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248 Chapter 12 ABSTRACT Purpose of review: To investigate the efficacy and safety of pre-, pro- and synbiotics in the treatment of pediatric functional constipation (FC). Recent findings: A recent study reported that the gut microbiota in obese children with FC differs from that of obese children without FC. The gut microbiota may be involved in the pathophysiology of FC. Pre- and probiotics have been suggested as potential treatment modalities for FC in children. Summary: PubMed and Cochrane databases were searched from inception to February 2016. We found six RCTs on prebiotics, six RCTs on probiotics and one RCT concerning synbiotics. Overall, most studies were at high risk of bias. The majority of studies were unable to demonstrate a significant effect of pre-, pro- or synbiotics on predefined outcome measures such as defecation frequency, fecal incontinence and painful or difficult defecation. Pre-, pro- and synbiotics were not associated with significant adverse effects. In conclusion, there is insufficient evidence to recommend pre-, pro- or synbiotics in the treatment of children with FC. High-quality randomized controlled trials are warranted to further explore these treatment modalities.