According to the Federal Bureau of Investigation's National Crime Information Center, 840,279 missing persons were reported to law enforcement in 2001, an increase of 444% from 1982. Approximately 85% of the 840,279 missing persons were younger than 18 years. This means that more than 2,000 children are reported missing to law enforcement every day. Fortunately, only a small fraction of these reports prove to be actual abductions. According to the FBI's National Incident-Based Reporting Systems, abduction of juveniles constitutes only 1% of all crimes against juveniles.¹ And only about one of every 10,000 reports of a missing child turns out to be an actual abduction that results in murder.²

Nature and scope of child abductions In 1984, Congress passed the Missing Children's Assistance Act. It requires the US Department of Justice's Office of Juvenile Justice and Delinquency Prevention to conduct periodic national surveys to determine the incidence of children reported missing as well as those who were recovered for that particular year. The first National Incidence Studies of Missing, Abducted, Runaway, or Thrownaway Children (NISMART-1) was conducted in 1988. The most recent survey, NISMART-2, was conducted in 1999.^3,4 NISMART-2 differed significantly from NISMART-1 in its method of data collection and sought to standardize definitions of missing children. NISMART-2 also added perspective to the survey results by interviewing parents who reported children missing, law enforcement agencies, and juvenile facilities (group homes, detention centers, youth shelters, etc.).

NISMART-2 describes the following types of missing children events:

• nonfamily abductions, including stereotypical kidnapping
• family abductions
• runaway/thrownaway episodes
• missing—involuntary, lost, or injured
• missing—benign explanations

When a child goes missing, abduction by a stranger is least likely

The table above summarizes the results of the NISMART-2 survey. In the study year (1999), more than 58,000 children were victims of nonfamily abductions. Far more children—more than 1.6 million—were runaways or thrownaways.

Of the 58,000 victims of nonfamily abductions, 99% were returned home, but nearly half were sexually assaulted. Most victims were adolescents; 59% were between 15 and 17 years old. Only 7% of victims of nonfamily abductions were between birth and 5 years; 12%, between 6 and 11 years; and 22%, between 12 and 14 years.

In 45% of nonfamily abductions the perpetrator was described as a stranger. In 21% of cases, he (or she) was described as an acquaintance and, in 17%, as a friend. Other perpetrators included babysitters or caretakers, neighbors, or persons of authority. In the study year, there were only 115 child victims of stereotypical kidnappings (see NISMART definitions). In 40% of these episodes the abducted child was killed and in 4%, the child was not recovered.

Family abductions are typically the result of a custody dispute between parents that stem from divorce-related legal proceedings. Data from NISMART-2 suggest that some 200,000 family abductions occur each year, with the large majority of children returned to the custodial parent within a short time. NSMART-2 data show that about 46% of children involved in family abductions are gone for less than a week; 21% are gone for more than a month. Less than 6% are never returned to the custodial parent.

Abduction in perspective: Small risk, tragic consequences Just last year, the American Academy of Pediatrics (AAP) revised its 1992 policy statement, "The Pediatrician's Role in the Prevention of Missing Children."⁵ In the revised statement, the AAP continues to emphasize the importance of teaching children their name, address, and phone number to expedite their return if separated from their family, as well as the need to teach children to "know the rules" to avoid abduction. The new policy omits an earlier recommendation that children be taught not to talk to strangers, because such advice frightens children with no benefit—most abducted children don't consider the abductor a "stranger" once that adult has gained their confidence. The statement notes that there is a need to strike a balance when offering advice on preventing abduction: Safeguard children but do not generate fear.

The AAP strongly recommends that parents be encouraged to keep a recent photo of their child and be taught how to report a missing child to law enforcement and the National Center for Missing & Exploited Children (NCMEC). The AAP does not encourage fingerprinting and other mechanisms of child identification, such as saliva swab storage for DNA identification; these methods help identify bodies but may unduly frighten parents and children and do not usually assist in retrieving a living child.

NISMART-2 data confirm that stereotypical kidnappings remain uncommon. But because the methodologies of NISMART-1 and NISMART-2 differ radically, no conclusion can be reached as to whether the rate of nonfamily abductions is increasing. However, we do know more about the nature of kidnappings (who the perpetrators and victims are, where abductions occur) than we did a decade ago. According to a report issued by the Attorney General of Washington, the typical murder victim of a nonfamily abduction is just over 11 years of age. In most cases the initial contact between victim and killer is within a quarter mile of the victim's home.⁵ Some 76% of victims are female. The youngest female victims (1 to 5 years old) tend to be killed by friends or acquaintances, while older female victims (over 16) tend to be killed by strangers. In contrast, male victims across all age categories are more likely to be killed by strangers.

Most abductions are crimes of opportunity, with only 14% of child abduction murder victims chosen because of some physical characteristic of the victim. The motivation of most killers in child abduction cases is sexual assault. Typically, the murderer of an abducted child is an unmarried male, 27 years of age, who lives alone or with his parents. Almost two-thirds have a history of violent crime and that history often includes rape or other sexual as-sault involving children.

From tragedies come heroes Parents whose children were the victims of child abduction and murder have played an important role in advocating for more local and federal government involvement in abduction prevention and retrieval. John Walsh's efforts led to the passage of the Missing Children Act of 1982 and the Missing Children's Assistance Act of 1984. The 1984 bill established the NCMEC as a national clearinghouse and database for missing or abused children. Children can be reported missing, or a sighting of a missing child can be reported, by calling 1-800-THE-LOST or logging on to www.missingkids.org.

The KlaasKids Foundation (www.klaaskids.org) was developed by Mark Klaas to educate parents and law enforcement about abductions and assist in the retrieval of missing children. To date, the KlaasKids Foundation has helped search for more than 4,700 missing children, with a yearly recovery rate of over 85%. The foundation also disseminates child safety materials and petitions the government for relevant legislative support.

The Amber Alert system also was born of tragedy. In 1996, 9-year-old Amber Hagerman was kidnapped while riding her bicycle in Arlington, Texas, and was murdered. Outraged by the lack of coordinated law and media resources to help search for a missing child, broadcasters in the Dallas-Fort Worth area teamed with local police to develop an early warning system—the AMBER plan (now an acronym for America's Missing Broadcast Emergency Response)—to help locate abducted children. Other communities and states subsequently developed their own AMBER plan. In April 2003, the Prosecutorial Remedies and Other Tools to End the Exploitation of Children Today (PROTECT) Act was signed into law, establishing a national AMBER Alert program and coordinator. At the time this article was being prepared for publication, 49 states had developed an AMBER plan and more than 188 recoveries had been made utilizing AMBER alerts.

AMBER plans recognize that time is of the essence following an abduction: 74% of children who are found murdered are killed within three hours of abduction, but there is typically a two-hour delay before parents report a child missing to law enforcement. Although each local or state program establishes its own AMBER plan criteria, NCMEC suggests that three criteria be met before an alert is activated:

• Law enforcement confirms that a child has been abducted.
• Law enforcement believes the circumstances surrounding the abduction indicate that the child is in danger of serious bodily harm or death.
• There is enough descriptive information about the child, abductor, or suspect's vehicle to believe that an immediate broadcast alert will help.

If an AMBER alert is to be issued, law enforcement gathers descriptive information about the child and the suspect and rapidly distributes that information via the emergency alert system to area radio and television stations, which interrupt programming to broadcast the alert. Many states also use highway billboards to alert motorists. In addition, law enforcement officers can log onto www.beyondmissing.com to create a poster and alert message that can be distributed within 15 minutes to appropriate individuals within a 200 to 400 mile radius of the abduction via e-mail, fax, phone, and pager.

The pediatrician's role As with many situations that pose a hazard to children—poisoning, the possession of firearms, fires, drowning, and motor vehicle accidents—the pediatrician's role in preventing abduction and facilitating retrieval is primarily one of providing anticipatory education to parents. Our advice is usually taken to heart and has played an important role in accident prevention. It is appropriate for us to assume a similar role in preventing child abductions.

It is no longer believed that teaching children just to avoid "strangers" is an adequate prevention strategy. Parents need to make their children difficult targets by teaching them age-appropriate methods to thwart abductors. The following suggestions have been compiled from information from the NCMEC and the KlaasKids Foundation. The information should be shared with families at well visits by means of a directed discussion that can be reinforced with handouts that highlight relevant information. A Guide for Parents is provided. That guide (www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=151509) and two other handouts for parents are available in pdf format (www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=151512, www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=151510).

Preschoolers should always be under the direct supervision of an adult and be taught their full name, address, and telephone number and how to dial 911. They also need to learn what "private parts" are and be able to distinguish between an "OK touch" and a "not OK touch." If lost, they need to seek assistance from a uniformed police officer, store cashier, or woman with a child. They should always ask a parent before accepting gifts or going anywhere with anyone. Especially important are dialogues with children to make them understand that they need to inform a parent or trusted adult if anyone hurts them or asks them to keep a secret.

Older children (6 to 10 years) should never go anywhere unaccompanied and should always use the buddy system. Parents need to always know where their children are, where they are going, and the approximate times of arrival and departure. Children need to keep a safe distance (10 feet or more) from a car with someone in it, and they should never get into a car unless a parent gives permission.

In addition, children should be warned about common tricks that abductors use to "befriend" children. Adults do not need to ask children for directions or for help in finding a lost animal or child. Latchkey children should never tell phone callers that their parent isn't home and should not open the door if someone knocks. They also need to know who to call in an emergency. When threatened, children should scream "No" or say "Fire"—such actions immediately attract attention and are one of the most effective maneuvers to thwart an abductor.

If a child is followed by someone, he (or she) should run to a safe place, a store, or anywhere there are lots of people. Last, if a child is grabbed by someone whose intention is unknown, he should immediately attempt to twist away and then run as quickly as possible.

Teenagers should continue to use the buddy system when going anywhere and should let a parent know where they are. Providing cell phones to responsible teenagers can improve their ability to communicate their whereabouts to parents. They should also be made aware that drugs and alcohol impair judgment, rendering a person more susceptible to exploitation. When arriving home, teenagers should survey the house for suspicious signs before entering, always lock the door behind them, and call a parent to let them know they have arrived. As with younger children, callers should never be told that the parents aren't home. Instead, they should be told that the parent cannot come to the phone, and offer to take a message.

In addition to providing information that can prevent abductions, parents need to know what to do if an abduction occurs. Parents should be made to realize that time is critically important if a child is abducted and that law enforcement should be notified as soon as abduction is suspected.

Maintaining an up-to-date child ID kit, which contains personally identifiable information such as photos, can significantly expedite retrieval of a child. All parents should be encouraged to keep one in a secure and accessible location and give it to the police in the event a child is missing. Information for putting together a child ID kit can be printed from www.pollyklaas.org/safe/pdf/childidbooklet.pdf or www.klaaskids.org/Child_ID_Kit.pdf.

The KlaasKids Foundation and NCMEC encourage parents to keep a swab of their child's saliva or blood in their freezer. They further advise parents to be aware of any community programs to fingerprint children or educate children to prevent abductions. While fingerprints and DNA samples do not usually assist in retrieving a living child, they do help identify a child's body, allowing the family to know as soon as possible what has happened to their missing child.

To monitor the location of children, high-tech devices

High-tech prevention Although child kidnapping occurs infrequently, many parents want to use every means possible to prevent the unthinkable. Such parents may consider purchasing a child emergency device called the Wherify watch (www.wherifywireless.com). The device is a watch with a cut-resistant strap that can be removed only with an unlocking device transponder. If an attempt is made to remove the watch, the parent is notified immediately via phone, pager, or Internet. The device provides location information through a telephone or the Internet, functions as a numeric pager, and has an emergency 911 button. The Wherify costs $199, with a monthly fee of $20 to $45.

Another high-tech approach to safeguarding children is an electronic "leash." One example is the ionKids child monitor from Bluespan LLC (www.bluespan.com). The system comprises a handheld-base unit that "activates" a wrist tag worn by the child and tracks the child via wireless communication. When the child wanders beyond the preset distance, the base unit and wrist tag sound an alarm, and the base unit shows a radar-type display that is used to locate the child. The wrist tag will also activate a system alarm if any effort is made to remove it. The ionKids system can be used to monitor as many as four children simultaneously at distances as great as 500 feet indoors and 350 feet outdoors. A starter kit, with one wrist tag and base unit, costs $220; additional wrist tags are $50 each.

Cautionary noteworth sounding A brief discussion with parents alerting them to parenting strategies that can prevent child abduction is an overdue addition to the health-maintenance visit. Although the risk of any one child being abducted is small, the consequences are great, and every parent should be on guard to the danger.

DR. SCHUMAN is adjunct assistant professor of pediatrics at Dartmouth Medical School, Lebanon, N.H., and practices pediatrics at Hampshire Pediatrics, Manchester, N.H. He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.

REFERENCES Finkelhor D, Ormrod R: Kidnapping of Juveniles: Patterns from NIBRS. US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, June 2000

2. Gregoire CO: Executive summary: Case management for missing children homicide investigation. Office of the Attorney General, State of Washington, 1997

3. Sedlak AJ, Finkelhor D, Hammer H, et al: National incidence studies of missing, abducted, runaway, and thrown-away children: National estimates of missing children: An overview. US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, October 2002

4. Finkelhor D, Hammer H, Sedlak AJ: National incidence studies of missing, abducted, runaway, and thrownaway children: Nonfamily abducted children: National estimates and characteristics. US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, October 2002

5. Howard BJ, Broughton DD, and the Committee on Psychosocial Aspects of Child and Family Health: The pediatrician's role in the prevention of missing children. Pediatrics 2004;114:1100

Abductions and disappearances vary by type*

• Nonfamily abduction A nonfamily perpetrator takes a child, or detains a child for at least one hour in an isolated place, by the use of force or threat of bodily harm and without parental permission.
• Stereotypical kidnapping A stranger or slight acquaintance perpetrates a nonfamily abduction in which a child is detained overnight, transported at least 50 miles, held for ransom, abducted with intent to keep the child permanently, or killed.
• Family abduction In violation of a custody order, a member of the child's family or someone acting on behalf of a family member takes or fails to return a child, and the child is concealed or is transported out of state with the intent to deprive the caretaker of custodial rights.
• Runaway A child leaves home without permission and stays away overnight; or a child 14 years or younger who is away from home chooses not to return and stays away overnight; or a child 15 years or older stays away two nights.
• Thrownaway A child is asked or told to leave home (or prevented from returning home) by a parent or other household adult, no adequate alternative care is arranged, and the child is out of the household overnight.
• Missing—involuntary, lost, or injured A child's whereabouts are unknown to the child's caretaker, causing the child's caretaker to be alarmed for at least one hour and to try to locate the child. The child was trying to get home or make contact with the caretaker but was unable to because the child was lost, stranded, or injured; or the child was too young to know how to return home or make contact.
• Missing—benign explanation A child's whereabouts are unknown to the caretaker, causing the caretaker to be alarmed, to try to locate the child, or to call police. The child was not lost, injured, abducted, victimized, or classified as a runaway or thrownaway.

*NISMART-2 definitions

Advice for pediatriciansHere is how the AAP encourages you to address the issue of missing children and child abduction:

• Help parents and children put the risk of becoming missing in perspective
• Encourage families to teach children self-identifying information without connecting it to a threat of becoming missing
• Encourage families to keep a high-quality, current photograph of each child
• Encourage families to teach children to accept only touches that are comfortable to them, regardless of their relationship to the person doing the touching
• Encourage families to teach older children, especially girls, to "know the rules":

1. When going out, don't go out alone
2. Always tell an adult where you are going
3. Say "No" if you feel threatened

• Consider advocating for an appropriate personal-safety curriculum to be taught in schools, and check its approach
• Continually screen for risk factors for missing children (e.g., family discord, divorce, coercive parenting, substance abuse, school failure, deviant peer group) and intervene early with appropriate work-up and referrals
• Assess whether adolescents consider themselves to have several sources of support, including the pediatrician, so that they need not resort to running away
• Be skeptical of new patients presenting with vague stories about absent parents, or children who report mysterious parent deaths or separations without contact, because they may represent abductions
• Insist on prompt transfer of medical records as a routine practice
• Support programs that serve runaways
• Consider providing or coordinating comprehensive care to any families who have just had a missing child returned
• Expose programs that spuriously generate fear of abduction
• Look at, and encourage others to look at, pictures of missing children

Reproduced with permission from Pediatrics, Vol. 114(4), p 1104, 2004 AAP

Online resources about child endangerment To report information about child pornography, child molestation, child prostitution, and the online enticement of children, use the NCMEC's CyberTipline, www.cybertipline.com.

The following Web sites provide information about protecting children from abduction and exploitation.

National Center for Missing & Exploited Children (NCMEC) www.missingkids.org

NCMEC's Web site to teach children about dangers on the Internet www.netsmartz.org

KlaasKids Foundation www.klaaskids.org

The Federal Bureau of Investigation's Crimes Against Children Web page http://www.fbi.gov/hq/cid/cac/crimesmain.htm

The Federal Bureau of Investigation's Tips and Public Leads Web page https://tips.fbi.gov

McGruff the Crime Dog http://mcgruff-safe-kids.com

(Information about child safety, identification, abduction, fingerprinting, and crime prevention)

GUIDE FOR PARENTS

Preventing abduction As a parent, you can do many things to make your child a difficult target for kidnappers and sexual predators. Here are age-appropriate suggestions from the National Center for Missing & Exploited Children and the Polly Klaas Foundation. In addition, consider putting together a child identification kit that contains personally identifiable information, including photos, and update the information at least once a year.

A preschooler should

• always be under the direct supervision of an adult
• be taught his (her) full name, address, and phone number and how to dial 911
• if lost, seek assistance of a uniformed police officer, store cashier, or a woman with a child
• Always ask your permission before accepting a gift or going somewhere with someone

A school-age child should

• never go anywhere unaccompanied and always use the buddy system
• let you know where he is and where he is going, and his approximate times of arrival and departure
• keep a safe distance (10 feet or more) from a car with someone in it, and never get into a car unless you have given permission to do so
• be informed that adults do not need to ask a child for directions or for help finding a lost animal or child
• never tell a phone caller that you aren't home or open the door if someone knocks if he is home alone. A latchkey child also needs to know who to call in an emergency
• scream "No" or say "Fire" when threatened. Such action immediately attracts attention and is an effective maneuver for thwarting an abductor
• if followed, run to a safe place, a store, or anywhere there are lots of people

A teenager should

• continue to use the buddy system when going anywhere and let you know where she is. (Consider providing a cell phone to a responsible teenager, to make it easier for her to communicate her whereabouts to you.)
• be made aware that drugs and alcohol impair judgment, rendering a person more susceptible to exploitation
• check out the house before entering when arriving home; lock the door behind her; and call you to let you know she has arrived
• never tell a phone caller that you are not home

This guide may be photocopied and distributed without permission to give to your patients and their parents. Reproduction for any other purpose requires express permission of the publisher, Advanstar Medical Economics Healthcare Communications. 2005