Using picture books in teaching is a popular trend in early childhood education. However, little attention has been paid to such pedagogy in mathematics learning. For this article, we reviewed 16 empirical studies from the past two decades (2000–2022) regarding the use of picture books in mathematics instruction, in order to investigate their effects on mathematics learning in students. We analyse and critically assess approaches used to integrate picture books into mathematics instruction, the overall effects of such integration on the mathematical performance of students, and the factors that inhibit or enhance these effects. The findings of our review reveal that most of the selected studies targeted early mathematics education, with only a minority addressing secondary education. Various approaches are available for the integration of picture books into mathematics teaching, having various positive effects on student attitudes toward mathematics, as well as their academic performance and mathematical representation ability. The reported inhibiting factors for teachers using picture books in teaching included a lack of pedagogical knowledge and confidence, time constraints, resource constraints and doubts regarding the expected outcomes. Conversely, the enhancing factors included early educational stage (especially the pre‐school level), perceived pedagogical benefits, desire to improve teaching and enabling social norms. Suggestions for future research focused on the integration of picture books into classroom teaching are also discussed.