Introduction: According to the 2012 Lao Social Indicator Survey, 6 % of children inLaos live with neither one of their parents. This study explores the determinants of child-parent separation and the consequences of existing alternative care arrangements from the perspectives of adults and young people. Method: Interviews with community leaders, government authorities, and senior staff from residential institutions (n = 26) and group discussions with adult caregivers (n = 192) and children (n =294) living in family-based and residential care settings were conducted in rural and urban communities in Luangprabang and Xayaboury provinces in 2013. Findings: Parents were the main caregivers of children, and child abandonment was considered rare. Parental death or divorce, material poverty, access to school, infertility, and religious and ethnocultural beliefs resulted in child-parent separation and transitions across types of care. Informal kinship care was a common care response. Conclusion and Implications: A strong evidence base is needed to inform the development of a national alternative care strategy, policy, plan of action, and standards of care and to monitor their subsequent implementation. Caregivers and young people provide valuable perspectives to monitor quality of care.