Background: CVADs are essential to support long-term intravenous access. Silicone and polyurethane have distinct mechanical properties that may influence complications. Evidence guiding CVAD selection in children is sparse and largely extrapolated from adult studies. This study aimed to synthesise the available paediatric evidence and identify gaps. Methods: A systematic review (1980-2025) was conducted using PRISMA guidelines on studies describing complications of silicone and polyurethane CVADs in children. Proportional meta-analysis for non-comparative studies was conducted and reported as % (95% CI). I2 was used to assess heterogenicity with >50% considered significant. Results: We identified 1,269 articles from 5 databases; 9 studies met the inclusion criteria (6 retrospective, 3 prospective). Complications assessed: -CVAD occlusion: Silicone 2.9% (1.15-5.3); I2 = 49% – Polyurethane 5.7% (2.5-10.1); I2 = 59% -CVAD–associated bloodstream infection (CLABSI): Silicone 16.5% (7.3-28.4); I2 = 89% - Polyurethane 11% (2.5-24.5); I2 = 91% -Local site complications (e.g., wound infection): Silicone 2.0% (0.6-4.1); I2 = 0% - Polyurethane 1.4% (0.2-8.0); I2 = 78% -CVAD‑associated venous thromboembolism: Silicone no data - Polyurethane 2.1% (0.9-14.4); I2 = 74% -Dislodgement/accidental removal: Silicone 7.1% (1.2-17.3); I2 = 80% - Polyurethane no data -Rupture: Silicone 1.0% (0.04-3.1); I2 = 0% - Polyurethane no data -Mechanical complications at removal: Silicone 5.0% (0.4-14.3); I2 = 89% - Polyurethane 10.0% (5.1-16.1); I2 = 65.4% Conclusions: Evidence directly comparing silicone and polyurethane CVADs in children is extremely limited, preventing meaningful statistical comparison. Proportional meta‑analysis of non‑comparative studies showed low but variable complication rates for both materials, with substantial heterogeneity and important gaps in reporting. Current data do not demonstrate clear superiority of either material. Robust prospective comparative studies are needed to determine whether catheter material influences clinical outcomes in paediatric CVADs use.