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Background We performed a systematic review and meta-analysis to identify pre-diagnostic symptoms/signs for childhood abdominal tumours to inform ongoing efforts to achieve earlier diagnoses of childhood cancers.Methods Medline (OVID), Embase (OVID) and PubMed were searched for studies published between January 2005 and December 2023, including children (<18 years) diagnosed with abdominal tumours, with no language restrictions. Pooled proportions of symptoms/signs were calculated. Sub-analyses were performed according to tumour location and age.Results 133 eligible studies were identified, totalling 8611 cases. The most frequently reported symptoms/signs were abdominal mass (39.3% (31.5% to 47.5%)), pain (14.5 (10.9% to 18.5%), abdominal swelling/distension (7.2% (3.3% to 12.1%)), haematuria (7.2% (2.9% to 6.2%)), fever (3.9% (2.2% to 5.9%)) and/or hypertension (2.6% (1.4% to 4.2%)).For adrenal tumours, precocious puberty (20.6% (2.8% to 46.8%)), Cushing’s syndrome (16.4% (5.9% to 30.1%)) and/or hypertension (12% (2.8% to 25.3%)) were reported.For liver tumours, abdominal mass (42.9% (0.0% to 100.0%)), abdomen mass and/or discomfort (16% (0.0% to 73.1%)), hepatomegaly (9.7% (0.0% to 60.7%)), abdominal swelling/distension (9.4% (0.0% to 64.0%)) and/or abdominal pain (7.7% (0.0% to 28.3%)) were reported.For renal tumours, abdominal mass (49.7% (39.0% to 60.5%)), abdominal pain (12.3% (8.5% to 16.6%)), haematuria (10% (7.4% to 13.0%)), abdominal swelling/distension (5.4% (1.5% to 11.2%)), hypertension (4.7% (2.5% to 7.5%)) and/or fever (3.5% (1.9% to 5.5%)) were reported.For neuroblastoma, abdominal mass (24% (7.0% to 46.4%), abdominal swelling/distension (9.2% (0.0% to 27.9%)), fever (7.4% (0.3% to 20.4%)), hepatomegaly (4.8% (0.0% to 19.8%)), anaemia/pallor (4.1% (0.0% to 13.3%)), abdominal pain (4% (0.0% to 13.4%)), screening/antenatal screening (3.4% (0.4% to 8.2%)) and/or opsoclonus-myoclonus-ataxia syndrome (2.7% (0.0% to 8.3%)) were reported.Conclusions The clinical presentation of childhood abdominal tumours varies according to location and tumour type. These variations in presentation should be used to guide interventions to facilitate earlier diagnosis, such as the UK’s new Child Cancer Smart campaign.