Background
With increased screen time among children and adolescents, concerns about the impact of loot boxes (LB) on gambling behaviors have grown. LBs, often included in video games as purchasable items with randomized rewards, resemble gambling mechanics, raising concerns about potential risks for youth.

Methods
This systematic review collected and analyzed all available studies on LB use and gambling in individuals under 18 years old. A literature search was conducted using Cochrane, SciELO, and PubMed databases up to March 30, 2024. The inclusion criteria focused on peer-reviewed empirical studies examining the association between LBs and gambling behaviors in minors, while studies on unrelated gambling behaviors or those involving adults were excluded.

Results
From 74 initial articles, 4 studies met the inclusion criteria. Findings consistently showed a positive association between LB engagement and gambling tendencies in adolescents. Results indicate that adolescents involved with LBs are at a higher risk of problematic gambling behaviors, with gender differences also observed, as male adolescents showed higher engagement with LBs and gambling risks.

Conclusions
The review suggests a clear association between LB use and gambling behaviors in youth, with potential for LBs to act as a "gateway" to gambling. The findings highlight the need for regulatory actions, including age restrictions and educational efforts to protect youth from these risks. Further research with representative samples is necessary to deepen understanding of the LB-gambling link in young populations.