This review article explores sports and recreational precautions in children with solitary kidneys. In 2001, the American Academy of Pediatrics published recommendations for activity in children with medical conditions. Those with solitary kidneys were graded a "qualified yes": no restriction in non-contact sports, and individual assessment for limited-contact, contact, and collision sports. Recent trauma data suggests that classification according to degree of contact is inaccurate. We propose an updated, data-driven classification of sports/recreation according to risk of high-grade renal trauma or loss of renal unit. Given the paucity of literature on the topic and lack of consensus, children with congenital renal anomalies should exercise caution in both sports and recreation.