OBJECTIVE To evaluate the safety of gastrostomy tube (G-tube) placement in children with Crohn's disease and the efficacy of prolonged enteral hyperalimentation in children with growth failure complicating Crohn's disease. METHODS Twenty children with Crohn's disease and growth failure were offered enteral hyperalimentation via nasogastric tube (NG-tube) for treatment of growth arrest, with follow-up for complications, compliance, and response to nutritional support. The use of a G-tube was offered to children who refused to use the NG-tube. Medical and surgical management were provided as dictated by the disease activity. RESULTS Thirteen children were started on NG-tube feeds, and five were started on G-tube feeds after refusal to use an NG-tube at the outset. Two children required surgery at the time of diagnosis and had a G-tube placed during the operation. Nine of 13 children found the use of an NG-tube too disruptive and were later changed to a percutaneous endoscopic gastrostomy (PEG) or surgically-placed G-tube. A total of 16 children had a percutaneous endoscopic gastrostomy (eight children) or a surgically-placed G-tube (eight children) for 6-29 months. Two of those children had endoscopic evidence of gastroduodenal Crohn's disease, and six had microscopic patchy chronic gastritis. Minor complications occurred in five of the 16, including external leakage, button dislodgement, local pain, and local wound infection. At this time, the G-tube has been removed from 13 children, 12 of whom had prompt and complete healing of the G-tube site and one of whom had a small gastrocutaneous fistula that required suture for successful closure. Poor compliance with G-tube feeds was observed in four of 16 children. During the period of nutritional support, there was resumption of normal growth rates for all; in addition, eight of 16 had catch-up growth. CONCLUSIONS Nutritional therapy is important in the management of children with growth failure due to Crohn's disease, though it may not be the only factor affecting growth. G-tubes are safe and well tolerated by children with Crohn's disease and should be offered to those children who do not tolerate prolonged use of an NG-tube.