There are significant differences between paediatric and adult gastrointestinal (GI) disease, and even the normal GI histology shows some variation.Excess eosinophils in the gut can be present in food allergies (frequent in children) but also in eosinophilic gastroenteritis. Inflammatory bowel disease (IBD) has some distinctive features when it presents in children. Genetic factors may play a greater role in pathogenesis, and the combination of clinical and histological criteria required for diagnosing Crohn’s Disease or ulcerative colitis (UC) is different. Atypical UC patterns are more common and clinical presentation of Crohn’s disease can also be different; the frequency of granulomas in Crohn’s disease is significantly higher in children. Inflammatory Bowel Disease Unclassified (IBDU) has its highest frequency in younger patients, possibly because of atypical characteristics of paediatric UC. Monogenic forms of IBD-like colitis typically develop during infancy or early childhood, an can have features of Crohn’s disease, UC or IBD unclassified. Histology is often indistinguishable from conventional IBD.Necrotising enterocolitis (NEC) primarily affects the small intestine of premature infants, with haemorrhagic necrosis of the bowel wall.Fibrosing colonopathy has been reported in children exposed to high doses of pancreatic enzymes and is characterised by bowel wall thickening, submucosal fibrosis and chronic mucosal inflammation.