Our experience with proctocolectomy and the J-pouch procedure in eight children with ulcerative colitis is reported. The mean age at diagnosis was 8.4 years, and the mean time between diagnosis and colectomy was 2.2 years. We decided on a three-stage operation. The protective ileostomy was removed after approximately 4 months pouch-training. Two patients suffered pouchitis as a specific complication. An ileus occurred in two patients, one patient had a serious eosinophilic enteritis, and two children had multiple abdominal wall abscesses. All patients showed a significant increase in height velocity and the prepubertal patients experienced catch-up growth after the colectomy. All patients are continent during the day. Our experience suggests that proctocolectomy and the ileoanal-J-pouch procedure provide improved growth, continence and a low incidence of surgical complications.