Abstract: Tidal flats, serving as critical interfaces of land-sea interactions, play vital roles in coastal protection and biodiversity conservation. Extensive tidal flats have developed along the coast of East China. However, in recent years, significant alterations in their erosion-accretion patterns and considerable challenges to their systemic stability have emerged, driven by multiple factors including a drastic reduction in riverine sediment supply, the expansion of reclamation projects, sea-level rise, and the increased frequency of extreme events. This paper systematically reviews the current status of tidal flat erosion and accretion along the East China coast, aiming to elucidate the evolutionary trends of different tidal flat types under the interplay of natural factors and human activities. The findings reveal that the erosion-accretion response of tidal flats along the East China coast demonstrates significant spatial heterogeneity, governed by regional hydrodynamic-sediment-morphodynamic processes and human interventions. Three distinct response patterns are identified: ① Along Jiangsu’s open coast, erosion has progressively intensified and erosional hotspots have migrated southward under combined conditions of sediment supply reduction and enhanced hydrodynamics; ② In the Yangtze Estuary-Hangzhou Bay estuarine system, significantly influenced by the dramatic decline in Yangtze-derived sediment, tidal flats have transitioned from accretion to partial erosion, with erosion intensity generally decreasing in a landward direction; ③ The Zhejiang-Fujian embayment tidal flats have maintained net accretion with a southward-decreasing intensity, though their recent accretion rates have diminished due to the reduced sediment flux from the Yangtze River and ongoing intensive reclamation activities. The insights from this study can provide a scientific basis for the protection and ecological restoration of tidal flats along the East China coast.