Schools often credit instructional gardens with improving fruit and vegetable consumption and physical activity in children. Many schools are able to obtain funding and supplies to establish a garden program, but there are challenges to program sustainability that often result in garden failure. This systematic review compares recommendations for garden sustainability to maximize the effects of gardens on child and adolescent health. Search terms ("school garden" OR "instructional garden" AND sustain* AND strategy OR practice) were applied to academic databases, including ProQuest Central, ERIC, Agricola, and Science Direct. Articles had to address strategies for sustaining gardens used for educational purposes. The search resulted in 694 peer-reviewed articles, of which 17 met the eligibility criteria. A review of article references resulted in two additional articles (n = 19). Most common recommendations included building a broad network of support in the community, providing professional development to teachers involved with the garden, and providing teachers with standards-based curricula to integrate the garden into multiple content areas. To increase the effect of gardens on student health behaviors, health educators should use the National Health Education Standards, Characteristics of an Effective Health Education Curriculum, and Healthy Behavioral Outcomes to integrate gardens into health education.