This study examined the performances and differences between Taiwanese and Malaysian preschool educators in their cognition and practice of prevention and treatment of child sexual abuse, especially for preschoolers. We initially interviewed two Taiwanese preschool educators. Based on the interview results and related literature, a preliminary 24-item questionnaire was drafted, and then two Taiwanese and four Malaysian academics and practitioners were invited to participate in expert validity. A preliminary test was conducted on 51 Taiwanese and 53 Malaysian preschool educators. Through an item analysis, bivariate correlation analysis, reliability analysis, and factor analysis, some items in the questionnaire were deleted. A formal 24-item questionnaire was developed using Cronbach’s alpha tests for further reliability verification. Subsequently, a formal survey was conducted on 471 Taiwanese and 353 Malaysian preschool educators. The research results reveal that preschool educators in both countries showed differences between their cognition and practice in the prevention and treatment regarding child sexual abuse. In addition, Taiwanese preschool educators demonstrated a better performance than their Malaysian counterparts in both cognition and practice. According to the results of the study, four preschool educators were interviewed afterward to add to the reasons of such results. Suggestions for the promotion of preventing children’s sexual abuse were offered in terms of subjects, the combination of teaching and researching for university teachers, and future research.