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High-intensity interval training (HIIT) is an emerging exercise strategy to improve health and fitness, but previous studies have evaluated HIIT interventions across different populations and outcomes. This review aimed to comprehensively synthesize published evidence on the effects of HIIT on key cardiometabolic health parameters in children and adolescents. We searched seven databases until February 2024. Systematic reviews were eligible if they 1) compared HIIT and active/non-active control conditions with meta-analysis, 2) examined cardiorespiratory fitness, body composition and cardiometabolic risk biomarkers, and 3) examined children and adolescents. We included 18 systematic reviews with meta-analysis, including 223 original studies and 13,900 unique participants. HIIT is effective for cardiorespiratory fitness in children and adolescents with diverse health and weight status (median standardized mean difference [SMD] = 0.75). Improvements in body composition and several cardiometabolic risk biomarkers, including systolic blood pressure (median SMD = −0.40), diastolic blood pressure (median SMD = −0.22), triglyceride (median SMD = −0.30), low-density lipoprotein cholesterol (median SMD = −0.90), and high-density lipoprotein cholesterol (median SMD = 0.34), have also been observed following HIIT, with a notably more pronounced effect in youth with overweight/obesity or metabolic disorders. Our umbrella review supports the effectiveness of HIIT in enhancing cardiometabolic health, suggesting its integration into physical activity promotion programmes in schools and communities. [ABSTRACT FROM AUTHOR]