A 13-year-old girl described to the BBC how 10 UN peacekeepers gang-raped her in a field near her Ivory Coast home, and left her bleeding, trembling and vomiting on the ground.
No action has been taken against the soldiers.
The report also found that aid workers have been sexually abusing boys and girls.
After research involving hundreds of children from Ivory Coast, southern Sudan and Haiti, the charity said better reporting mechanisms needed to be introduced to deal with what it called "endemic failures" in responding to reported cases of abuse.
It also said efforts should be made to strengthen worldwide child protection systems.
"It's a minority of people but they are using their power to sexually exploit children and children that don't have the voice to report about this.
"They are suffering sexual exploitation and abuse in silence."
Save the Children says the international community has promised a policy of zero-tolerance to child sexual abuse, but that this is not being followed up by action on the ground.
A UN spokesman, Nick Birnback, said that it was impossible to ensure "zero incidents" within an organisation that has up to 200,000 personnel serving around the world.
He said: "What we can do is get across a message of zero tolerance, which for us means zero complacency when credible allegations are raised and zero impunity when we find that there has been malfeasance that's occurred."
Save the Children said the most shocking aspect of child sex abuse is that most of it goes unreported and unpunished, with children too scared to speak out.
No action has been taken against the soldiers.
The report also found that aid workers have been sexually abusing boys and girls.
After research involving hundreds of children from Ivory Coast, southern Sudan and Haiti, the charity said better reporting mechanisms needed to be introduced to deal with what it called "endemic failures" in responding to reported cases of abuse.
It also said efforts should be made to strengthen worldwide child protection systems.
"It's a minority of people but they are using their power to sexually exploit children and children that don't have the voice to report about this.
"They are suffering sexual exploitation and abuse in silence."
Save the Children says the international community has promised a policy of zero-tolerance to child sexual abuse, but that this is not being followed up by action on the ground.
A UN spokesman, Nick Birnback, said that it was impossible to ensure "zero incidents" within an organisation that has up to 200,000 personnel serving around the world.
He said: "What we can do is get across a message of zero tolerance, which for us means zero complacency when credible allegations are raised and zero impunity when we find that there has been malfeasance that's occurred."
Save the Children said the most shocking aspect of child sex abuse is that most of it goes unreported and unpunished, with children too scared to speak out.
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