Early adversity, including institutional orphanage care, is associated with the development of internalizing disorders. Previous research suggests that institutionalization can disrupt emotion regulation processes, which contribute to internalizing symptoms. However, no prior work has investigated how early orphanage care shapes emotion regulation strategy usage (e.g., cognitive reappraisal, expressive suppression) and whether the said strategy usage contributes to internalizing symptoms. This study probed emotion regulation strategy usage and internalizing symptoms in a sample of 36 previously institutionalized and 58 comparison youth. As hypothesized, previously institutionalized youth exhibited higher rates of internalizing symptoms than comparison youth, and more frequent use of suppression partially accounted for the relationship between early institutional care and elevated internalizing symptoms. Contrary to our initial hypotheses, reappraisal use did not buffer previously institutionalized or comparison youth against internalizing symptoms. Our findings highlight the potential utility of targeting emotion regulation strategy usage in adversity-exposed youth in future intervention work.