Abstract
Generative artificial intelligence (GAI) has created new avenues for the commercial sexual exploitation of children through the creation or manipulation of sexually explicit images using a child's likeness. Such images constitute a form of child sexual abuse material (CSAM), including when they are generated or manipulated without physical contact with the child. Because this abuse may occur without the child's awareness, it can complicate recognition, disclosure, and intervention while contributing to ongoing psychological harm. When such content is produced, distributed, or monetized in exchange for anything of value, it may also constitute commercial sexual exploitation of children (CSEC), a term commonly used to describe child sex trafficking. Healthcare providers play an important role in identifying possible GAI child sexual abuse material (GAI-CSAM), supporting affected children and caregivers, and incorporating digital safety into routine care. This article highlights clinical considerations for pediatric, primary care, and mental health settings, including developmentally appropriate assessment of online experiences, caregiver education, trauma-informed response, and multidisciplinary collaboration. As generative technologies evolve, clinician awareness is essential to strengthen prevention, early intervention, and responses to technology-facilitated exploitation.