ecent cases of child sexual abuse in Pakistan have brought the issue of child protection to the forefront. Pakistan has made progress by recognising child sexual abuse as a serious crime, enacting legislative reforms, improving reporting and raising public awareness.

These are important steps but they also prompt a deeper question: what does it really mean to protect children?

Child sexual abuse remains a significant problem. In 2025, 3,630 abuse cases were reported, including 2,003 sexual abuse cases—more than nine children abused daily. While 82 percent of the cases are registered with the police, a gap in psychological support for recovery persists.

Beyond being a heinous crime, child sexual abuse is a damage to a child’s sense of safety, trust and relationships. Childhood is built on the belief that adults protect children. During these years, children learn about themselves, who they can trust and whether the world is safe. Child sexual abuse shatters those beliefs. Even after the abuse ends, its emotional effects can persist as children grow.

A common misconception is that trauma is easily recognised. Children rarely show trauma as adults expect: some become quiet; others, angry, fearful or overly obedient.

School is often the first area affected. Instead of saying “I have PTSD,” children may show bad grades, withdrawal, being labelled as disobedient or skipping school. These behaviours, often mistaken for misbehaviour or ‘phases,’ are ways children communicate distress when they can’t express it in words. Their responses depend on their experience, age, relationship to the perpetrator and the support they receive afterward.

Disclosure of abuse is often gradual. Many think children report abuse immediately. However, fear, guilt, self-blame or lack of language often delay disclosure. Sometimes, children don’t realise it was abuse until later. Delayed disclosure reflects trauma’s complexity and a child’s sense of safety, not dishonesty.

In reality, children take their time to talk about abuse. They may fear they won’t be believed, worry about causing problems, blame themselves or not know how to explain what happened. Some do not realise it was abuse until they are older, so they speak up later. This delay does not mean they are lying; it shows how complex trauma is. When children do tell, it often reflects how safe they feel, not just the abuse itself.

Children recover through their relationships. They look to adults to know whether they are safe, whether they are believed and whether life can feel normal again. They are not only trying to understand what happened but also what it means. Some may blame themselves. Others may wonder if adults can be trusted or if the world is safe.

This experience is also very painful for families. Parents often wonder if they missed signs; did something wrong; or could have done more to protect their child. Feelings like guilt, anger, sadness and helplessness are common and can show up in different ways. These feelings are even harder when the person responsible is someone the child or family knows and trusts.

According to Sahil’s Cruel Numbers 2025 report, acquaintances are still the most common offenders of child sexual abuse in Pakistan. Abuse breaks not only a child’s sense of safety but also a family’s trust in the people and communities around them. Sometimes, the person they fear or trust is also the one who takes them to school, attends family events or is part of their daily life.

Psychological care should start alongside medical, legal and protection efforts, not come later. Child protection work stops once a child is removed from danger, with medical exams, police investigations and court cases. These steps are important for safety, evidence gathering and holding people accountable. But they only address immediate risks ; they do not deal with the emotional and developmental effects of child sexual abuse.

People often think psychological care just means helping children talk about trauma—it is more than that. It involves meeting the child where they are; using conversation, play, drawing and building safe relationships. The goal is to help children see that trauma does not define them; support them in understanding and managing their emotions; rebuild their confidence and relationships; and encourage healthy development. It is not about erasing memories but about making sure trauma does not control their future.

Psychological care is not just for the child. Parents and caregivers also need help to understand how trauma affects a child’s behaviour, emotions and relationships. Teaching caregivers to see these behaviours as signs of trauma—not just ‘misbehavior’—is key to recovery. Caregivers’ consistent, patient and calm responses are vital. Supporting the family is often the best way to help the child.

Understanding the need for psychological care is one thing but making sure children get it is another. Pakistan still has too few child and adolescent mental health professionals. Many children do not get specialist help after abuse. While expanding specialist services is important for the future, trauma-informed care should not be limited to psychologists and psychiatrists. Every emergency department, child protection unit, police station, medico-legal service and school should have a clear mental health referral process from the start. Paediatricians, teachers, social workers, healthcare workers, police and child protection staff should all receive basic training to recognise childhood trauma, respond with care and know when to refer to specialists. This does not replace specialist care but is a key part of building a child protection system that supports both recovery and justice.

We often count arrests and convictions because they are easy to measure. But we rarely ask if children went back to school, slept without nightmares, rebuilt friendships or got the help they needed. These are also important child protection outcomes. Our systems focus on collecting evidence for court but they should also recognise trauma, support recovery and make sure every child gets the right psychological care.

It may be time to rethink what child protection really means. Protecting children is not just about stopping abuse or seeking justice afterward. It also means protecting their development. The effects of child sexual abuse go beyond the abuse, impacting children’s emotional, social and psychological growth for a long time. A good child protection system does more than respond to abuse; it supports children and families as they recover and rebuild.

One of the greatest failures of Pakistan’s child protection system has been in expecting children to recover on their own. Mental healthcare is as basic to childhood as forensic exams and the justice system. Justice punishes offenders but recovery protects childhood. Strong reporting, investigations and accountability are vital—protection should not end when abuse stops. If sexual abuse disrupts development, protection must also support growth. Psychological care is not an afterthought; it is essential to protection. Justice helps children survive but trauma-informed care helps them heal. A truly child-centered system needs both.

Dr Aisha Sanober Chachar is a consultant adult, child and adolescent psychiatrist at Synapse Pakistan Neuroscience Institute.

Sarah Rizwan is a project manager at Synapse Pakistan Neuroscience Institute.