Objective To investigate the clinical pattern and influencing factors of pediatric Crohn's disease. Methods To conduct a retrospective analysis of 59 patients who were originally diagnosed with Crohn's disease and treated at the Children's Hospital Affiliated to Nanjing Medical University, from November 2015 to November 2020. All patients’ baseline datum were gathered, including demographics like age and sex, clinical presentation, laboratory, radiological, and endoscopic tests, as well as details on their treatment plan. Patients were followed up until December 31, 2023, and we analyzed the factors which influence the clinical pattern of children with Crohn's disease by logistic regression. Results There were 59 children with Crohn's disease. 11 patients were lost to follow-up, and 48 patients completed long-term follow-up, with a median follow-up of 42 months (range: 36-82 months). The median age of the 48 patients was 12.6 years (range: 1.1-15.9 years) and 29.2% (14 cases) were female. During the follow-up, 1 patient died, 1 underwent partial enterectomy, 7 patients (14.58%) developed new stenotic disease behavior, and 29 patients (60.4%) recurred. During the follow-up period, 31 patients (64.6%) reported a decrease in the severity of intestinal symptoms . Only 2 patients (4.2%) reported an increase in symptom severity, while 5 patients (10.4%) reported chronic persistent symptoms and 10 patients (20.8%) reported chronic recurrent symptoms .The regression models indicated that wasting at the time of initial diagnosis could be a risk factor for patients to progress to the 'severe' pattern (OR, 4.009, 95% CI, 1.047-15.346, P=0.043); the percentage of patients with combined stenosis or perforation was significantly higher in the "severe" pattern than in the "quiescent" pattern (41.2% versus 16.1%); the Crohn's disease pattern was not influenced by the treatment regimen at the time of initial diagnosis. Conclusion Wasting at the time of initial diagnosis could potentially increase the risk of progressing to a 'severe' disease pattern, which may require more aggressive treatment and closer follow-up.