Glucocorticosteroids have an over 60-year history in the treatment of inflammatory bowel disease. The major anti-inflammatory effects of glucocorticoids result from interactions between the activated glucocorticoid receptor and transcription factors that mediate the expression of inflammatory genes. Although first-line anti-TNF treatment is gaining ground in pediatric Crohn disease, systemic corticosteroids continue to be used widely in the induction of remission of Crohn disease and ulcerative colitis. However, side effects, lack of mucosal healing, and lack of efficacy in the maintenance of remission limit their use. Topical corticosteroids, such as budesonide, have been developed and designed for controlled release in either the ileum (Entocort®) or colon (Cortiment®, Uceris®). These formulations have moderate efficacy in inducing remission in both Crohn disease and ulcerative colitis with fewer side effects than systemic corticosteroids.