Most chemotherapy, with the exception of hormone-type agents, are used in children. The "Pediatric Considerations" added to the monographs in this manual include: 

• usual pediatric dosages 
• dilutions and infusion rates of parenteral antineoplastics for children 
• exceptional susceptibilities of children to certain toxicities 
• uses in pediatric malignancies 
• long-term effects, wherever information is available

Dosage guidelines should be regarded as guidelines only. Protocols for chemotherapeutic treatment of pediatric malignancies are constantly being revised and should be referred to prior to administration of drugs.

Infants pose a particular therapeutic challenge as organ systems such as the liver, kidney and gut are not fully developed. Dosing on a square metre basis may result in excessive dose-related toxicities. The following formula may be used to convert square metre dosages to mg/kg dosages for infants <1 year of age:

Some protocols include dosage guidelines for infants less than 1 year of age, and in some cases, for children less than 3 years of age.

Children generally tolerate the acute toxicities of chemotherapy better than adults, with certain exceptions. Children, however, may be more susceptible to delayed or long-term sequelae such as effects on growth, development and reproductive capacity. In general, pre-pubertal boys and girls are less susceptible to gonadal damage than post-pubertal children. If gonadal dysfunction occurs however, recovery is difficult to predict.

Relatively little is known about long-term adverse effects of chemotherapy in children. As more children survive childhood cancer, more information is expected to accumulate.

Bibliography:

Crist WM, Kun LE. Common solid tumors of childhood. N Engl J Med 1991;324(7):461-71.

Dunn NL, Mauer HM. The role of the practitioner in the care of children with acute leukemia. Pediatr in Rev 1983;5:81-7.

Mulne AF, Koepke JC. Adverse effects of cancer therapy in children. Pediatr in Rev 1985;6:259-68.