Background: Actual and perceived motor competence are important correlates of various health-related behaviors. As such, numerous studies have examined the association between both constructs in children and adolescents. Objectives: The first aim of this review and meta-analysis was to systematically examine, analyze and summarize the scientific evidence on the relationship between actual and perceived motor competence (and by extension more general physical self-perception) in children, adolescents and young adults with typical and atypical development. The second aim was to examine several a priori determined potential moderators (i.e., age, sex, and developmental status of study participants, as well as level of alignment between measurement instruments) of the relationship between actual motor competence and perceived motor competence/physical self-perception. Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and was registered with PROSPERO on August 21st 2017. Data Sources: A systematic literature search of five electronic databases (i.e., MEDLINE, SPORTDiscus, Web of Science, PsycINFO and EMBASE) with no date restrictions was conducted. Eligibility Criteria for Selecting Studies: Eligibility criteria included (1) a study sample of youth aged 3–24 years, (2) an assessment of actual motor competence and perceived motor competence/physical self-perception, and (3) a report of the association between both, using a cross-sectional, longitudinal, or experimental design. Only original articles published in peer-reviewed journals with at least the title and abstract in English were considered. Analyses: Meta-analyses were conducted by type of actual motor competence (i.e., overall motor competence, locomotor, object control, stability/balance and sport-specific competence) through univariate and multivariable random-effects meta-regression and clustered random-effects meta-regression models. Results: Of the 1643 articles screened, 87 were included for the qualitative review, while 69 remained for the final meta-analyses. All included studies had some risk of bias with only 15% meeting five of the six examined criteria. Significant (p < 0.001) pooled effects were found for overall motor competence (N = 54; r = 0.25; 95% CI [0.20, 0.29]), locomotor (N = 45; r = 0.19; 95% CI [0.13, 0.25]), object control (N = 50; r = 0.22; 95% CI [0.17, 0.27]), stability/balance (N = 8; r = 0.21; 95% CI [0.12, 0.30]), and sport-specific competence (N = 8; r = 0.46; 95% CI [0.28, 0.61]). None of the hypothesized moderators significantly influenced the relationship between actual motor competence and perceived motor competence/physical self-perception. Conclusions: The strength of the association between actual motor competence and perceived motor competence/physical self-perception in youth is low to moderate, with current data demonstrating that the strength of association does not differ by age, sex, developmental status, or alignment between measurement instruments. However, this review highlights the lack of clarity on the relationship between actual motor competence and perceived motor competence/physical self-perception. Future research should address issues surrounding the design of studies and measurement of actual motor competence and perceived motor competence/physical self-perception as well as explore other potential confounding variables (i.e., product- versus process-oriented assessments, race, culture) that might affect the relationship between these two constructs.