Participation in backcountry wilderness recreation has increased in recent years with children and adolescents making up an increasing number of participants visiting wilderness destinations. Engaging in wilderness activity involves the risk of injury, illness and even death. Unfortunately, there is very little research investigating the health challenges facing children and adolescents in the wilderness. With the intent of increasing awareness among the sports medicine community, this review examines reported paediatric and adolescent wilderness injuries reported in the state of Washington and in US National Parks, injuries reported during outdoor wilderness programmes and global youth expeditions, and health challenges in wilderness settings where the threat of acute mountain sickness is elevated. Future studies addressing the challenges of establishing numerator data linked to suitable denominator data and monitoring injured and non-injured children and adolescents in the wilderness are recommended.