Introduction: This study examines participation patterns and environmental supports and barriers for children with and without disabilities within their home setting. Method: The Participation and Environment Measure for Children and Youth (PEM-CY) is a newly developed, reliable parent/caregiver-report tool, which combines assessment of children's participation and the environment. The PEM-CY was completed online by 576 parents of children or youth (5 to 17 years old) with and without disabilities from Canada and the United States. ANOVA analyses were performed to examine group differences in PEM-CY summary scores. Item-level differences are presented descriptively using radar plots. Results: After controlling for age and income, significant differences between children with and without disabilities were observed for all home-based PEM-CY participation and environment summary scores. Differences between the two groups were also evident at the item level, particularly when comparing the percentage of children and youth who never participate in specific home-based activities and when comparing perceived barriers to participation. Conclusion: Although all children and youth participate frequently in home-based activities, those with disabilities tend to participate in less complex and quieter/sedentary activities. This, in addition to parental report of environmental barriers to participation, highlights the potential importance of home-based occupational therapy intervention to optimise participation in this setting.