Background <p>Anxiety disorders are among the most prevalent psychiatric conditions, particularly affecting children and adolescents. Since the COVID-19 pandemic, the incidence of anxiety in this population has increased, making it a significant public health concern. This study aimed to evaluate the effectiveness of various interventions for anxiety disorders in children and adolescents and identify the most effective approach to mitigate the impact of these disorders.</p> Methods <p>We conducted a thorough search of eligible randomized controlled trials across five databases: Cochrane, Embase, PubMed, Scopus, and Web of Science. A Bayesian network meta-analysis was performed using R Studio, and the quality of evidence was evaluated using the GRADE method.</p> Results <p>From 19,442 publications retrieved, 30 RCTs involving 1,711 participants were included. The results showed that Acceptance and Commitment Therapy was the most effective intervention for treating anxiety disorders in children and adolescents (MD = -3.83 [95% CrI: -9.33, 1.51]). Cognitive Behavioral Therapy was the second most effective (MD = -3.64 [95% CrI: -7.36, -0.48]), followed by Virtual Reality Exposure Therapy (MD = -2.53 [95% CrI: -8.23, 3.32]) and Physical Exercise (MD = -2.16 [95% CrI: -9.99, 5.52]).</p> Conclusions <p>Acceptance and Commitment Therapy (ACT) appears to be the most effective intervention for anxiety disorders in children and adolescents. However, this finding should be interpreted with caution due to the overall low quality of evidence, high heterogeneity, and imprecision in the results. Future research should investigate the potential benefits of combining physical exercise or virtual reality-assisted therapies. Moreover, large-scale, high-quality randomized controlled trials are essential to further validate and refine these findings.</p> Trial registration <p>PROSPERO, CRD42024587910.</p>