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46 Chapter 1 Moreover, outdoor play activity was described to be less common in children with FC as compared to children without FC (81.3% vs. 100%, P = .04). 23 Regular sporting activity time (i.e. >4 times a week) was described in 17% of constipated children versus 28% of children without FC ( P = .015). 44 Contradicting results were reported on body weight and the relationship with FC. In 4 studies, no significant differences in weight or BMI were found between children with and without FC. 23,28,32,34 In contrast, one study showed that the prevalence of FC was higher in 191 overweight children as compared to the 259 normal-weight children between the ages of 4-18 years (OR = 1.83, 95% CI:1.12–2.98, P = .01). 47 Furthermore, significantly more children who were overweight had symptoms of FI associated with constipation as compared to children with normal weight (OR = 4.40, P = .005). 34 Psychological factors Children with FC have been described to be more often exposed to stressful life events as compared to children without FC. 44,53 Out of 416 children with FC in a Sri Lankan cohort, 82.2% had been exposed to a school-related, family-related or other type of stressful life event compared to 64.7% of controls (OR 2.52, P < .00). 20 Also, the prevalence of physical and psychological trauma was higher in children with constipation as compared to controls (38.8% vs. 22.7%, P = .001). 44 Moreover, living in a war affected area was described to be independently associated with FC. 53 Similar results were described in another study among children with FC-associated fecal incontinence. 53 Furthermore, sexual (17% vs. 2.3%), emotional (40.4% vs. 22.7%) and physical abuse (51% vs. 24.3%) were significantly more common in children with fecal incontinence as compared to children without fecal incontinence. 52 A study from Nigeria found no significant differences of family related stressful life events between children with FC and controls. 51 A study assessingpersonality traits in childrenwith FCaccording to theChildhoodPersonality Assessment Questionnaire (Child PAQ) found that children with FC had significantly higher scores for hostility and aggression, negative self-esteem, negative self-adequacy, emotional unresponsiveness, emotional instability and a negative world view compared to healthy controls (all P < .001). 25 Health Related Quality of Life (HRQoL) in children with FDDs was assessed in 4 studies. Using the PedsQL, Ranasinghe et al . and Lewis et al . found significantly lower HRQoL scores for all domains in children with FC compared to children without functional gastrointestinal disorders. 25,46 Furthermore, children with FC-associated fecal incontinence had even lower scores. 25,46,52 Quality of school life (QOSL) was not significantly different in children with FC as compared to children with other functional gastrointestinal disorders. 26