Children and adolescents with Crohn's disease (CD) present often with a more complicated disease course compared to adult patients. In addition, the potential impact of CD on growth, pubertal and emotional development of patients underlines the need for a specific management strategy of pediatric-onset CD. To develop the first evidenced based and consensus driven guidelines for pediatric-onset CD an expert panel of 33 IBD specialists was formed after an open call within the European Crohn's and Colitis Organisation and the European Society of Pediatric Gastroenterolog, Hepatology and Nutrition. The aim was to base on a thorough review of existing evidence a state of the art guidance on the medical treatment and long term management of children and adolescents with CD, with individualized treatment algorithms based on a benefit-risk analysis according to different clinical scenarios. In children and adolescents who did not have finished their growth, exclusive enteral nutrition (EEN) is the induction therapy of first choice due to its excellent safety profile, preferable over corticosteroids, which are equipotential to induce remission. The majority of patients with pediatric-onset CD require immunomodulator based maintenance therapy. The experts discuss several factors potentially predictive for poor disease outcome (such as severe perianal fistulizing disease, severe stricturing/penetrating disease, severe growth retardation, panenteric disease, persistent severe disease despite adequate induction therapy), which may incite to an anti-TNF-based top down approach. These guidelines are intended to give practical (whenever possible evidence-based) answers to (pediatric) gastroenterologists who take care of children and adolescents with CD; they are not meant to be a rule or legal standard, since many different clinical scenario exist requiring treatment strategies not covered by or different from these guidelines.

2nd Department of Paediatrics Iuliu Hatieganu University of Medicine and Pharmacy Emergency Children's Hospital Crisan nr 5 400177 Cluj Napoca Romania

Child Life and Health Paediatric Gastroenterology Royal Hospital for Sick Children 9 Sciennes Road Edinburgh EH9 1LF United Kingdom

Department of Gastroenterology and Nutrition Hopital Robert Debré 48 Bd Sérurier APHP 75019 Paris France; Université Paris Diderot Sorbonne Paris Cité 75018 Paris France

Department of Gastroenterology and Nutrition Meyer Children's Hospital Viale Gaetano Pieraccini 24 50139 Florence Italy

Department of Gastroenterology Helsinki University Hospital for Children and Adolescents Stenbäckinkatu 11 P O Box 281 00290 Helsinki Finland

Department of Gastroenterology Hepatology and Feeding Disorders Instytut Pomnik Centrum Zdrowia Dziecka Ul Dzieci Polskich 20 04 730 Warsaw Poland

Department of Medicine 1 Agaplesion Markus Hospital Wilhelm Epstein Str 4 60431 Frankfurt Main Gemany

Department of Paediatric Gastroenterolgoy Hepatology and Nutrition Hospital Sant Joan de Déu Paseo Sant Joan de Déu 2 08950 Barcelona Spain

Department of Paediatric Gastroenterology and Nutrition Children's University Hospital Laarbeeklaan 101 1090 Brussels Belgium

Department of Paediatric Gastroenterology APHP Hôpital Necker Enfants Malades 149 Rue de Sèvres 75015 Paris France; Université Paris Descartes Sorbonne Paris Cité 2 Rue de l'École de Médecine 75006 Paris France; INSERM U989 Institut IMAGINE 24 Bd Montparnasse 75015 Paris France

Department of Paediatric Gastroenterology Children's Hospital University of Zagreb Medical School Klaićeva 16 10000 Zagreb Croatia

Department of Paediatric Gastroenterology Dr von Hauner Children's Hospital Lindwurmstr 4 80337 Munich Germany

Department of Paediatric Gastroenterology Erasmus Medical Center Wytemaweg 80 3015 CN Rotterdam Netherlands

Department of Paediatric Gastroenterology Hepatology and Nutrition University Medical Center Groningen P O Box 30001 9700 RB Groningen Netherlands

Department of Paediatric Gastroenterology Yorkhill Hospital Dalnair Street Glasgow G3 8SJ United Kingdom

Department of Paediatrics 1 Semmelweis University Bókay János str 53 1083 Budapest Hungary

Department of Paediatrics 460 Hvidovre University Hospital Kettegård Allé 30 2650 Hvidovre Denmark

Department of Paediatrics Hospital for Sick Children University of Toronto 555 University Avenue M5G 1X8 Toronto ON Canada

Department of Paediatrics St Marien Hospital Robert Koch Str 1 53115 Bonn Germany

Department of Pediatric Gastroenterology and Nutrition Rambam Health Care Campus Rappaport Faculty Of Medicine 6 Ha'alya Street P O Box 9602 31096 Haifa Israel

Department of Pediatrics Centre for Clinical Research Entrance 29 Västmanland Hospital 72189 Västerås Karolinska Institutet Stockholm Sweden

Department of Pediatrics University Hospital Motol Uvalu 84 150 06 Prague Czech Republic

Department of Translational Medical Science Section of Paediatrics University of Naples Federico 2 Via S Pansini 5 80131 Naples Italy

Division of Gastroenterology and Nutrition and Children's Research Center University Children's Hospital Zurich Steinwiesstrasse 75 8032 Zurich Switzerland

Division of Pediatric Gastroenterology Hepatology and Nutrition Mass General Hospital for Children 175 Cambridge Street 02114 Boston United States

Gastroenterology and Endoscopy Unit Istituto G Gaslini Via G Gaslini 5 16148 Genoa Italy

Gastroenterology Sheba Medical Center 52621 Tel Hashomer Israel

Paediatric Gastroenterology and Nutrition Unit Edmond and Lily Safra Children's Hospital Sheba Medical Center 52625 Tel Hashomer Israel

Paediatric Gastroenterology and Nutrition Unit Hospital Materno Infantil Avda Arroyo de los Ángeles s n 29009 Málaga Spain

Paediatric Gastroenterology and Nutrition Unit Tel Aviv University Edith Wolfson Medical Center 62 HaLohamim Street 58100 Holon Israel

Pediatric Gastroenterology Unit Shaare Zedek Medical Center The Hebrew University of Jerusalem Israel

Unit of Paediatric Gastroenterology Hospital S João A Hernani Monteiro 4202 451 Porto Portugal

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