As the prevalence of childhood obesity continues to increase, there has been comparatively slow growth in the literature describing how best to dose obese children. For medications with low lipid solubility where doses are calculated by the total body weight (TBW) of the child, increasing adiposity may lead to the administration of doses well in excess of that required for therapeutic effect, and potentially beyond the safe therapeutic interval of the medication. This concern underlies recommendations to use alternative bodyweight measurements for some medications when dosing obese children.