Chronic inflammatory bowel disease (IBD) is increasingly recognized in children and adolescents, particularly in countries withWestern lifestyle. As timely diagnosis and therapy have a significant impact on the long-term outcome of the disease, close cooperation between pediatricians and pediatric gastroenterologists is necessary. In the absence of infectious causes IBD must be excluded in cases of chronic or recurrent symptoms. Increased concentrations of inflammatory markers in feces (e. g. calprotectin) are very sensitive in active IBD but not specific. The diagnostic work-up essentially includes endoscopy and small bowel imaging. In addition to pharmaceutical treatment and nutritional therapy for Crohn's disease, new biologicals and immunomodulators are available. To tailor treatment modalities knowledge of drug effects, potential side effects, drug interactions, individual risk factors, IBD phenotype as well as disease activity is required.