Child institutionalization remains prolific in Myanmar, with most institutionalized children residing in unregistered residential care facilities operating unlawfully and outside of the regulatory framework of the government. Concerns have been raised that clientelism may be facilitating the recruitment of children into unregistered facilities, putting children at risk. Clientelism refers to dyadic, enduring, asymmetrical relationships between patrons and clients that exist to facilitate mutually beneficial reciprocal exchange. Clientelism theory has not previously been applied to residential care in Myanmar to examine the presence of clientelism in this context or its effects. In this article, the Conceptual Model for Identifying Clientelism in New Sites is used to extend clientelism theory and examine relationships between stakeholders involved in forty-five residential care facilities in Myanmar. Through deductive thematic analysis of data collected through qualitative interviews with senior social workers, the study confirms the existence of clientelism in these facilities. Clientelism emerges as a distinct driver of child institutionalization in Myanmar and as a mechanism that facilitates the recruitment and admission of children into unregulated residential care facilities, undermining their rights and safety. This article illuminates previously underexplored processes linked to the operations of unregulated residential care facilities, with clientelist relationships identified as fundamental to the business model of privately run, profit-driven institutions. It highlights how clientelism obstructs reintegration efforts and hinders broader child protection system reforms in Myanmar. The article recommends for clientelism to be addressed as an integral part of child protection and care reform strategies aimed at preventing unnecessary separation and ending child institutionalization. In addition, it calls for specialized training for social workers to equip them with the skills to detect and manage clientelism in reintegration case management, thus mitigating its harmful effects on children’s reintegration.