The effectiveness of anti-tumor necrosis factor (TNF) treatment for patients with very early onset inflammatory bowel disease (VEOIBD) is not well understood at this time. In this study, researchers intended to determine how long it took for patients with VEOIBD to advance to the point where they needed anti-TNF medication. They looked back at the British Columbia (BC) Pediatric IBD database for cases of IBD identified in kids younger than 6 years between January 2005 and December 2019. Disease features, geographic distribution, and severity assessments were recorded. Anti-TNF treatment information such as biologic, dosage, and the response was gathered both at the outset and over the course of follow-up. Kaplan-Meier curves were used to analyze the time and risk factors involved in starting anti-TNF therapy. About 89 people were identified as having VEOIBD while the study was ongoing. Patients median age at diagnosis was 3.8 years (IQR: 2.6-5.1), 45.3% were diagnosed with Crohn’s disease (CD), and 62.8% were male. In general, researchers followed their subjects for 6.39 years on average (IQR 3.71–10.55). Patients at a rate of 39.5% had anti-TNF medication initiated, while those at a rate of 7.0% had surgical intervention. Individuals with Perianal fistulizing disease or stricturing disease on CD were more likely to proceed quickly to biologic treatment (P=0.026 and P=0.033, respectively), as were patients with the severe disease on UC (P=0.017). Infliximab was administered at a median dose of 10 mg/kg (IQR 7.5-11) once every 4 weeks during the first year of treatment (IQR 4–6). About 61.8% of those who took their first biologic drug had complete clinical remission. Greater infliximab doses with shorter infusion intervals may account for the higher response rate seen compared to earlier reports.