Background <p>Pediatric palliative care (PPC) provides holistic and family-centered support that extends beyond end-of-life care. Children living with life-limiting or life-threatening conditions frequently experience significant emotional distress, psychosocial burden, and symptom related challenges. Early access to psychological interventions may help address their complex needs and enhance overall well-being. This systematic review and meta-analysis aimed to synthesize the evidence on psychological interventions delivered to children eligible for PPC.</p> Methods <p>Five electronic databases were searched for randomized-controlled trials including children (&lt; 18 years) eligible for PPC who received a psychological intervention were included. Eligible studies reported quantitative outcomes related to psychological symptoms. Risk of bias was assessed using Cochrane risk-of-bias tool (RoB-2) and meta-analyses were conducted when at least two trials reported comparable outcomes for post-treatment.</p> Results <p>Thirty studies met inclusion criteria, focusing on children with cancer (25 studies), sickle cell disease (4 studies), or cystic fibrosis (1 study). Most psychological interventions were cognitive-behavioral approaches. The results of the meta-analysis were associated with significant reductions in symptoms of anxiety (<i>p</i> &lt; 0.00001) and depression (<i>p</i> &lt; 0.005). Significant improvements were also observed in physical outcomes, such as overall pain intensity (<i>p</i> = 0.0003). In addition, psychological interventions significantly reduced distress, anxiety, and pain associated with invasive medical procedures (<i>p</i> &lt; 0.00001). Although heterogeneity across studies was moderate to high, most interventions demonstrated beneficial effects, particularly those incorporating cognitive-behavioral and coping-based strategies.</p> Conclusions <p>The available evidence suggests that psychological interventions, especially those grounded in cognitive-behavioral approaches, may offer meaningful benefits for children eligible for PPC, improving emotional well-being and reducing symptom burden. Integrating such interventions into routine PPC could enhance comprehensive care. Further high-quality trials across a wider range of life-limiting conditions are needed to expand the evidence base and strengthen clinical implementation.</p> Clinical registration <p>This study is registered in PROSPERO (CRD42024594171).</p>