Exercise supports the physical, mental, and social development of children and adolescents. Although Tai Chi is a well-documented mind-body exercise with established benefits in adults, its effects in younger populations remain unclear. This systematic review examined the physical, psychological, and safety outcomes of Tai Chi in children and adolescents and explored its potential underlying mechanisms.

Electronic searches of randomized controlled trials involving Tai Chi in children and adolescents were conducted from database inception to October 15, 2024, across major English- and Chinese-language databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), SinoMed, and Wanfang. Two reviewers independently performed the study selection and data extraction. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool.

Fifteen trials involving 1004 participants aged 8‒18 years, both healthy and with chronic conditions were included. Yang-style Tai Chi was the most frequently used intervention, and control groups received either no Tai Chi or alternative exercise programs. Several studies reported positive effects on balance, physical function, mobility, muscle strength, fall risk, kyphosis, stereotypical behavior, and self-concept, suggesting possible mechanisms of benefit. However, safety data were limited. The overall methodological quality was moderate: three studies (20%) had low risk of bias, six (40%) had some concerns, and six (40%) had high risk.

Tai Chi may improve balance, flexibility, motor skills, physical fitness, and psychological factors such as self-concept in children and adolescents. However, further high-quality research is required to confirm its effectiveness and safety in this population.