In many countries the cut off age for pediatric care lies between 15-18 y of age (1). Above that age, patients are transferred to gastroenterologists for adult patients. Adequate transition for these patients has been the subject of many publications (1-3). Even though pediatric Crohn’s disease (CD) patients differ from adults (4), there is often a grey zone for teenagers, whom gastroenterologists accept under their care.

Pediatric CD patients present more often with severe and extensive disease, growth retardation and pubertal delay (4, 5). Growth is specific to childhood and adolescence and it is a crucial factor at diagnosis. Disease management needs to incorporate the achievement of full growth potential (6). Even though general treatment practices for pediatric care are derived from adult practice, specific approaches such as nutritional therapy, have proven to be particularly efficient in the pediatric age group (7). Specific criteria for the diagnosis of pediatric inflammatory bowel disease (IBD), the Porto Criteria, have been published evoking the importance of clinical, biochemical and endoscopic evaluation of upper and lower gastrointestinal (GI) tract as well as small bowel imaging (8). The diagnostic yield of an upper endoscopy in pediatric CD is around 10% in recent studies (9, 10), while upper endoscopy in adult care is not considered mandatory. In this article we review the difference in presentation, diagnostic procedures and initial treatment between pediatric CD patients registered in the Belgium registry for pediatric Crohn’s disease (BELCRO) by pediatric gastroenterologists and gastroenterologists for adult patients. The BELCRO database was initiated in May 2008 through a collaboration of the IBD working group of the Belgian Society for Pediatric Gastroenterology, Hepatology and Nutrition (BESPGHAN) and the Belgian IBD Research and Development Group (BIRD). The registry recruited previously and newly diagnosed pediatric CD patients over a 2 y period and is following them prospectively for 5 years. All Belgian pediatric and adult gastroenterology centers were invited to participate in the registry. More details about the recruitment and the