Purpose <p>Paediatric epigastric hernias are usually superficial fascial defects in the linea alba containing extra-peritoneal fat only. We aimed to determine the frequency of incarceration of epigastric hernias in children and the incidence of full thickness defects.</p> Methods <p>A systematic review was performed following PRISMA guidelines (PROSPERO: CRD42024622980). A literature search was undertaken using sources from the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, Grey literature sources, references of included studies, all in English language only, using the keywords and variations of, “children”, “epigastric hernia”, “supraumbilical” and “paediatric”. Data extraction for each included study, included bibliographic details (authors, title, publication date), study design, study period, region of origin, number of children with epigastric hernia and incarcerated epigastric hernia and management of incarcerated epigastric hernia.</p> Results <p>Twenty-five reports were selected for full text screening and seven studies were included (between the years of 1975 to 2019) in the final systematic review and analysis. A total of 80 cases are described, 33 males and 47 females, with an average age at presentation for each series ranging between 2 and 9 years. Our systematic review found that no previous studies have reported paediatric cases of incarcerated, full thickness epigastric hernias.</p> Conclusions <p>Epigastric hernias are commonly encountered in general surgery of childhood however studies of this disease are limited. Incarceration of epigastric hernias in children is rare and has only been reported previously to contain extra-peritoneal fat.</p> Levels of evidence <p>Level IV.</p>