This chapter from Residential Child and Youth Care in a Developing World: Global Perspectives focuses on the institutional care of children and young people deemed ‘at risk’ according to current Malaysian law on child welfare: Malaysian Child Act (2001). Institutionalisation of children and young people in Malaysia dates from the social welfare development of the country during the British colonisation of the Malay States. With the development of universal social policies such as the United Nation Convention on the Rights of a Child (UNCRC), Malaysia observes and supports this policy and implements them according to local needs. Institutionalisation of children and young people remains the ‘last preferred option’ but in reality, this option frequently offers the best solution for high-risk children. Challenges and issues of institutionalisation continue to challenge Malaysian social services. What the future holds for children and young people going through residential care in Malaysia remains uncertain. Ensuring the welfare and futures of these children after leaving residential care remains a priority.