Crohn's disease (CD) is an idiopathic inflammatory disease of the gastrointestinal tract and typically causes inflammation with granuloma formation. Biologic agents like infliximab (IFX) that target tumor necrosis factor alpha (TNF-α), have emerged as important medications for treating refractory CD. With increasing use, there also are reports of rare but potentially fatal complications associated with exposure to TNF-α, such as bowel perforation. We present a case report of spontaneous bowel perforation in a child with Crohn's while on IFX therapy, and a review of the current literature. The purpose of this report is to alert physicians to this rare association, especially in pediatric patients with intestinal strictures.