BACKGROUND: Increasing evidence has shown an increased risk of non-suicidal self-injury (NSSI) in left-behind children and adolescents (LBCAs). However, a systematic summary of studies comparing the risk of NSSI between LBCAs and non-LBCAs in China is lacking. AIM: To investigate the risk of NSSI among LBCAs in China. METHODS: We performed a systematic search of Embase, PubMed, and Web of Science from initiation to October 25, 2024, for all relevant studies of NSSI and LBCAs. The effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CI). Sensitivity analyses were conducted to further confirm the stability of the findings. RESULTS: A total of 10 studies with 165276 children and adolescents were included in this study. LBCAs had significantly higher rates of NSSI compared with non-LBCAs (OR = 1.33, 95%CI: 1.19-1.49), with high heterogeneity observed ( CONCLUSION: LBCAs are found to be at an increased risk of NSSI compared with children and adolescents of non-migrants. More attention and intervention are urgently needed for LBCAs, especially those living in developing countries.