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340 In chapter 11 , wedescribe a cross-sectional survey study on treatment adherence in children with FC treated with polyethylene glycol. It is generally acknowledged that nonadherence to pharmacological maintenance treatment is common in children with chronic diseases, and nonadherence is considered a strong predictor of poor outcome. 36–38 However, studies on treatment adherence in childrenwith FC are scarce and factors associatedwith treatment adherence in children with FC remain poorly understood. Our study among parents of 115 children with FC showed that adherence to polyethylene glycol treatment in children with FC is associated with parental illness perceptions, satisfaction with treatment and perceived treatment convenience. When interacting with children suspected of being nonadherent to laxative treatment, one should therefore consider to evaluate these factors to assess whether they play a role in treatment adherence. In this way, treating physicians, together with patients and their parents, can identify ways to overcome these barriers. As a result of the development of culture-independent techniques to detect bacteria, the human microbiome and its role in health and disease have been the topic of much interest over the past decade. Consequently, pre-, pro- and synbiotics have been suggested as potential treatment modalities for a multitude of diseases and disorders, including FC. In chapter 12 , we systematically reviewed the literature to investigate the efficacy and safety of pre-, pro- and synbiotics in the treatment of childhood FC. We identified six randomized controlled trials (RCTs) on prebiotics, six RCTs on probiotics and one RCT concerning synbiotics. We concluded there was insufficient evidence to recommend pre-, pro- or synbiotics in the treatment of children with functional constipation and that high- quality randomized controlled trials were needed. Since the publication of our systematic review, another randomized controlled trial evaluating the efficacy of Lactobacillus casei rhamnosus Lcr35 in children under 5 years of age was published. 39 This study showed that this specific probiotic strain was not more effective than placebo in the management of FC. A subsequent systematic review on the efficacy of probiotics in the treatment of FC in children therefore reached the same conclusion as our systematic review. 40 Interestingly, and in contrast to currently available evidence, physicians frequently recommend probiotics to their pediatric patients with FC. 41,42 The reason for this practice is unknown and should be sought out in the future. If pharmacological treatment of FC fails, patients and physicians alike are desperate to find ways to improve symptoms. Transanal irrigation is a medical non-pharmacological treatment modality, which has been shown to be effective in children with constipation due to organic causes. 43–47 Recently, its use in children with functional defecation disorders has been described to be successful as well. 48,49 In chapter 13 , we present a survey study on treatment efficacy and parental satisfaction in 67 children with intractable FC treated with transanal irrigation. In a subset of children, fecal incontinence was treated successfully and