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Ustekinumab is an anti IL12 and IL 23 monoclonal antibody available to treat Crohn’s and Ulcerative colitis. We wanted to review it’s use in our patients. A list of patients was obtained from ‘Infoflex’ database and electronic patient notes were reviewed for IBD type; age at a diagnosis; age of starting Ustekinumab; disease distribution; previous biologics and outcome of our patients who had been treated with Ustekinumab. 27 patients were treated with Ustekinumab, of whom 2 received Ustekinumab on 2 separate episodes. 4 patients were excluded as they had transferred to adult services with no follow up data. 23 patients; (10 females) were evaluated. All patients received an induction dose intravenously followed by subcutaeous injection as per standard protocol.21 patients were diagnosed with Crohn’s disease (13 ileocolonic disease) and 2 had IBDU. The median age at diagnosis was 13.8 y (range 3.5 y- 15.1 y). The median age of starting Ustekinumab was 11.7 y (range 11.3 y – 16 y). All patients had undergone conventional treatment with steroids and or exclusive enteral nutrition; azathioprine and between 1 and 3 biologics, including adalimumab, infliximab and vedolizumab, prior to starting Ustekinumab. 12/21 patients stopped treatment because of poor response. 4/12 patients underwent surgery for failed medical treatment; 2 subtotal colectomy with ilesotomy and 2 right hemicolectomy. Ustekinumab drug levels were not freely available. 5/12 patients stopped Ustekinumab because of inadequate response, despite adequate drug levels of > 1.1 mg/L. Only 2/23 patients reported side effects of Ustekinumab.Ustekinumab was a safe and well tolerated drug, although more than half the patients stopped treatment due to inadequate clinical response. Proactive drug therapeutic monitoring may help improve our understanding of appropriate dosing of Ustekinumab and levels required to treat paediatric patients optimally compared with adult patients.