Objective To systematically review the efficacy and safety of pediatric tuina in the treatment of children with acute diarrhea.Methods CNKI, VIP, WanFang Data, CBM, PubMed and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on the treatment of children acute diarrhea with tuina from inception to November 20th, 2020. Two researchers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 15 RCTs involving 1 464 children were included. The results of meta-analysis showed that, compared with western medicine, tuina for children with acute diarrhea could increase the cure rate (RR=1.43, 95%CI 1.26 to 1.63, P<0.001), shorten the time for the frequency of diarrhea to return to normal (MD=−0.86, 95%CI −1.05 to −0.66, P<0.001) and the time for stool traits to return to normal (MD=−1.07, 95%CI −1.15 to −0.99, P<0.001). There was no statistically significant difference in the incidence of adverse reactions between tuina and western medicine (RR=0.25, 95%CI 0.03 to 2.23, P=0.22).Conclusions Current evidence shows that tuina has a superior effect on treating children with acute diarrhea, the incidence of adverse reactions is not increased. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.