Learning the meaning of number words is a lengthy and error-prone process. In this review, we highlight outstanding issues related to current accounts of children’s acquisition of symbolic number knowledge. We maintain that, despite the ability to identify and label small numerical quantities, children do not understand initially that number words refer only to sets of discrete countable items, not to other nonnumerical dimensions. We question the presence of a sudden change in children’s understanding of cardinality, and we report the limits of the give-a-number task. We also highlight that children are still learning the directional property of the counting list, even after acquiring the cardinality principle. Finally, we discuss the role that the Approximate Number System may have in supporting the acquisition of symbolic numbers. We call for improvements in methodological tools and refinement in theoretical understanding of how children learn natural numbers.