What is one reason that pediatric dosing differs from adult dosing?

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Pediatric dosing differs because children's bodies are not just smaller versions of adults; growth and development change how drugs move through and are processed by the body. Weight is a key factor, but age-related maturation of organs and physiology alters pharmacokinetics in several ways. Infants have more body water and less fat, which affects how hydrophilic versus lipophilic drugs distribute. Absorption can vary due to immature gastric pH and slower or irregular gastric emptying. Metabolism depends on liver enzyme systems that mature at different rates, so some drugs are metabolized more slowly in younger children. Renal clearance also increases with age as kidney function matures, changing how quickly drugs are eliminated. Because these factors shift during development, dosing is typically expressed in mg per kg (and sometimes adjusted for body surface area or age), with careful monitoring.

That’s why the idea that children metabolize drugs identically to adults isn’t correct, and why dosing isn’t universally larger in kids. Age-specific guidelines exist precisely because maturation affects pharmacokinetics and, consequently, dosing and safety.