More than fifteen million native Chinese-speaking children are at risk for reading difficulties (RD), making effective Chinese reading interventions crucial for enhancing individual and societal well-being. A total of 51 studies from 2,015 children aged 6 to 13 years were included in the current meta-analysis to examine what works for reading interventions among Chinese children at risk for RD. For decoding outcomes, results indicated positive effects of interventions targeting decoding skills, g = 1.18, meta-linguistic skills, g = 0.57, and cognitive skills, g = 0.52. Interventions targeting decoding skills showed a stronger effect than those targeting cognitive skills. Interventions solely targeting decoding skills were as effective as multi-component interventions (e.g., combining decoding and meta-linguistic skills). For reading comprehension outcomes, results indicated positive effects of interventions targeting decoding skills, g = 0.64, and meta-linguistic skills, g = 0.79, but not of those targeting cognitive skills, g = - 0.08. Interventions targeting decoding skills were more effective than those targeting cognitive skills. These findings, taken together, suggest that compared to cognitive skills, interventions targeting decoding or meta-linguistic skills are consistently effective for improving decoding and reading comprehension. Decoding seems to be the active ingredient for successful reading interventions. Implications for future research were also discussed.