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The introduction of biologic agents, beginning with monoclonal antibodies targeting tumor necrosis factor (TNF) alpha, has launched a new era of advancements that have markedly improved short\u2010 and long\u2010term outcomes of Crohn's disease and ulcerative colitis. Along with these improvements, there have been challenges to address in optimizing use of biologic therapies in children with IBD. Young children may have rapid drug clearance, and growing children have changing medication needs related to changes in body size, metabolism, and development. For these and other reasons, one size (one dose) does not fit all. Therapeutic drug monitoring (TDM), which involves measurement of drug concentration in serum usually, typically at the predose trough, has emerged as a valuable tool for optimizing dosing and preventing pharmacokinetic failure. This society paper reviews the use of TDM, including target ranges during induction and maintenance therapy for anti\u2010TNF agents and for emerging biologics. This report has been compiled by pediatric gastroenterologists on behalf of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition IBD committee after extensive review of the current literature. The purpose of this clinical position statement is to provide guidance to clinicians in the use of TDM to optimize the treatment of children with IBD.<\/jats:p>","DOI":"10.1002\/jpn3.70158","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T05:38:51Z","timestamp":1753162731000},"page":"1100-1117","source":"Crossref","is-referenced-by-count":18,"title":["North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper on the therapeutic drug monitoring in pediatric inflammatory bowel disease"],"prefix":"10.1002","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2382-1058","authenticated-orcid":false,"given":"Lina M.","family":"Felipez","sequence":"first","affiliation":[{"name":"Nicklaus Children's Hospital Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5887-5454","authenticated-orcid":false,"given":"Sabina","family":"Ali","sequence":"additional","affiliation":[{"name":"Benioff Children's Hospital University of California at San Francisco Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0946-9759","authenticated-orcid":false,"given":"Edwin F.","family":"de Zoeten","sequence":"additional","affiliation":[{"name":"Children's Hospital of Colorado Anschutz Medical Center University of Colorado Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8623-4665","authenticated-orcid":false,"given":"Anne M.","family":"Griffiths","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3302-7589","authenticated-orcid":false,"given":"Sandra C.","family":"Kim","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Children's Hospital, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4435-2644","authenticated-orcid":false,"given":"Ashish S.","family":"Patel","sequence":"additional","affiliation":[{"name":"Phoenix Children's Hospital Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5108-3950","authenticated-orcid":false,"given":"Joel R.","family":"Rosh","sequence":"additional","affiliation":[{"name":"Cohen Children's Medical Center, Zucker School of Medicine New Hyde Park New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4857-6098","authenticated-orcid":false,"given":"Jeremy","family":"Adler","sequence":"additional","affiliation":[{"name":"C.S. 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