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Background: Anxiety disorders are amongst the most common mental health disorders in children and are becoming more prevalent. As such, it is essential that interventions are timely and effective. Schools are being recognised as fertile ground for fostering positive mental health and for implementing preventative programmes. Method: Systematic database searching yielded 1113 studies with 52 duplicated papers. 1044 studies were excluded against eligibility criteria for various reasons: age group was too high, delivery of programme was not actually universal. Twelve studies from the remaining seventeen were selected for this review after critical appraisal. All twelve were randomised control trials with large enough sample sizes ranging from one whole school population to forty schools' population. Results: The majority of the universal programmes in this review reported significant effects on the reduction of anxiety symptomology with some reporting sustained improvements over time. Areas of specific impact included: reduction of oppositional coping strategies; reduction in behaviour difficulties; increase in social and emotional competence and improved social skills and ability to cope. One study reported improved social climate and less bullying in the classroom. Where parents or carers were involved in a programme, they reported significant gains in their children's coping skills and emotional and behavioural competence, reductions in their own stress and more positive perceptions of their children's behaviour. Conclusions: Universal anxiety prevention programmes delivered at primary school level show promising outcomes for children. Implications for teacher training, engagement with delivery and parental involvement are discussed.