This meta-analysis aimed to determine whether Chinese-English bilingual children with reading difficulties (RD) have significant deficits in morphological awareness (MA), phonological awareness, and word reading, in both their first and second languages (L1 and L2). It also evaluated the influence of RD severity, age, diglossia context, and methodological design on effect sizes. The study included 29 samples (N = 4,516) from 14 studies on children with RD in L1 morphosyllabic Chinese and L2 morphophonemic English. Results showed medium effect sizes for MA (g = −0.722) and PA (g = −0.625), and a large effect size for word reading (g = −2.042) in L1 Chinese. In L2 English, medium to large effect sizes were found for MA (g = −1.083), PA (g = −0.857), and word reading (g = −0.730). Age was the only significant moderator, with larger deficits observed as age increased. These findings align with studies on monolinguals with dyslexia and bilinguals with normal abilities or disabilities, recommending MA tasks in assessments.