Inflammatory bowel disease (IBD) is an increasingly common cause of morbidity in the pediatric population. Despite the establishment of dedicated multidisciplinary IBD teams in many centers, the care offered by emergency physicians is often crucial in the period before diagnosis and at times of relapses or acute complications. Crohn's disease and ulcerative colitis can present with a myriad of acute and chronic symptoms to the emergency department. Pediatric Crohn's disease encompasses a variety of phenotypic forms and often does not present with the classic triad of diarrhea, abdominal pain, and weight loss. Pediatric ulcerative colitis tends to be more extensive than adult-onset disease, with a greater predilection to acute severe exacerbations requiring urgent recognition. Disease- and treatment-related complications of IBD, both intestinal and extraintestinal, can be life threatening and require an integration of medical and surgical care from triage until discharge from the emergency department.