To evaluate the impact of missed or late meal boluses (MLBs) on glycemic outcomes in children and adolescents with type 1 diabetes using automated insulin delivery (AID) systems. AID-treated (Tandem Control-IQ or Medtronic MiniMed 780G) children and adolescents (aged 6-21 years) from Stanford Medical Center and Steno Diabetes Center Copenhagen with ≥10 days of data were included in this two-center, binational, population-based, retrospective, 1-month cohort study. The primary outcome was the association between number of algorithm-detected MLBs and time in target glucose range (TIR; 70-180 mg/dL). The study included 189 children and adolescents (48% females with a mean ± SD age of 13 ± 4 years). Overall, the mean number of MLBs per day in the cohort was 2.2 ± 0.9. For each additional MLB per day, TIR decreased by 9.7%-points (95% CI 11.3; 8.1), and compared to the quartile with fewest MLBs (Q1), the quartile with most (Q4) had 22.9% less TIR (95% CI 27.2; 18.6). The age-, sex-, and treatment modality-adjusted probability of achieving a TIR of >70% in Q4 was 1.4% compared to 74.8% in Q1 (p<0.001). MLBs significantly impacted glycemic outcomes in AID-treated children and adolescents. The results emphasize the importance of maintaining a focus on bolus behavior to achieve higher TIR, and supports the need for further research in technological or behavioral support tools to handle missed and late meal boluses.