Background: Reports of post-treatment control following antiretroviral therapy (ART) have prompted the question of how common immune control of HIV infection is in the absence of ART. In contrast to adult infection, where elite controllers (EC) have been very well characterized and comprise approximately 0.5% of infections, very few data exist to address this question in paediatric infection. Methods: We describe 11 ART-naïve EC from 10 cohorts of HIV-infected children being followed in South Africa, Brazil, Thailand, and Europe, and describe their key clinical features. Results: All but one EC (91%) are female. The median age at which control of viraemia was achieved was 6.5yrs. Five of these 11 (46%) children lost control of viraemia at a median age 12.9yrs. Children who maintained control of viraemia had significantly higher absolute CD4 counts in the period of EC than those who lost viraemic control. Based on the data available from cross-sectional cohorts, the prevalence of EC in paediatric infection is estimated to be 5-10-fold lower than in adults. Conclusion: These data indicate that, whilst paediatric elite control can be achieved, compared to adult EC this occurs rarely, and takes some years after infection to achieve. Also, loss of immune control arises in a high proportion of children and often relatively rapidly. These findings are consistent with the more potent antiviral immune responses observed in adults and in females.