Introduction: Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there is limited evidence regarding the utility of elective FB in children. This systematic review aimed to determine the utility of FB on its impact in clinical decision making and patient-reported outcome measures (PROMs). Methods: We searched Pubmed, Cochrane central register of controlled trials, Embase, World Health Organisation Clinical Trials Registry Platform and Cochrane database of systematic reviews from inception to 20 ^th April 2023. We included systematic reviews (SRs) and randomised controlled trials (RCTs) that used parallel group design (comparing use of elective FB versus no FB, or a wait-list approach [early FB versus usual wait FB]) in children aged ≤ 18 years. Our protocol was prospectively registered and used Cochrane methodology for systemic reviews of interventions. Results: Our search identified 859 articles; 102 duplicates were removed, and 753 articles were excluded by title and abstract. Four full text articles were reviewed and subsequently excluded, as none met the inclusion criteria outlined in our PICO framework. Conclusions: Given the paucity of data, there is need for high-quality evidence to support the routine use of elective FB in children with respiratory conditions. We recommend clinicians adhere to current international guidelines until such evidence emerges. Registration: PROSPERO CRD42021291305.