OBJECTIVES: Extraintestinal manifestations (EIM) are common complications of inflammatory bowel disease (IBD) associated with morbidity and reduced quality of life (QOL). The aim of this study was to identify and validate predictors for EIM in children with IBD. METHODS: The medical records of children with IBD were retrospectively reviewed, and EIM present before diagnosis and those detected during follow-up, were recorded. RESULTS: One-hundred children were included, and their median age (interquartile range) was 13.9 (11.9-15.2) years. Forty-six (46%) children had EIM, including 10 (10%) whose EIM was present before diagnosis and 36 (36%) during follow-up. The most common EIMs were aphthous stomatitis (18%), arthralgia (14%), dermatologic manifestations (8%), and arthritis (6%). A body mass index in the lower or upper quartile (hazard ratio [HR] 9.30 and 23.71, respectively, p < 0.001), moderate-to-severe disease activity (HR 4.43, p < 0.001), extensive Crohn's disease (HR 3.43, p = 0.025), lower hemoglobin level (HR 2.29, p < 0.001), lower albumin level (HR 2.86, p = 0.029), and higher C-reactive protein level (HR 1.04, p < 0.001) at diagnosis were identified as risk factors for EIM during follow-up. CONCLUSIONS: Identification of risk factors at IBD diagnosis may help healthcare providers to predict EIM in children with IBD and to improve their management for lessening morbidity and enhancing QOL.