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The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body.
Acid is essential to degrading certain oral drugs before systemic absorption.
Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space.
Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs.
However, prodrugs experience the opposite effect because enzymes are necessary in allowing their active form to enter systemic circulation.
Islamic writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Serapion, Avicenna, and Averroes.
The Persian philosopher and physician al-Razi (865–925) published a monograph on pediatrics titled Diseases in Children as well as the first definite description of smallpox as a clinical entity.Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body.Supply of these enzymes increase as children continue to develop their gastrointestinal tract.In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wrocław), both in 1837.In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West.In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys.This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.Many drug absorption differences between pediatric and adult populations revolve around the stomach.Neonates and young infants have increased stomach p H due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth.Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (ie.oxidation, hydrolysis, acetylation, methylation, etc.). Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults.