Victims of child sexual abuse in the UK were described as having "consensual" relationships, "making choices" when in dangerous situations and being "promiscuous" despite clearly being exploited, Ofsted has said.
The inspectorate uncovered a series of concerns in the way police, health professionals and social care experts work together to protect vulnerable children.
Despite evidence of improvements and good progress since 2014 in tackling child sexual abuse, the education watchdog said it had concerns that not all frontline healthcare staff are able to identify the signs of sexual exploitation.
Insensitive and inappropriate language posed great risk in damaging trust between children and adults, Ofsted said, and reinforced a sense of blame among victims.
"The term 'promiscuous' was used in relation to a clear case of sexual exploitation," the report said.
"The rape of a 15-year-old was described as 'consensual', and the age gap between a victim and perpetrator was described as 'small' when the perpetrator was 23 and the child 15. Young people were described as 'making choices' when they were found in situations of harm or risk."
Health professionals also missed obvious risks, Ofsted found.
It said: "In one case, a child as young as 13 was described as having 'multiple sexual partners' a language that is inappropriate and reflects the professional's inability to recognise that the young person was being sexually exploited."
The report concluded there was variation in police practice, meaning some children have to wait too long to get the help and support they need, and police risk assessments are inconsistent, with limited effectiveness for some children.
Better understanding of why children go missing is required, while there were examples of "significant failures" in management.
While most professionals were found to be "highly committed" to engaging with children, in some cases there were poor quality assessments.
Ofsted, Care Quality Commission and police and probation watchdogs looked at how local authorities, police, probation services, youth offending teams, health services and local safeguarding children boards dealt with child sexual exploitation and missing children in central Bedfordshire, Croydon, Liverpool, Oxfordshire and south Tyneside.
Eleanor Schooling, Ofsted national director for social care, said that when key frontline staff are well-trained, take their responsibilities seriously, work closely together and build relationships with children, sexual exploitation can be dealt with "sensitively and successfully".
She said: "We have found that strong leadership makes a huge difference. Those areas where there was clear direction and a collective will to tackle this issue did well by their vulnerable children.
"Practice needs to improve. Local authorities, police and health services need to gain a better understanding of why children run away from home. We need to understand why the current system of return home interviews is not working if we really want to help children who go missing."
Wendy Williams, HM Inspector of Constabulary, said police need to improve consistency over how children are supported.
But the NSPCC said the report had exposed a "patchy" care system where agencies are not adequately working together or sharing information.
A spokeswoman said: "It is encouraging to see some improvements highlighted, showing that it is possible for agencies like the police, schools, and local authorities, to collaborate and keep children safe.
"But this good practice must filter across to every part of the country so that we can be confident that every child is protected."