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239 Treatment adherence 11 with >75% of prescribed medication containers empty. 39 The authors demonstrated an adherence rate of 38% in the first month of treatment and 30% in the sixth month of treatment. These results are similar to the adherence rate we found in the current study (37%) as defined by a MARS-5 score ≥23. These findings suggest that healthcare providers should seek for ways to optimize treatment adherence in children with FC. In order to do this, a better understanding of potential barriers and facilitators of treatment adherence in children with FC is required. Our results suggest that convenience of taking medication is one of the most important determinants of treatment adherence in children with FC. Parents who viewed the administration of their child’s medication as convenient, reported higher adherence rates according to the MARS-5. These results confirm previous findings from studies performed in children with asthma receiving inhaled corticosteroids. 12,13 This association was found for both intentional and unintentional adherence. Another important determinant seems to be treatment satisfaction; the more satisfied parents were, the higher the proxy-reported treatment adherence of their children. Again, this association was found for both intentional and unintentional adherence. This suggest that, in clinical practice, it may be worthwhile not only to inquire about symptoms as a parameter of treatment success, but also to explore how satisfied parents are with the treatment, if they encounter any difficulties due to inconvenience of taking the medication and to evaluate if there are ways to overcome these barriers. By managing expectations and giving practical advice to minimize medication- related inconvenience, treatment adherence may be improved. In our study, the emotional impact of children’s symptoms on their parents was negatively correlated with treatment adherence. Although this quantitative study did not qualitatively evaluate the exact type of emotional impact reported by these parents, this potentially reflects the problem that FC symptoms can be frustrating and embarrassing not only for the child, but also for the parents. Especially fecal incontinence, a problem that many children with FC struggle with, is known to have an important negative impact on the quality of life in both children with FC and their parents. 40–42 Such emotions related to symptoms of FC could negatively affect treatment adherence and make it more difficult to address the issue of taking medication in a household. If such emotions seem to arise, these should be discussed with children and their parents in a non-accusatory manner. Parents of nonadherent children reported more concerns about their child’s laxative medication and on the other hand attributed more importance to the medication in controlling their child’s symptoms, which seems contradictory. These parents report to be more worried about their child’s laxative treatment but also more aware of the importance of treatment adherence in regulating their child’s symptoms. Possibly, the concerns related