A systematic review and meta-analysis examined the efficacy and safety of probiotics in the treatment of childhood asthma based on six randomized controlled trials with 731 pediatric patients. Probiotics significantly reduced interleukin-4 (IL-4) levels [SMD –0.66, 95% CI –1.24 to –0.08, P = 0.03] and increased interferon-γ (INF-γ) levels [SMD 1.78, 95% CI 95.03%]. However, they did not affect daytime or nighttime asthma symptom scores, forced expiratory volume in 1 s, forced vital capacity, peak expiratory flow, or tumor necrosis factor-α levels (P ≥ 0.05). Trial Sequential Analysis (TSA) did not confirm the robustness of these findings, and funnel plots indicated potential publication bias. The certainty of the evidence was rated as very low and all studies were from China. Available evidence does not support the routine use of probiotics as adjunctive therapy for childhood asthma.