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When children develop inflammatory bowel disease (IBD), physicians and researchers are presented with a singular opportunity to understand the nature of these chronic, idiopathic illnesses in the earliest stages. Genetic susceptibility factors tend to be common, whereas complicating environmental factors such as cigarette smoking are generally not an issue. As opposed to the case in adult patients, Crohn's disease is usually diagnosed in children at an early, inflammatory phase of the disease. Pediatric ulcerative colitis tends to present with more severe and more extensive involvement than in adults. In both forms of IBD, the severity of disease activity often dictates the need for early aggressive nutritional, immunomodulatory, and biologic therapy. As a result, the lessons learned from the evaluation and treatment of children with IBD are critically important to the clinician caring for adults with the same disorders.

The literature of the past year has produced significant advances relevant to the diagnosis and treatment of children and adolescents with inflammatory bowel disease. This review focuses on new observations regarding the epidemiology, genetics, etiology, diagnosis, and treatment of both Crohn's disease and ulcerative colitis in children. Particular attention is paid to the expanded indications for the use of immunomodulatory therapy, and to the early published data regarding the safety and efficacy of treatment with infliximab.

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