In 2018, Sims was nominated for Streamer of the Year at Summer in the City for her streaming on Twitch. Sims has a Twitch channel with 769,700 followers, and streams six days per week. Sims is a judge on YouTube's gaming creator competition show, uTure. In August 2020, Sims joined other Sims YouTubers in speaking out against the lack of diversity in skin tones in The Sims 4. Part of this campaign included getting the #justiceforcowplants trending on the Sims gallery via a 'shell' building challenge. In a July 2020 patch to The Sims 4, all cowplants in the game were given the default name 'Little Simzee' as a nod to Sims' campaign for the ability to name cowplants in game.

One of Sims' longest running YouTube series was the '100 Baby Challenge' series, in which she completed the 100 Baby Challenge in The Sims 4 over the course of five years. In 2019, for her 'Simsie Save', in which Sims renovates the game's worlds and characters, Sims made all toilets in her save gender-neutral. Sims is the creator of the Wolf Pack Challenge, which uses The Sims 4: Cats & Dogs expansion pack, and the Not So Berry Challenge, created with her friend Zoë (alwaysimming). As of May 2021, Sims has over a million subscribers. Sims' most popular YouTube video, 'I left The Sims unpaused all night by accident and THIS is what happened.' has over 1.2 million views. Sims started making YouTube videos about The Sims in 2015. Sims is best known for playing The Sims 4, collaborations with EA on projects such as The Sims 4: Snowy Escape and The Sims 4: Growing Together, and her charity work for St. Kayla Marie Sims (born August 14, 1999), also known by her YouTube handle lilsimsie, is an American YouTuber and Twitch streamer.

Sims 4 default skin