Objective: To conduct a systematic review to evaluate the effectiveness of Pilates intervention on physical function in children and youth.Data Sources: Six electronic databases were searched from inception to June 2018 using the term 'Pilates'. Study Selection: Articles were included if they (1) reported original data for a Pilates-only intervention, (2) involved children or youth aged up to 22 years and (3) reported a musculoskeletal, pain or function study outcome. Searches identified 2565 papers and 11 studies fulfilled the inclusion criteria. Data Extraction: The two authors independently screened and assessed all studies and any discrepancies were resolved by consensus. Data Synthesis: Level of evidence was classified using the Oxford Centre for Evidence Based Medicine (OCEBM). Study quality was assessed using the Physiotherapy Evidence Database (PEDro) for RCTs and RoBiNT scale for SCED studies. Four studies were high quality, 3 were fair quality and four were of low quality. Findings showed that Pilates does appears to improve flexibility (n=6); muscle strength, power and movement speed (n=3); postural control, orientation and balance (n=3); metabolic cost (n=1); functional ability (n=1)and health related quality of life (n=1) and reduce pain (n=2) in children with musculoskeletal pathology, the majority with a large effect size.