text: Review Mental health impacts of the COVID 19 pandemic on children and youth a systematic review The COVID 19 pandemic has posed an unprecedented threat to global mental health Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage fear of infection home confinement suspension of regular school and extracurricular activities physical distancing mandates and larger scale threats such as global financial recessions and associated impacts Our objective was to review existing evidence of the COVID 19 pandemics global impact on the mental health of children and adolescents 19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes We conducted a search of peer reviewed and preprint research published in English from January 1 2020 to February 22 2021 We included studies collecting primary data on COVID 19 related mental health impacts on children and adolescents We graded the strength of included articles using the Oxford Centre for Evidence Based Medicine rating scheme Our search and review yielded 116 articles presenting data on a total of 127 923 children and adolescents 50 984 child and adolescent proxy reports e g parents healthcare practitioners and 3 000 chart reviews A high prevalence of COVID 19 related fear was noted among children and adolescents as well as more depressive and anxious symptoms compared with prepandemic estimates Older adolescents girls and children and adolescents living with neurodiversities and or chronic physical conditions were more likely to experience negative mental health outcomes Many studies reported mental health deterioration among children and adolescents due to COVID 19 pandemic control measures Physical exercise access to entertainment positive familial relationships and social support were associated with better mental health outcomes This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents especially those in higher risk subgroups to mitigate short and long term pandemic associated mental health effects 