This paper briefly summarizes the literature on elements of research, practice, and policy pertaining to the development and care of children raised in institutions. It covers the development of such children while they reside in institutions and after their transition to adoptive or foster families. Of special interest are attachment and indiscriminate friendliness, physical growth, neurobiological deficits, and sensitive periods. Early exposure of a year or two to a substandard institution is related to higher-than-expected rates of a variety of long-term neurological, physical, cognitive, and behavioral deficiencies and problems even in children subsequently reared in advantaged families. Countries that seek to transition from a reliance on institutions to family-care alternatives face a variety of unique challenges relating to prevailing historical, cultural, political, and financial circumstances of each country. While progress has been made, developing a child welfare system of family alternatives may take time in some countries.