Background Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients. Objectives To summarize the efficacy of SDM interventions in pediatrics on patient-centered outcomes. Data Sources We searched Ovid Medline, Ovid Embase, Ovid Cochrane Library, Web of Science, Scopus, and Ovid PsycInfo from database inception to December 30, 2013, and performed an environmental scan. Study Eligibility Criteria We included interventions designed to engage pediatric patients, parents, or both in a medical decision, regardless of study design or reported outcomes. Study Appraisal and Synthesis Methods We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias assessment. Meta-analysis was performed on 3 outcomes: knowledge, decisional conflict, and satisfaction. Results Sixty-one citations describing 54 interventions met eligibility criteria. Fifteen studies reported outcomes such that they were eligible for inclusion in meta-analysis. Heterogeneity across studies was high. Meta-analysis revealed SDM interventions significantly improved knowledge (standardized mean difference [SMD] 1.21, 95% confidence interval [CI] 0.26 to 2.17, P =.01) and reduced decisional conflict (SMD -1.20, 95% CI -2.01 to -0.40, P =.003). Interventions showed a nonsignificant trend toward increased satisfaction (SMD 0.37, 95% CI -0.04 to 0.78, P =.08). Limitations Included studies were heterogeneous in nature, including their conceptions of SDM. Conclusions and Implications of Key Findings A limited evidence base suggests that pediatric SDM interventions improve knowledge and decisional conflict, but their impact on other outcomes is unclear. Systematic Review Registration Number PROSPERO CRD42013004761 (http://www.crd.york.ac.uk/PROSPERO/display-record.asp?ID=CRD42013004761).