This paper reports the results of an international review of academic literature on sexual abuse in residential child and youth care, 1945-2011. The review focusses on questions related to the nature and scope of sexual abuse, on personal and institutional factors providing either protection or risk, and on how residential institutions have responded to signals of sexual abuse. Empirical research did not appear until the 1990s, and is still scarce. Variety of research designs and of definitions of sexual abuse obscure the prevalence of sexual abuse in residential care. Sexual abuse by peers is often overlooked, while this accounts for almost half of the known cases. Histories of sexual abuse prior to placement, group dynamics, institutional culture and insufficient knowledge of professionals on how to address issues of sexuality, appear to be crucial factors in peer abuse. Gender also plays a significant role: most, though not all, victims are females, most, though not all, perpetrators are males. Instead of understanding sexual abuse as a phenomenon related to individual characteristics, it is important to address both institutional factors (culture) and group dynamics in order to provide children in residential homes with the care they need.