Endoscopy for a hospitalized patient with acute severe ulcerative colitis should be limited to flexible sigmoidoscopy. If, during pregnancy, inflammatory bowel disease (IBD) is active or if a new diagnosis of IBD is suspected, endoscopy may be needed to guide medical decision-making. The determination to proceed with endoscopy during pregnancy is nuanced and requires the ability to discern appropriate indications, knowledge regarding safety of bowel preparation and anesthesia. Pediatric patients with IBD represent a unique subset of IBD with distinctive diagnostic, therapeutic, and monitoring considerations.