This review was designed to assess the pooled prevalence of early childhood caries (ECC) in India. An electronic data search was done in PubMed/MEDLINE and Scopus databases in October 2020. Epidemiological surveys assessing the prevalence of ECC were included, and data on gender, geographic region, sampling strategy, feeding habits, and dmft values were extracted. The risk of bias was assessed, and a meta-analysis was performed for pooled prevalence and mean dmft values. The selection of articles, data extraction, and validity assessment were done independently by the two reviewers (ID and RV). A third reviewer (CJ) resolved any conflict between these two reviewers. A total of seventy-one studies were included for quantitative analysis. The pooled prevalence of ECC estimated from 71 studies with 69,330 participants is 46.9% (confidence interval [CI] 46.5-47.2). Males had a higher prevalence of ECC (47%, CI: 46.4-47.6,40 studies, 26,840 participants) than females (43.8%, CI: 43.2-44.2,40 studies, 24,389 participants). Region-wise analysis showed the highest number of studies (44) in southern India, with a sample size of 35,988 with a pooled prevalence of 44.6% (CI: 44-45.1). The pooled mean dmft (random effect) is 2.23 (1.97-2.48), with males having a higher proportion of 2.26 compared to 2.23 in females. The pooled prevalence of ECC was 46.9%, and the pooled mean was 2.23. The results from this study state that one in every two children in India is suffering from ECC, reflecting its public health relevance.