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Background The negative impact of institutionalization on children's development and well-being has led to a global recommendation for deinstitutionalization. In countries with weak infrastructure and family support, some children in institutional care have been found to have better outcomes, which may be due in part to the family-like environments created by some Charitable Children's Institutions (CCIs). Objective The goal was to examine whether and how alternative kinship structures were reproduced in CCIs. Method Qualitative data from 22 caregivers and 30 orphaned or separated children and adolescents (OSCAs) were collected using participant observation and in-depth interviews, and analysed using a symbolic interactionist theoretical framework. Results Social interaction with caregivers contributed meaning towards the definition of family within some CCIs, particularly those modeled after a village and/or a single family. These CCIs created a family-like care environment, resulting in OSCAs redefining the traditional concept of family based on consanguinity to one composed of non-kin providing care and support. Social interaction through family-related activities produced novel familial identities, and some OSCAs felt they were part of a quasi-family. However, OSCAs lacked autonomy, feared consequences of not following the rules of behaviour, and felt retraumatized and re-abandoned when they exited the CCIs at age 18. Conclusion Some CCIs created an "alternative" kinship structure in which most children focused on their education, were provided with basic needs, and formed long-term positive relationships. Despite a number of challenges, family-like CCIs may be a supportive last resort for children without kin to care for them.