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Background Recent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. However, little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence. Methods We conducted a systematic review on the clinical presentation and complications of children and adolescents aged 0 to 18 years with a robust diagnosis of ZIKV infection. We searched PubMed, Web of Science, LILACs, and EMBASE until 13 February 2020 and screened reference lists of eligible articles. We assessed the studies’ risk of bias using pre-specified criteria. Findings Our review collated the evidence from 2543 pediatric ZIKV cases representing 17 countries and territories, identified in 1 cohort study, 9 case series and 22 case reports. The most commonly observed signs and symptoms of ZIKV infection in children and adolescents were mild and included fever, rash, conjunctivitis and arthralgia. The frequency of neurological complications was reported only in the largest case series (identified in 1.0% of cases) and in an additional 14 children identified from hospital-based surveillance studies and case reports. ZIKV-related mortality was primarily accompanied by co-morbidity and was reported in one case series (, Author summary Although the number of Zika virus (ZIKV) cases has declined following the 2015–2016 outbreak in the Americas, ZIKV remains a public health concern due to the potentially severe consequences of in utero exposure to the virus. While there is an increasing understanding of the effects of prenatal congenital ZIKV infection, less is known regarding the potential consequences of postnatal non-congenital ZIKV infection in children and adolescents. As this age group may also be vulnerable to the adverse effects of ZIKV on the nervous system, a better understanding of ZIKV infection in this population is needed. This knowledge may help to inform the case definition for ZIKV disease in children and elucidate whether children and adolescents should be included in strategies and measures for prevention of ZIKV infection, which are currently aimed primarily at pregnant women. After a review of the existing literature, the authors found that ZIKV infection in children and adolescents appears to be similar to adults and primarily mild, with little evidence of severe neurological consequences. Further research using prospective methods and neurodevelopmental assessments is warranted.