Introduction: Given associated risks, sexting among children and adolescents has yielded significant interest in recent years. Several previous reviews have examined data on the prevalence, determinants, and correlates of sexting behaviour, however, in an ever-changing digital media context, a comprehensive overview of findings regarding its outcomes is warranted. This novel review aimed to systematically identify and conduct a narrative synthesis of empirical evidence regarding the outcomes of sexting involvement for children and adolescents. Methods: Four databases were searched for peer-reviewed literature on sexting, and 54 articles were identified for inclusion in the review. The quality of included studies was appraised using Dixon-Woods et al. ( 2006) five question prompts. Results: Four 'outcomes' categories were derived, namely, psychological (victimisation; sexual abuse/victimisation; mental health and quality of life; and emotional outcomes), behavioural (sexual activity, risk behaviours, and perpetration of abuse and harassment), relational (personal connections with others & reputational outcomes), and systems-level (distribution/public exposure of sexting content). Conclusions: Findings indicate that the outcomes of sexting for children and adolescents (aged ≤19 years) are wide-ranging, some positive and desirable, others negative and unwanted. Furthermore, identified outcomes were located along a continuum spanning benefits for adolescents' well-being and relationships, stigma and associated difficulties, and serious harm or trauma. Limitations (e.g., methodological constraints of studies) and implications (e.g., informing harm prevention/intervention initiatives; further large-scale and replication studies) are discussed within.