The conflict in the Eastern Democratic Republic of Congo (DRC) has been particularly devastating for children and has been typified by high levels of sexual and gender-based violence (SGBV). In this study, we seek to characterize the patterns and impact of sexual violence on children in the Eastern DRC. Semi-structured questionnaires were administered among a convenience sample of women <18 years of age presenting for post-sexual-violence care at Panzi Hospital in South Kivu, DRC. Analysis included quantitative and qualitative methods to describe the characteristics of the violence, perpetrators, and survivors and to illuminate common themes within the narratives. A total of 389 survivors of SGBV under the age of 18 were interviewed between 2004 and 2008. These paediatric survivors were more likely than adult survivors to have experienced gang rape, been attacked by a civilian perpetrator, and been assaulted during the day. Survivor and perpetrator characteristics were further stratified by type of attack. Reports of violence perpetrated by civilians increased 39-fold while reports of violence perpetrated by armed combatants decreased by 70% between 2004 and 2008. Qualitative analysis of the narratives revealed common themes, such as physical signs and symptoms among SGBV survivors (23.9%), pregnancy resulting from rape (19.3%), perpetrators being brought to justice (18.3%), and neighbourhood men as perpetrators (17.7%). Children in the Eastern DRC continue to face significant threats of sexual violence. By understanding the patterns of this violence, local and international approaches could be more effectively implemented to protect these vulnerable children.