Background Pediatric patients represent approximately 2% of overall confirmed cases of COVID-19. Illness severity and symptoms differ from adults. Most cases in children are mild but various studies have reported severe and critical cases as well as fatal outcomes. Methods A systematic review and meta-analysis of the available literature was performed. Frequencies were used for reporting categorical variables. Meta-analyses were performed using the binary random effects model for symptoms frequencies in children and illness severity. Results We found 44 studies (n=6026), 38 were used for quantitative synthesis to estimate the frequency of symptoms in the pediatric population with Covid-19 and illness severity, 44 were used for qualitative synthesis. The most common symptoms were fever 64% (CI 95% 54-72%), cough 42% (CI 95% 37-48%) and gastrointestinal symptoms like vomit 31% (CI 95% 17-47%) and diarrhea 28% (CI 95% 17-40%). For illness severity 2% (CI 95%0-5%) were severe and 3% (CI 95% 1-6%) were critical. Children <1-year-old had the higher odds of severe/critical cases with an OR of 2.07 (IC95% 1.40-3.05). All patients were hospitalized, and a total of 10.34% children admitted to PICU. The mortality rate was 0.16% (8/487). A total of 141 patients developed PIMS-TS and only one died. Conclusions: Most cases in children were non-severe, nevertheless children less than 1 year had the higher risk of severe/critical cases. Symptoms frequencies encountered from major to minor were fever, cough and gastrointestinal symptoms. More testing in children should be done in order to understand transmission characteristics in the pediatric population.