Abstract Group IV nanodots (NDs) have gathered considerable attention not only for their easy and low cost of synthesis, large surface area, nice photostability, excellent biocompatibility but for their special nanozyme properties. In this review, group IV NDs including carbon (C), silicon (Si) and germanium (Ge) NDs, are summarized and discussed, with an emphasis on biosensing application. The rational design of the group IV NDs based nanoplatforms to detect various biomarkers via colorimetric, fluorescence, electrochemical, electrochemiluminescence (ECL) and photoelectrochemical (PEC) methods for various biomarkers are thoroughly reviewed. The structure-properties relationship is stated, and some typical detection mechanism also emphasized. The current limitations and future directions of these materials are presented with new insights into the remaining challenges and trends of group IV ND research. It hopefully provides researchers with a distinct perspective on the synthesis of functional group IV NDs with specific properties and construction of biomarker sensors with high selectivity and sensitivity.