Aim To compare the effects of physical therapy with hippotherapy versus physical therapy alone on the gross motor function of children and adolescents with cerebral palsy (CP). Method Electronic searches were conducted in January 2021. We included controlled trials of the gross motor function of children and adolescents with CP, aged 2 to 18 years. We extracted means, standard deviations, and changes from the baseline to the end of the intervention. We used the Cochrane Collaboration’s tool modified by Effective Practice and Organization of Care (EPOC) to assess the methodological quality and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to verify evidence synthesis. We conducted the meta‐analysis using Revman 5.3. Results A total of 315 individuals from six studies were included. Both groups received physical therapy including strength, aerobic, stretch, and mobility exercises, and neurodevelopmental treatment. Studies presented high risk of bias. Both therapies presented similar effects for Gross Motor Function Measure scores, cadence, stride length, and speed during gait. The level of evidence was very low. The change was greater for the physical therapy with hippotherapy group, but inferior to the smallest real difference or the minimal detectable change. Interpretation Physical therapy with hippotherapy presented similar effects to physical therapy alone on the gross motor function of children and adolescents with CP. Future studies should include larger sample sizes and studies with low risk of bias.