Crohn’s disease (CD) is an immune-mediated, chronic inflammatory disease without a present cure. Surgical intervention for disease complications is common among CD patients, however post-operative strategies to prevent disease recurrence represent a critical knowledge gap, particularly in the pediatric CD population. Although adult CD data suggest effectiveness of anti-Tumor Necrosis Factor (TNF) therapies for prevention of recurrence, similar evidence is scarce for the pediatric population. We sought to evaluate the effectiveness of anti-TNF monotherapy compared to immune modulator (methotrexate or thiopurine) monotherapy for prevention of surgical recurrence in pediatric CD patients using a large, geographically diverse administrative claims database.