A systematic review and meta-analysis of paediatric, maternal, and congenital mpox cases, along with vaccine and therapeutic use, was conducted. Of 61 studies, 53 reported paediatric outcomes (n=2123 cases), seven maternal or congenital outcomes (n=32 cases), two vaccine safety studies (n=28 recipients), and three breastfeeding transmission cases (n=4). While seven observational studies reported uneventful tecovirimat use in 21 children and 12 pregnant individuals, no randomised trials evaluated safety or efficacy. Common paediatric symptoms included rash (100%), fever (73%), and lymphadenopathy (47%). Among pregnant individuals, rash was common (100%), while fever and lymphadenopathy were less so. Most paediatric complications arose from secondary bacterial infections, with a pooled case fatality ratio of 11% (95% CI 4–20). Data from 12 pregnancies showed half resulted in fetal death. Vaccine and immune globulin safety research in children and pregnant individuals remains limited. The review highlights critical knowledge gaps in mpox epidemiology, prevention, and treatment in children and pregnant individuals, especially in endemic countries. Increased funding, international collaboration, and equitable research are needed to inform mpox control strategies for at-risk communities.A systematic review and meta-analysis of paediatric, maternal, and congenital mpox cases, along with vaccine and therapeutic use, was conducted. Of 61 studies, 53 reported paediatric outcomes (n=2123 cases), seven maternal or congenital outcomes (n=32 cases), two vaccine safety studies (n=28 recipients), and three breastfeeding transmission cases (n=4). While seven observational studies reported uneventful tecovirimat use in 21 children and 12 pregnant individuals, no randomised trials evaluated safety or efficacy. Common paediatric symptoms included rash (100%), fever (73%), and lymphadenopathy (47%). Among pregnant individuals, rash was common (100%), while fever and lymphadenopathy were less so. Most paediatric complications arose from secondary bacterial infections, with a pooled case fatality ratio of 11% (95% CI 4–20). Data from 12 pregnancies showed half resulted in fetal death. Vaccine and immune globulin safety research in children and pregnant individuals remains limited. The review highlights critical knowledge gaps in mpox epidemiology, prevention, and treatment in children and pregnant individuals, especially in endemic countries. Increased funding, international collaboration, and equitable research are needed to inform mpox control strategies for at-risk communities.