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229 Treatment adherence 11 INTRODUCTION Functional constipation (FC) affects between 0.7% and 29.6% of children worldwide. 1 It is a common reason for consultations to pediatricians and pediatric gastroenterologists and is associated with substantial healthcare costs. 2,3 Treatment of FC consists of a combination of non-pharmacological and pharmacological interventions. 4 Non-pharmacological interventions involve education and demystification, scheduled toilet sits, instating a reward system and keeping a defecation diary. Pharmacological treatment primarily consists of laxative treatment with polyethylene glycol and comprises three steps: disimpaction, maintenance treatment and weaning. 5 After 6-12 months of treatment, approximately 50% of patients visiting a pediatric gastroenterologist is off laxatives and recovered, but 40% of patients remain symptomatic despite intensive pharmacological treatment. 5,6 Although prognostic factors for treatment failure in children with FC are poorly studied, treatment adherence is thought to play an important role. 7 Adherence is defined as “the extent to which a person’s behavior, in terms of taking medication, following diets, or executing lifestyle changes, coincides with medical or health advice”. 8 Nonadherence to pharmacological maintenance treatment is common in children with chronic diseases, and is considered a strong predictor of poor outcome. 7,9,10 Nonadherence can either be intentional (i.e. based on an active decision to change the dose or not to take the medication) or unintentional (e.g. forgetfulness, carelessness or as a consequence of a lack of capacity or resources). 11,12 Adherence is considered to be influenced by various determinants. Previous studies in children with chronic conditions have shown that adherence is associated with parental beliefs about medication, illness perceptions, treatment satisfaction and satisfaction with information about medication. 12–14 Studies on treatment adherence in children with FC are scarce and factors associated with treatment adherence in children with FC remain poorly understood. Therefore, the aim of this study was to evaluate treatment adherence in children with FC and identify associated factors. METHODS Study design For this cross-sectional questionnaire study, we included children aged 0-18 years diagnosed with FC (according to the Rome IV criteria) who were using polyethylene glycol as maintenance treatment. 15,16 Exclusion criteria were limited knowledge of the Dutch language and organic causes of constipation.