The guideline offers clinicians a consistent approach toward evaluating, diagnosing and managing treatment of children suspected of having faltering weight
ITASCA, IL--The American Academy of Pediatrics, in partnership with the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), has published its first clinical guidance on diagnosis and management of “faltering weight,” a condition formerly described as “failure to thrive” that affects 5-10% of young pediatric patients who are not growing as expected.
The “Clinical Practice Guideline for Diagnosis and Management of Faltering Weight” and two accompanying technical reports are published in the April 2026 Pediatrics (published March 16 online). The reports provide a clear definition of faltering weight with specific diagnostic criteria, and a consistent approach to the evaluation and management of children suspected of having faltering weight.
“The guideline takes a whole-child approach to evaluation and treatment and recognizes that safe, stable, nurturing relationships are necessary components for normal growth and development,” said Hans B. Kersten, M.D., FAAP, lead author of the guideline. “The goals are to help doctors make accurate diagnoses, avoid unnecessary tests, and use health care resources wisely.”
Policies and guidelines created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics. The AAP also contracted with the Evidence Foundation to conduct a systematic review of evidence and chose a panel of experts to facilitate the guideline’s development. The panel included general and subspeciality pediatricians, an informatician, an epidemiologist, a social worker, a dietitian, a psychologist and a patient representative.
Faltering Weight is a common reason for pediatric clinic visits and hospital admissions, occurring in approximately 5% to 10% of children in primary care settings and 3% to 5% of those in the referral setting. The AAP no longer uses the term “failure to thrive” because it has no precise definition, is stigmatizing and has unclear standards of care.
For the first time, a mathematical calculation called the z-score (or standard score) is used to more accurately measure the infant’s weight.
According to the guideline, a child may be diagnosed with faltering weight if they meet any of the criteria:
Testing such as imaging studies and laboratory tests are recommended only if there are signs of a specific problem or if poor weight gain continues. Endoscopy is recommended only for those children who have persistent faltering weight after appropriate therapies have been implemented or in other cases in which diagnosis cannot be confirmed without looking inside the body.
Treatment recommendations include increased calories through food or energy-rich meals, use of oral nutrition supplements, and therapy for feeding disorders.
The clinical practice guideline includes two technical reports that examine evidence supporting the guideline. The report, “The Benefits and Harms of Endoscopy and Other Diagnostic Tests to Detect Underlying Conditions in Children With Faltering Weight: Technical Report” describes systematic reviews to identify the benefits and harms of diagnostic tests, including endoscopy, in children younger than 5 years who live in high-income countries. The report, “The Impact of Socioeconomic Status and Different Treatment Modalities on Children With Faltering Weight: Technical Report” suggests that socioeconomic status is not a reliable predictor of failure to thrive in children younger than 5 years who live in high-income countries.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.