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Background: Cerebral palsy (CP) is the most common cause of impaired motor function in young children. Dysfunction of the upper limb can have an adverse impact on the performance of daily life activities. A variety of interventions have been studied to improve upper limb function, botulinum toxin injections being one of them. A previous systematic review stated that there is high level evidence for using botulinum toxin as an adjunct therapy in the management of the upper limb in children with CP. Objectives: We aimed to further assess the efficacy of botulinum toxin injections in the upper limb in children with CP. In particular, we wanted to map the effect of repeated injections, longitudinal outcomes, the best additional therapies and determine the appropriate dose of botulinum toxin. Data sources: Pubmed, MEDLINE, EMBASE, CINAHL and CENTRAL were searched from August 2008 until the 17th of May 2018. Results: Ten trials met the inclusion criteria. Repeated injections may be superior over single injections. Thermoplastic night splints appeared to be useful whereas gaming technology was not. Modified constraint-induced therapy (mCIMT) and bimanual occupational therapy (BOT) are both beneficial and should be applied according to the goal of either unimanual or bimanual improvement. Conclusion: Repeated botulinum toxin injections may be more beneficial than single injections, though this needs further investigation. Depending on the goal of therapy, botulinum toxin injections can be efficiently combined with a variety of treatments to improve upper limb function. To define the best responders and long-term effects, future studies are crucial.