To comprehensively review the available published literature for cross-linking in the pediatric population. Review of the literature published in English in PubMed. Two hundred ten publications were considered. One hundred fifteen were considered relevant to this review. Studies of cross-linking in pediatric patients are sparse, with relatively short follow-up times, and mostly on small groups of patients. Treatment with cross-linking halts progression of keratoconus in the pediatric population, and early treatment seems to be cost-effective compared with later penetrating keratoplasty. Long-term effects and regression rates remain unclear, and further studies are needed in this population.