Asthma is a common chronic disease in childhood, and achieving optimal symptom control remains challenging. Lifestyle-related factors, including dietary patterns such as the Mediterranean diet, may influence asthma outcomes through anti-inflammatory and antioxidant effects.To systematically review the evidence on the association between postnatal adherence to the Mediterranean diet and asthma control and exacerbations in children and adolescents.A systematic literature search was conducted in PubMed to identify studies published between 2007-2024 evaluating Mediterranean diet adherence and asthma-related outcomes in individuals aged 0-18 years. Eligible studies used validated Mediterranean diet indices (e.g., Mediterranean Diet Score, KIDMED) and reported asthma control, wheezing, or exacerbation outcomes. Prenatal exposure studies and adult populations were excluded. The methodological quality of included observational studies was assessed using the Newcastle–Ottawa Scale (NOS) and considered in the interpretation of findings. Reported adjusted odds ratios and corresponding confidence intervals were collated and synthesized to support comparative presentation of results.A total of six pediatric studies, including population-based cross-sectional studies and a limited number of prospective or intervention studies from Europe, Latin America, and the Middle East, were included. Higher adherence to the Mediterranean diet was associated with improved asthma-related outcomes, with reduced odds of wheezing or asthma symptoms (adjusted odds ratios ranging from 0.45 to 0.70 (95% CI: 0.28-0.90). Incremental increases in Mediterranean diet scores were linked to a modest reduction in severe asthma or frequent wheezing. Evidence on asthma exacerbations was limited and heterogeneous, as objective outcomes were infrequently reported.Greater adherence to the Mediterranean diet is associated with better asthma control and fewer respiratory symptoms in children, while evidence for a reduction in asthma exacerbations remains inconclusive.From a primary care perspective, promoting healthy dietary patterns may represent a feasible, low-risk, non-pharmacological approach to support pediatric asthma management. Further prospective studies and randomized controlled trials are needed.