Sensory processing difficulties are worth exploring in youths with ASD and feeding problems considering their high frequency and therapeutic potential. To synthesize prior knowledge and discrepancies between studies, a systematic review and meta-analysis were conducted. The quality of the 16 reviewed studies was regarded as moderate. The association between sensory processing difficulties in all modalities and problematic eating behaviors was not statistically significant. Oral sensory processing difficulties were associated with food refusal (SMD = - 0.88, p = 0.04) and all types of problematic eating behavior (SMD = - 1.31, p < 0.001), with little evidence supporting the role of atypical sensory processing in non-oral modalities. These findings highlight the importance of considering oral sensory processing performance of youths with ASD and eating complaints.