Global systematic review of how climate change degrades the wellbeing and health of Indigenous children

Climate change worsens global health, with Indigenous children among the most vulnerable. Despite increasing research on climate-related health impacts, Indigenous children’s unique vulnerabilities remain underrepresented. This is the first review to synthesise systematically the global evidence on how climate change impacts the health of Indigenous children. We consolidated reported health outcomes directly caused by climate change in Indigenous children. We adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and followed a reflexive framework that considered researcher positionality, Indigenous definitions of health, and ongoing Indigenous engagement. We did a systematic search of five databases on 2 March 2025 and collaboratively screened eligible studies on climate-related health outcomes in Indigenous children and pregnant women, assessing them using the mixed-methods appraisal tool. A convergent integrated synthesis approach mapped exposure-outcome patterns and guided a theme-based narrative analysis. Meta-analysis was not feasible due to study heterogeneity. Fifty-three studies met inclusion criteria, comprising 16 qualitative, 23 quantitative non-randomised, 6 quantitative descriptive and 8 mixed-method designs. Five main health outcomes emerged: ( i ) psychosocial and cultural wellbeing, ( ii ) malnutrition, ( iii ) infectious diseases, ( iv ) perinatal health, and ( v ) morbidity and mortality. Reflecting the interconnected and relational nature of Indigenous health conceptualisations, most studies addressed multiple climate exposures and outcomes. Psychosocial and cultural wellbeing was the most cross-cutting theme, interconnected with all other health domains. Heat exposure and seasonal and hydroclimatic variability were the most frequently linked climate exposures. Indigenous children across diverse contexts are experiencing adverse climate-related health outcomes. Our review consolidates the evidence base to inform culturally grounded, strengths-based responses that engage Indigenous Knowledge systems and younger generations. Advancing this field requires more geographically diverse, disaggregated, and methodologically rigorous research.