Exchanges of help in childhood produce many positive consequences, such as increasing academic success, promoting happiness, and fostering positive peer relations. For this reason, caretakers encourage helping behavior early in life, and schools implement intervention programs to nurture children’s prosociality. An often overlooked issue, however, is that providing and receiving help do not always produce positive outcomes. We review the latest research that converges to suggest that when children receive, witness, or provide help there can be unintended negative consequences—for example, receiving help can produce feelings of incompetence. We also grapple with how to balance the negative and positive outcomes of helping behavior, with an eye toward promoting children’s well-being and social cohesion in society.