In paediatric patients, Crohn's disease often presents with an inflammatory phenotype. However, a subgroup of individuals develop complicated disease behaviours (stricturing or fistulizing) over time so a model for predicting the risk of complications is needed to guide treatment decisions. In the latest study, Kugathasan et al. performed a multicentre, prospective, inception cohort study in children (n = 913) newly diagnosed with Crohn's disease and free of initial complications. After 36 months of follow-up, 9% of patients developed disease complications and a validated risk-prediction model based on clinical, serological, microbial and gene expression factors was found to have a sensitivity of 66%, a specificity of 71% and a negative predictive value of 94%. Also, patients who received early anti-TNF therapy were less likely to have fistulizing complications but not stricturing complications. Thus, this model could identify patients at low-risk of complications and prioritize those that might benefit from anti-TNF therapy.