HELMHOLZ first reported in 1923 the occurrence of chronic ulcerative colitis in children.4 In this report the author contrasted the results of medical and surgical therapy and strongly urged operative treatment in those cases failing to improve after six to eight weeks of medical management. Since then, numerous reports of chronic ulcerative colitis in children have appeared and these have increased in frequency in recent years.1,2,5,6,8,9 In general most of these communications have documented the seriousness of the disease but overall management of the afflicted child has not changed appreciably since the time of Helmholz. The purpose of this communication is to present some of the clinical and pathological characteristics of chronic idiopathic ulcerative colitis as it occurs in children and to detail a combined clinical approach undertaken 3½ years ago by members of the departments of surgery, pediatrics, and psychiatry at the University of Michigan Medical Center,