Purpose: Maximal heart rate (MHR) is an important physiologic tool for prescribing and monitoring exercise in both clinical and athletic settings. However, prediction equations developed in adults may have limited accuracy in youth. The purpose of this study was to systematically review and analyze the available evidence regarding the validity of commonly used age-based MHR prediction equations among children and adolescents. Methods: Included articles were peer-reviewed, published in English, and compared measured to predicted MHR in male and female participants <18 years old. The standardized mean difference effect size (ES) was used to quantify the accuracy of age-predicted MHR values and a priori moderators were examined to identify potential sources of variability. Results: The cumulative results of 20 effects obtained from seven articles revealed that prediction equations did not accurately estimate MHR (ES= 0.44, p < 0.05) by 6.3 bpm (bpm). Subgroup analyses indicated that the Fox equation (MHR = 220-age) overestimated MHR by 12.4 bpm (ES = 0.95, p < 0.05), whereas the Tanaka equation (MHR = 208--0.7*age) underestimated MHR by 2.7 bpm (ES = -0.34, p < 0.05). Conclusions: Age-based MHR equations derived from adult populations are not applicable to children. However, if the use of age-based equations cannot be avoided, we recommend using the Tanaka equation, keeping in mind the range of error reported in this study. Future research should control for potential pubertal influences on sympathetic modulation during exercise to facilitate the development of more age-appropriate methods for prescribing exercise intensity.