Classroom listening conditions are often characterized by high levels of background noise. Beyond that, every second teacher develops voice disorders during their career, meaning that many pupils are taught in impaired (e.g., hoarse or breathy) voices. This systematic review and meta-analysis aims at understanding how background noise and a speaker’s impaired voice quality affect spoken language processing in 6-18-year-old children. We review 31 studies on the impact of noise and/or impaired voice on children’s answer accuracy and response time (RT) in listening tasks. A classification of the findings is presented in the SPADE framework, featuring three processing dimensions: speech perception, listening comprehension, and auditory working memory. Statistical analyses reveal that noise compromises children’s accuracy in listening tasks within each of these dimensions (Cohen’s d between –0.67 and –2.65), and that listening to an impaired voice impedes children’s accuracy in listening comprehension tasks (d = –0.35). RT data is too scarce to allow firm conclusions. Several factors related to the listener, task, environment, and type of exposure are identified as moderators of the impact of noise and impaired voice. Interaction effects between noise and impaired voice remain unclear and need further investigation. Our results highlight that acoustically adverse listening conditions disrupt children’s spoken language processing and may potentially hinder their academic achievement at school.