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18 Most published pediatric colonic manometry studies have been performed with low- resolution colonic manometry catheters with 8 recording sites (with sensors being spaced 10-15 cmapart).These studies tended to focus on thepresenceor absenceof high-amplitude propagating contractions. 58–61 Since these motor patterns are associated with spontaneous defecation, their presence, occurring either spontaneous or in response to chemical stimuli, is considered to be an important marker for colonic neuromuscular integrity. 4,5,62 However, with the development of high-resolution colonic manometry catheters, more detailed information on colonic motor patterns has become available and it has become clear that the colon exhibits more refined colonic motor patterns as well. 3 In adult studies utilizing high-resolution fiber-optic manometry, several other motor patterns have been identified prior to and after a meal, the most prominent of which is a distal colonic cyclic motor pattern (2-6 cycles per minute), that increases in prevalence after a meal and propagates in a predominantly retrograde direction. 3 The slow wave frequency of this motor pattern suggests that it is being generated by the pacemaker cells (interstitial cells of Cajal) within the submucosal plexus while its increase after a meal suggests that it can be influenced by extrinsic neural innervation. In adult patients with slow transit constipation an increase in this cyclic activity was not observed after a meal, potentially indicating an abnormality in the extrinsic neural innervation of the colon. 63 Alternatively a complete absence of cyclic propagating activity may indicate abnormalities in the intrinsic neural pathways. Chapters 7 and 8 describe findings from high-resolution colonic manometry studies in children with intractable FC. In chapter 9 , results from contrast enemas and colonic manometry in children with FC are compared. MEDICAL MANAGEMENT Conventional medical management of functional defecation disorders in children consists of nonpharmacological and pharmacological interventions. Nonpharmacological treatment recommendations for FC and FNRFI are similar, while the pharmacological treatments for both disorders are in contrast with one another. In 2014, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) published a guideline for the evaluation and management of childhood FC. 33 In chapter 10 , we assess the awareness and implementation of this guideline among physicians from the United States and the Netherlands.