In January 2022 the World Health Organization removed transgender identities from categorisation as a mental illness, marking a significant global shift from the pathologisation of gender diversity. However, a legacy of pathologisation of trans identities continues to impact trans lives, particularly on trans children. Informed by qualitative data from 30 families with trans children, this article examines the continued impacts of pathologisation on trans children and families in the UK, exploring how pathologisation manifests at individual, institutional and societal levels.The article advocates for trans depathologisation as a critical priority for child rights and social justice.