Background: Worldwide, a large number of infants, toddlers, and preschoolers are enroled in formal non-parental early childhood education or care (ECEC).Theoretically, lower adult/child ratios (fewer children per adult) and smaller group sizes are hypothesised to be associated with positive child outcomes in ECEC. A lower adult/child ratio and a smaller group size may increase both the extent and quality of adult/child interactions during the day.Objectives: The objective of this review is to synthesise data from studies to assess the impact of adult/child ratio and group size in ECEC on measures of process characteristics of quality of care and on child outcomes.Search Methods: Relevant studies were identified through electronic searches of bibliographic databases, governmental and grey literature repositories, Internet search engines, hand search of specific targeted journals, citation tracking and contact to experts. The primary searches were carried out up to September 2020.