For a study, researchers sought to determine the long-term durability of clinical remission, linear growth, and correlations of trough concentration (TC) with biomarker, endoscopic, and imaging outcomes in children who received adalimumab (ADA). A single-center retrospective study was used. Longitudinal measurements of Crohn’s disease (CD) activity index, C-reactive protein, fecal calprotectin, and height in children. The Cox proportional hazards model was used to assess discontinuation due to secondary loss of response (LOR). Cox regression with time-dependent variables was used to examine the links between TC and clinical and biomarker remission, as well as endoscopic and magnetic resonance imaging (MRI) improvements. 213 children (median age 14.1 years (interquartile range [IQR] 12.5–15.7), 65% males, started ADA between January 2007 and June 2018. A total of 174 people (82%) achieved clinical remission (PCDAI<10). During the 24.8 (IQR 15.6–38.4) months of follow-up, 26 (15%) people stopped using ADA because of LOR, and 10 (6%) because of adverse effects. Being anti-tumor necrosis factor (TNF) naive and engaging in inflammatory behavior was linked to a higher likelihood of clinical remission (odds ratio [OR] 2.39, P=0.033, and 3.13, P=0.013, respectively) and a lower likelihood of recurrence (hazard ratio [HR] 0.3, P=0.002, and HR 0.35, P=0.01, respectively). Within 1, 2, and 3 years, cumulative LOR among 135 anti-TNF naive patients was 0%, 8%, and 15%, respectively, with mono- and immunomodulator combination therapy equally durable. The mean height (−0.82) of prepubertal and early pubertal children was standardized to −0.07. Endoscopic (OR 10.4, P=0.002) and MRI (OR 7.6, P=0.001) improvements were linked with TC continuously more than 7.5 ug/mL (HR=17.24, P=0.001); TC more than 10 ug/mL (HR=6.56, P=0.001) remission and endoscopic (OR 10.4, P=0.002) and MRI (OR 7.6, P=0.001) improvements.  ADA monotherapy maintains clinical remission for a long time. Greater ADA exposure was linked to biomarker remission, mucosal and transmural improvements.