Family environment plays a very important role in early child development and the availability of stimulating material in the early years of a child's life is crucial for optimising development. The Home Observation for Measurement of the Environment (HOME) inventory is one of the most widely used measures to assess the quality and quantity of support and stimulation provided for children at home. This cross-sectional study aims to measure the existing situation of home environment with respect to child development using the HOME scale in two communities of Pakistan: TandoJam (Sindh) and Mastung (Baluchistan). From December 2009 until May 2010, all mothers with children from birth to age three were recruited for the study. Data on the home environment were collected from a cohort of 1,097 children using the Infant and Toddler HOME (IT-HOME) scale, further distributed over six subscales. Frequency distributions of all responses and mean and standard deviation for all subscales were calculated. The mean ± standard deviation age of study children was 16.6 ± 12.1 months. Overall, the mean score on the HOME scale was 31.7 ± 7.2 and 29.7 ± 6.9 in TandoJam and Mastung respectively. On a subscale level, about one-half of the families in TandoJam and three-quarters in Mastung scored in the lowest quarter category on the Learning Material subscale, whereas 41% of families in Mastung and 18% of families in TandoJam were in the lowest quarter on the Organization subscale. On the remaining three scales (Responsivity, Involvement and Variety) at least 50% of families scored in the upper quarter category. In conclusion, considerable evidence is available showing that poor home environment retards intellectual growth. The HOME inventory identified up to 23% of young children in the lowest quarter category who are potentially at risk of developmental delays. There is a need to develop culturally acceptable, evidence-based parenting interventions to improve the home environment.