The Clinical Practice Guideline for Diagnosis and Management of Faltering Weight from the American Academy of Pediatrics (AAP) and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is designed for pediatricians and other pediatric health care providers (PHCPS) who see children who have problems meeting growth expectations and goals.

The intended audience of this clinical practice guideline and supporting tools includes health care professionals caring for children with faltering weight (such as pediatricians, pediatric gastroenterologists, primary care clinicians, psychologists, social workers, and other providers), caregivers and policymakers. 

Key Concepts From the Clinical Practice Guideline and Toolkit

  • Replace the term “Failure to Thrive” with “Faltering Weight.”
  • Use z-scores in addition to percentile charts for diagnosis and management of Faltering Weight. 
  • Provide education on Z-scores to patients and caregivers. 
  • Refer to the algorithm for guidance on diagnostic criteria and management.
  • Refer to the dietary recommendations and resources from the toolkit for feeding and treatment options.
  • Reference key action statements and good practice statements where applicable.

(Please refer to the AAP Clinical Practice Guideline for specific key action statements.)

Professional Tools & Resources

Key Driver Diagrams

A guide to quality improvement that outlines what should be done and how to achieve the desired change.

Quality Metrics

Informed by the CPG key action statements, this resource helps pediatricians and PHCPS to measure the care team’s progress.

Z-Score Information for Providers

Access information regarding Z-Score Information for Providers. Option to download.

Faltering Weight Algorithm

A developed pathway to guide clinical decision making.

Coding Companion

Relevant coding information to help pediatricians accurately report services for payment.

Additional Resources

Dietary Recommendations

Additional educational resources regarding dietary recommendations.

Handout for Parents And Caregivers

A handout to educate patients and families about Z-Scores and Faltering Weight.

Percentile Charts

HealthyChildren.org Articles

Faltering Weight in Children: Parent FAQs

Understanding Growth Charts: A Parent's Guide to Percentiles & Z-Scores

Get Involved

Committee on Nutrition
The Committee on Nutrition (CON) studies the nutritional needs of infants, children, and adolescents and develop guidelines for the pediatrician based on sound, objective, clinical science as well as practical experience in fostering optimal health status.
Council on Quality Improvement and Patient Safety
The Council on Quality Improvement and Patient Safety is focused on innovations and activities supporting the integration of policy and practice, education, advocacy and implementation around the topic areas of quality improvement and patient safety.
Section on Administration and Practice Management
This section provides resources for the administration and management of the business functions of pediatric practice.
Section on Developmental and Behavioral Pediatrics
Their mission is to strengthen collaboration between primary care pediatricians, developmental and behavioral subspecialists, and families to ensure children receive comprehensive high quality developmental and behavioral (DB) pediatric care.
Section on Endocrinology
Their mission is to provide an educational forum to discuss endocrinology problems and treatments, stimulate research and teaching of endocrinology, and to disseminate knowledge of endocrinology through AAP resources.
Section on Gastroenterology, Hepatology and Nutrition
Is dedicated to improving the care of infants, children, and adolescents with gastrointestinal and nutritional disorders by providing an educational forum for the discussion of problems and treatments relating to gastroenterology, hepatology, and nutrition.
Last Updated

03/16/2026

Source

American Academy of Pediatrics