A critical review of the literature about insulin pump therapy for youths with Type 1 diabetes in ‘real-world’ settings was performed. MEDLINE and EMBASE databases were searched for English language papers published between 2006 and August 2011 using terms for Type 1 diabetes, diabetic ketoacidosis, insulin pumps and children. We identified 263 papers and 22 met our inclusion criteria. There is an increasing proportion of youths with Type 1 diabetes using pumps and discontinuation rates are low. Glycemic control tends to improve in the first year of pump therapy but then increases back toward baseline. Evidence of the rate of diabetic ketoacidosis and hypoglycemia in pump therapy compared with insulin injections is mixed. If it occurs, diabetic ketoacidosis is most likely to occur within the first year of pump therapy.