Blueberry Bioactives as Adjunctive Nutritional Strategies for Pediatric Neurodevelopmental and Emotional-Behavioral Health: Mechanisms, Evidence, and Translational Challenges.

The rising prevalence of neurodevelopmental, emotional, and behavioral disorders in children has prompted interest in dietary strategies that target neuroinflammation, oxidative stress, and gut dysbiosis. Blueberries (Vaccinium spp.) contain substantial amounts of anthocyanins and other neuroactive polyphenols that may confer neuroprotective effects. We summarize the literature published between 2016 and 2025 to examine how the bioactives in blueberries affect symptoms relevant to children with diagnosed neurodevelopmental or emotional-behavioral disorders, including ADHD, mood problems, and cognitive difficulties. Mechanistically, anthocyanins appear to modulate gut microbial composition, modulate neuroinflammation and alleviate oxidative stress via the Nrf2 pathway, and support synaptic plasticity and neurogenesis. Clinical trials, although limited in number and sample size, have reported modest improvements in mood and verbal memory in typically developing children and adolescents, with some gains in attention and executive function. However, direct trials in children with diagnosed neurodevelopmental or emotional-behavioral conditions remain scarce. There are substantial hurdles to translating these findings. Anthocyanins have poor physicochemical stability and low bioavailability, and routine food processing degrades their activity. Emerging solutions such as green extraction from agricultural by-products, colon-targeted microencapsulation, and zero-waste engineering could address these limitations. Rigorous randomized controlled trials in children with diagnosed neurodevelopmental or emotional-behavioral disorders are essential, as are advances in food engineering. Both are needed to move blueberry-based interventions from the laboratory to application.