The Pacific Islands region is home to a diversity of countries and territories, who are at the forefront of climate change and the triple burden of malnutrition. In recent years there has been increasing interest in schools as a setting for transforming food systems, improving nutrition and health outcomes, increasing educational outcomes and enhancing livelihoods in the Pacific Islands. This review examines and describes current school food and nutrition initiatives within the literature that aim to promote healthier, sustainable diets within the Pacific Islands region. As there is a paucity of literature in this area of interest in the Pacific Islands, the review focuses on the policy landscape, the provision of food near, and in schools, nutrition education, and future opportunities. The available literature demonstrates that there is broad regional interest and momentum from numerous stakeholders to enhance SFNE in the Pacific Islands, with several opportunities for future activities. While there are frameworks to explore food environments available there is a need for a Pacific Islands school food environment conceptual framework that captures aspects, both within and around schools, that can guide research and assessment for robust comparable data collection. This may in turn support healthier SFNE and ultimately nutritious food choices for children and adolescents