Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis, is a growing global health challenge, with approximately 25% of cases diagnosed before the age of 20. These chronic immune- mediated disorders result from complex interactions between genetic predisposition, environmental triggers, gut microbiome alterations, and immune dysregulation. Pediatric IBD presents with more extensive disease than adult-onset cases, with unique manifestations including growth failure and delayed puberty. Diagnosis relies on clinical assessment, fecal calprotectin, and endoscopic evaluation. Contemporary management emphasizes treat-to-target strategies using exclusive enteral nutrition (60–80% remission rates) and biologic therapies for moderate- to-severe disease. Anti-TNF agents remain first-line biologics, while ustekinumab has recently received Food and Drug Administration and European Medicines Agency approvals for pediatric CD based on the UNITI Jr trial, and emerging data on JAK inhibitors further expand the therapeutic landscape. This review provides a comprehensive overview of disease subtypes, pathophysiology, diagnostics, and evidence-based treatment strategies.