Granulomas were a pathologic hallmark of Crohn’s disease (CD), even though they were observed in only a portion of patients. For a study, researchers sought to determine the prevalence of microgranulomas in pediatric CD and evaluate the clinical course of cases with and without granulomatous inflammation. Investigators conducted a retrospective, single-center research of juvenile CD patients with at least 3 years of follow-up. A gastrointestinal pathologist meticulously reexamined the initial diagnostic samples. The terms granuloma (10+ histiocytes) and microgranuloma (4–9 histiocytes) were defined a priori. Kaplan-Meier survival plots were used to evaluate the disease outcomes of hospitalization, development of complicated disease behavior, perianal disease, and anti-tumor necrosis factor (anti-TNF) therapy. The study included 138 patients who were followed for 4.6 years. Granulomas were observed in 38 of 138 patients (27.5%), while an additional 38 subjects had at least 1 microgranuloma (also 27.5%) (in the absence of granulomas). Those with granulomas (P=0.001) and microgranulomas (P=0.0001) were more likely to receive anti-TNF medication than those without granulomatous inflammation. A substantial proportion of pediatric CD patients developed microgranulomas (in the absence of well-defined granulomas). Anti-TNF medication was raised more frequently in CD patients with microgranulomas than those without granulomatous inflammation (similar to those with granulomas). Pathologists should have a low reporting threshold for microgranulomas, which may aid illness prognosis.