Caroly Wilcox created the original Elmo puppet in 1979 as a generic "Anything Muppet" monster for Sesame Street.

Kevin Clash developed Elmo into the beloved character known today. In 1985, Clash took over performing the puppet, giving it a high-pitched falsetto voice, a kind and loving personality, and the habit of referring to itself in the third person. This transformation turned Elmo from a background figure into a star, hosting segments like "Elmo's World" aimed at toddlers.

Earlier puppeteers like Brian Muehl and Richard Hunt performed Elmo briefly before Clash. Clash performed Elmo from 1985 until 2012, after which Ryan Dillon took over.