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221 Guideline adherence 10 FIGURE 2. Discomfort as an important reason for omitting inquiry about sexual abuse, perianal inspection and digital rectal examination. DISCUSSION In our sample of Dutch and U.S. physicians working in pediatrics and pediatric gastroenterology, 31% of responders were not familiar with the 2014 ESPGHAN/NASPGHAN guideline for childhood FC. Unfamiliarity with the guideline was more common among general pediatricians, physicians from the U.S. and physicians with >15 years of experience. Nonetheless, overall therapeutic decisions correlated fairly well with recommendations from this guideline, especially for children ≥1 year of age. Two studies on the awareness and implementation of previous childhood FC guidelines have been published before. Focht et al. reported results from a cross-sectional survey study among 366 pediatricians across the U.S., assessing familiarity and implementation of the 1999 NASPGHAN guideline for childhood FC. 10 They found that only 8% of pediatricians were familiar with that guideline. Later, Yang et al. performed a cross-sectional survey study among 967 physicians in the U.S. (771 trainees, 196 attendings) evaluating familiarity and implementation of the 2006 NASPGHAN guideline. 11 In this study, 84% of responders reported being unfamiliar or only slightly familiar with the 2006 NASPGHAN guideline. In our current study, awareness of the 2014 ESPGHAN/NASPGHAN guideline was better than awareness of older guidelines reported in the two previous studies, although even in the current study still 31% of responders were unfamiliar with the 2014 ESPGHAN/NASPGHAN guideline.