BACKGROUND: The incidence of inflammatory bowel disease (IBD) in childhood and 
adolescence is 5-11 cases per 100 000 persons per year, corresponding to a new 
diagnosis of IBD in 800-1470 patients in Germany each year.
METHODS: This review is based on pertinent publications retrieved by a selective 
search in PubMed, including guidelines from Germany and abroad.
RESULTS: Children and adolescents with IBD often have extensive involvement and 
an aggressive course of disease. Nonetheless, infliximab and adalimumab are the 
only biological agents that have been approved for this group of patients. In 
Crohn's disease, exclusive enteral nutrition is the treatment of first choice 
for inducing a remission. Patients with (peri-)anal fistulae are treated 
primarily with infliximab. Corticosteroids and aminosalicylates should be used 
with caution. In contrast, children and adolescents with ulcerative colitis are 
treated with either aminosalicylates or prednisolone to induce a remission. As a 
rule, maintenance pharmacotherapy with thiopurines in Crohn's disease and severe 
ulcerative colitis, or with aminosalicylates in mild to moderate ulcerative 
colitis, is indicated for several years, at least until the end of puberty. 
Patients with refractory disease courses are treated with methylprednisolone, 
anti-TNF-α-antibodies, and/or calcineurin inhibitors. The spectrum of surgical 
interventions is the same as for adults. Specific aspects of the treatment of 
children and adolescents with IBD include adverse drug effects, the areas of 
nutrition, growth, and development, and the structured transition to adult 
medicine.
CONCLUSION: Children and adolescents with IBD or suspected IBD should be cared 
for by pediatric gastroenterologists in a center where such care is provided. 
Individualized treatment with multidisciplinary, family-oriented longterm care 
is particularly important. Drug trials in children and adolescents are needed so 
that the off-label use of drugs to patients in this age group can be reduced.