The advent of youth year-round baseball has come with an increased incidence of pitching related injury and surgery, most notably involving the shoulder and elbow (ulnar collateral ligament). These injuries become evident in high school and college, but begin at the youth level. Several studies have identified baseball pitching risk factors during youth that increase likelihood for injury and surgery in subsequent years. Based on these studies, the USA Baseball Medical & Safety Advisory Committee has published guidelines for pitching that include limits on pitch count and pitches per week and season as well as recommendations for number of rest days between pitching. Also, recommendations include the restriction of breaking balls prior to puberty, the importance of instruction for proper pitching mechanics as early as possible in development, and at least three months of rest after a season. This review is intended to help guide primary care physicians and pediatricians when discussing youth pitching and injury prevention with parents and coaches.