This paper reviews published work and projects on climate change and Small Island Developing States (SIDS), covering impacts, vulnerability, and adaptation. As a critical review, this paper does not seek to be comprehensive, but it extracts key ideas and discusses key material to evaluate the current state of knowledge on SIDS and climate change. Illustrative examples and references, rather than a full listing, are used to support points. The main way forward suggested for the future is better integration of top-down and bottom-up approaches to ensure that data and methods are based on local interests while acknowledging and integrating local and traditional knowledge with other forms of knowledge. Placing climate change into appropriate contexts is also important along with filling in prominent knowledge gaps, especially moving beyond the current focus on Caribbean and Pacific SIDS.