BACKGROUND: Acupuncture is frequently used to manage pediatric cerebral palsy (CP), yet updated evidence is needed to guide future research and clinical practice. METHODS: Seven databases were searched from 1994 to 26 June 2023. Randomized controlled trials (RCTs) involving body, scalp, or ear acupuncture for managing CP, excluding acupoint injection, catgut embedding, electro-acupuncture, or laser acupuncture, were included. RESULTS: Twenty RCTs with 1797 participants were analyzed. Acupuncture groups had better improvements in gross motor function measure (GMFM) scores by 5% (mean difference 5.93, 95% CI 3.67 to 8.19, p < 0.001, I2 57%); a 16% higher probability to yield prominent improvement in effectiveness rate (ER) (risk ratio 1.16, 95% CI 1.08 to 1.25, p < 0.001, I2 0%); and better outcomes in the Modified Ashworth Scale (MAS) (standardized mean difference (SMD) 0.3, 95%, CI 0.11 to 0.49, p < 0.001, I2 0%), the Berg Balance Scale (BBS) (SMD 2.48; 95% CI 2.00 to 2.97, p < 0.001, I2 72%) and ADL (SMD 1.66; 95% CI 1.23 to 2.08, p < 0.001, I2 91%). Studies with eight core acupoints identified from all ninety-five acupoints had better ER. CONCLUSIONS: Acupuncture, especially using core acupoints, may be effective for managing symptoms in children with CP.

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