Childhood IBD is an extensive disease and more aggressive when compared with adult-onset disease. There is a one-third risk of needing surgery within the first five years of the disease. Pediatric population include more systemic symptoms such as weight loss, anorexia, growth delay, delayed puberty, skin changes, depression, and anxiety. In these patients there are 5 categories — Typical UC, atypical UC, clear CD (including colonic CD), normal, or IBD-unclassified. Attention must be given towards impact on growth and development, school absenteeism, quality of life, missed school days, reduced participation in extracurricular activities, subjective school underperformance, and therapy adherence. 50% of pediatric patients do not adhere adequately to therapy.