Some sexual abuse cases are collapsing because children are being denied the support they need to give evidence in court, the NSPCC has warned.
It said fewer than 25% of 23,000 child sex offences recorded in England and Wales last year ended in prosecution.
The charity said all children who testify should have access to a registered intermediary who can help them with hostile questions.
New guidelines on child sex abuse cases are due out later this month.
Ministers say measures to help vulnerable witnesses are already available, but they acknowledge that more needs to be done.
Research by the NSPCC found that that more than 50% of child witnesses experienced symptoms of stress such as difficulty sleeping and eating, depression, panic attacks and self-harm in the lead-up to a trial.
At least half were unable to understand some of the questions they were asked in court, yet just 2% of all children giving evidence in criminal court cases receive guidance from registered advisors to help them understand criminal proceedings and legal language.
Last year, the charity's ChildLine service conducted more than 1,000 counselling sessions with children worried about attending court.
Peter Wanless, chief executive of the NSPCC said: ""These children have to publicly relive the most traumatic, upsetting and humiliating experience of their lives in order to try and get justice.
"A victim of child sex abuse is usually the sole witness to the crime and the strength of the case lies in their testimony. It is vital that children are supported by a registered intermediary when they are interviewed by the police and if they give evidence in a trial. Justice can only be served if they are able to give their best evidence."
'Credible witnesses'Lisa McCrindle, senior policy analyst for the NSPCC, said that intermediaries needed to be brought in to show courts how much children are "struggling".
End Quote Lisa McCrindle NSPCCThere is often little or no communication between the courts and the child"
"Barristers interview witnesses in quite an aggressive manner," she said. "The courts are concentrating on the point of law, which is correct, but it means there is often little or no communication between the courts and the child."
But she said that she was "hopeful" that new Crown Prosecution Service guidelines on prosecuting child sexual abuse cases, which are due out later this month, would work on prioritising children as "credible witnesses" and bringing about successful prosecutions.
The Advocates Gateway, which provides free access to guidance on vulnerable witnesses and defendants, says there are many examples of questions put to children in the courts.
These include a lengthy sentence asked by a barrister to a seven-year-old: "But if as you say it was dark outside, and if as you say there was no light on in the room, it would not have been possible for you to see what was happening on the bottom bunk, would it?"
There are also examples of over-complex sentences: "Where were you born and where do you reside?", the use of idioms and metaphors: "That's put it, as it were, into the long grass" and leading questions: "Now, this happened on a Friday, was it not?"
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