Objectives <p>Early childhood dental caries (ECC) is a prevalent dental condition affecting infants and young children, characterized by one or more carious lesions in primary teeth. ECC risk factors include malnutrition, genetic predisposition, specific dietary habits, lack of fluoride, and prolonged bottle feeding. A comprehensive prevalence estimate is crucial for understanding the extent of dental caries in the population. So, this study aimed to determine the prevalence of ECC and its associated risk factors in Iranian children.</p> Methods <p>A comprehensive literature search was conducted in Scopus, Web of Science, PubMed, Google Scholar, ACECR Scientific Information Database (<a href="http://www.ACECRScientificInformationDatabase.ir">www.ACECRScientific Information Database.ir</a>), and Magiran research databases. Eligible English and Persian studies published between 2006 and 2024 were reviewed and analyzed. The studies on ECC prevalence were identified and included in the meta-analysis. Random effect models were utilized to calculate the pooled prevalence, and meta-regression and sensitivity analyses were conducted to assess sources of heterogeneity in the systematic review of risk factors.</p> Results <p>The meta-analysis encompassed thirty eligible studies, providing the prevalence of ECC in Iran, with an estimated prevalence of 61.7%. Meta-regression analysis indicated a non-statistically significant increase in ECC prevalence with age and a substantial slight decrease over time. Additionally, 68 Studies evaluated categories such as age, gender, sociodemographic factors, microbial flora, oral hygiene, breast/bottle feeding, and dietary. Significant ECC-related factors identified included parents’ education and occupation, breastfeeding, and oral hygiene.</p> Conclusion <p>The overall prevalence of ECC in Iran was estimated at 61.7%, with notable heterogeneity. Most of the studies extensively evaluated sociodemographic factors as risk factors.</p>