More than half of Cambodia’s residential care institutions (RCIs) for children are operating in contravention of law and policy, consequently putting children at risk. Despite advancements in regulatory measures and a decrease in the number of institutions, there are concerns that clientelism may exist in RCIs enabling some RCI operators to exploit children and bypass regulations. Clientelism refers to enduring, asymmetrical relationships between patrons and clients that exist to facilitate reciprocal and mutually beneficial exchange. This article presents qualitative research that used the Conceptual Model for Identifying Clientelism in New Sites to understand relationships in RCIs. An analysis of the literature and data collected from interviews with key stakeholders were conducted. Findings showed that clientelism does exists in Cambodian RCIs, and how clientelism operates as a distinct driver of child institutionalisation, specifically facilitating the recruitment of children, their unlawful removal, irregular admission, prolonged institutionalisation, and how regulatory oversight is evaded. This article demonstrates the importance of addressing clientelism in the context of child protection and care reforms in Cambodia and strengthening child rights governance.