To the Editor: I totally agree with Al-Mahroos and Al-Amer1 in their claim that it was not clear if the rise in the number of childsexual abuse (CSA) cases reported in Bahrain was due to a genuine increase in the incidence of CSA cases or due to increased public and professional awareness and improved recognition and referral. However, it should be noted that various factors might contribute to the inaccurate reporting of CSA. They include the following: age of the abused child at the time of the event, the relationship between the perpetrator and the abused child, the gender of the abused child, the severity of the abuse, the developmental and cognitive status of the abused child, and the likely consequence of disclosure.2 Nevertheless, the 2.5% increase in reported cases of CSA in Bahrain in 10 years (2000–2009)1 is alarming. It really contradicts an older report that demonstrated that CSA cases in developing countries like the United States have declined approximately 39% from 1992 to 1999, according to estimates from the National Child Abuse and Neglect Data System (NCANDS). A diverse array of possible causes for that decline was postulated including: increased evidentiary requirements to substantiate cases, increased caseworker caution due to new legal rights for caregivers, and increasing limitations on the types of cases that agencies accept for investigation.3 Reinforcing the need for governments to take a systems approach to child protection, including policy/legislation, information-based programs and social services, as well as professional training and public awareness raising represent top-ranked priorities to contain the issue of CSA.4