Worldwide, up to 8 million children reside in institutional care. While some characteristics are common to most institutional settings (e.g., group rearing, non-related caregivers), the social environments of institutions are highly variable. Institutions in Russia, China, Ghana, and Chile are described with reference to the circumstances that lead to children’s institutionalization, resident children’s social-emotional relationships, and unique characteristics of each country’s institutional care (e.g., volunteer tourism in Ghana, and shifting demographics of institutionalized children in China). Children who have experienced extended and severely depriving institutional care are at higher risk of later social, emotional, and behavioral difficulties. Several intervention approaches have improved social-emotional care within institutional settings, with positive effects on resident children’s development and caregivers’ skill and wellbeing. Developing and implementing interventions that are both effective and locally sustainable is particularly crucial as institutions in many countries begin to shift from caring for mostly healthy children bound for adoption to higher proportions of children with disabilities who are likely to remain in residence for the longer-term.