The computed tomographic (CT) scans of 22 children with small bowel disease and those of 110 children with no small bowel disease were analyzed by two observers who were blinded with respect to clinical history and final diagnoses in order to determine which CT findings reliably indicated neoplastic, inflammatory, or noninflammatory processes. Bowel-wall thickening was the most reliable sign of disease. Five of six patients (83%) with bowel-wall thickness greater than 1 cm had neoplastic disease. Nine of ten patients (90%) with bowel-wall thickness between 3 mm and 1 cm had inflammatory disease, while four of six patients (66%) with wall thickness less than 1 cm and increased attenuation of mesenteric fat or an increase in the number of mesenteric vessels had noninflammatory edema. The presence of mesenteric masses was not a helpful sign for differentiating various disease processes. The results of this retrospective study suggest that the identification and classification of small bowel disease in children is possible from the objective analysis of CT findings.