The findings presented here are from a qualitative research study, adopting creative research methods with seven children to provide an in-depth understanding of their lived experience of living with Parental substance misuse (PSM). The children’s data were analysed using interpretive phenomenological analysis. The research also included focus groups with twenty-two professionals which added further understanding to the children’s experiences. Bronfenbrenner’s ecological theory was adopted as a framework to structure the research data from the micro to the macrosystem. Key messages identified the need for children living with PSM to be seen and heard and offered specialist support in their own right. The children experienced multiple risk factors, which were often enduring, and did not reduce as they grew older. This research provided an understanding of the complex needs of children and the risk factors which reach beyond their immediate home environment. This article argues for change, including improved training for front line practitioners, specialist service provision for children not reliant on their parents’ engagement, and for policy change and financial resources for their implementation. It is proposed that this would bridge the gap between research and practice and lead to improved outcomes for children living with PSM.