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Background The incidence of Pediatric Inflammatory Bowel Disease (PIBD) in Asia has increased significantly in recent years. In the Philippines, however, local data on affected children remain limited. Given the variability in disease presentation among children, identifying reliable predictors of disease severity upon diagnosis is essential for early risk stratification and individualized treatment. This study aimed to determine the predictors of disease severity among pediatric patients with IBD managed at the Philippine Children’s Medical Center from January 2018 to January 2025.Methods A retrospective cohort study was conducted, including 42 children diagnosed with PIBD based on the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Revised Porto Criteria. Clinico-demographic, biochemical, radiologic, endoscopic, and histopathologic data were extracted from the medical records. Chi-square was used to determine association and an independent T-test was used to assess differences among means. Logistic regression was utilized to determine predictors of severe disease at diagnosis, with odds ratios (OR), 95% confidence intervals (CI), and exact p-values reported.Results Of the 42 PIBD cases, 76.2% had Crohn’s Disease (CD) and 23.8% had Ulcerative Colitis (UC), with 45.2% classified as severe upon diagnosis. The mean age at diagnosis ranged from 4.1 years for UC to 10.3 years for CD. CD predominated among adolescents (65.52%) presenting with abdominal pain, weight loss, and diarrhea, whereas 80% of UC cases were classified as very early-onset. ( IDDF2026-ABS-0294 Table 1)Conclusions Fever, anemia, weight loss or failure to gain weight, wasting, and hypoalbuminemia were identified as significant predictors of severe PIBD at diagnosis. Fever reflects the overall systemic inflammatory burden, whereas anemia and hypoalbuminemia indicate both inflammatory and nutritional compromise. Weight loss and wasting further highlight the disease’s impact on growth. These findings underscore the importance of integrating systemic inflammatory markers, hematologic and nutritional assessments, into initial risk stratification to optimize therapeutic decision-making.Abstract IDDF2026-ABS-0294 Table 1Logistic regression analysis identifying factors associated with severe IBD at diagnosisFactorsCoefficient (B)SEOdds Ratio95% CIP-valueAnemia3.671.434.672.75-6.850.04Hypoalbuminemia1.342.121.372.47-4.890.045Fever2.40.95211.021.71-71.280.006Weight loss/Failure to gain weight2.321.153.021.25-5.740.017Wasting0.641.122.11.35-7.350.04