OBJECTIVE. We investigated whether children institutionalized in an orphanage would engage in more developmentally competent play with their caregivers as opposed to playing alone and whether specific qualities of caregiver–child interactions were associated with more developmentally competent play.

METHOD. Twenty-six children, ages 10 to 38 months, participated in independent play sessions and in a play session with a caregiver. Interrater reliability for coding play performance was established using the weighted kappa statistic (M = .82). Twelve pediatric experts rated both child and caregiver behaviors for the interactive sessions (mean effective reliability with intraclass correlations = .89).

RESULTS. The children demonstrated more developmentally competent play when interacting with a caregiver than when playing alone, t (25) = −1.88, p ≤ .04, one-tailed. The effect size was moderate (d = .53). Longer periods of institutionalization were associated with less improvement in play performance from independent to interactive play sessions (r = −.51, p ≤ .01). Successful engagement for the child was associated with having a caregiver who provided more structure and assistance and who was directive and encouraging (r = .82, .75, .75, and .64, respectively).

CONCLUSION. Caregivers facilitated more developmentally competent participation in play with children residing in an orphanage, despite the fact that these interactions occurred in an environment vulnerable to many challenges not typical of an exclusive caregiver–child relationship. Findings are discussed in the context of environmental challenges and occupational therapy practice.