be considered.
Chest wall pain may be triggered by injury.
 Fever, flu-like symptoms, spots on palms or soles of feet, tiny broken blood vessel spots under nails, in the mouth, whites of the eyes or chest.Infective endocarditis risks are further increased though injected illicit drug use and dirty drug paraphernalia.
 Increased blood pressure, palpitations and/or cardiac arrest.Illicit drug use may have cardiovascular consequences. Many drugs impact blood pressure including synthetic cannabinoids such as Spice/K2, amphetamines, methamphetamine, other stimulants and club drugs.
Cocaine use increases the risk of cardiac arrest.
Respiratory system65 67
 Coughing, breathing difficulty, chest pain, feverChildren in MSHT may live in or be exposed to unsanitary living conditions and other vulnerable individuals. Risk of tuberculosis and other infective causes of respiratory symptoms should be considered. Underlying immune system weakness may be triggered by poor nutritional status, chronic stress or underlying dysfunction (consider HIV). Pretrafficking exposures to pathogens should also be considered.
 Breathing difficulty, wheeze, collapseChildren with asthma may find their condition poorly controlled due to exposure to dust, smoke, pesticides or other irritants. Access to appropriate medication and health reviews may be limited.
Gastrointestinal system40 52
 Constipation, diarrhoea, abdominal pain—infective symptomsUnsanitary living conditions and food supply may increase risk of gastroenteritis and parasitic infections.
 Constipation, diarrhoea, abdominal pain—non-infective symptomsMay be caused by malnutrition, dehydration, stress and regulated toilet breaks.
Children may also be forced to pack drugs into the anal canal, misusing constipating or laxative agents to facilitate this.
 Collapse, systemically unwellChildren used as drug mules may be required to swallow or body-pack drugs (commonly cocaine or heroin) wrapped in condoms or plastic. Packet rupture can result in abrupt toxicity and overdose. Seizures, tachycardia, hypertension and hyperthermia may occur with cocaine toxicity. Coma and respiratory depression may occur with heroin.
Intestinal obstruction, rupture and peritonitis are additional risks.
 Anal pain and/or dischargeAnal injury or infection may be caused through sexual activity, assault and/or body packing of drugs.
Irritable bowel syndrome exacerbated by stress may present with discharge.
Urinary system68 69
 Urinary incontinence, bed-wettingChildren under high-stress situations may be affected by urinary incontinence and bed-wetting. Restricted toilet use may be an additional factor.
 Dysuria, urinary frequency, abdominal painChildren may experience urinary infections or urogenital symptoms in the context of sexual abuse and/or poor sanitary conditions.
  • MSHT, modern slavery and human trafficking.