Journal article
Clinical Practice Guideline for Diagnosis and Management of Faltering Weight
Pediatrics (Evanston), v 157(4), e2025075764
16 Mar 2026
PMID: 41833317
Abstract
This evidence-based guideline from the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition is intended to support health care providers who care for children with poor weight gain. This clinical practice guideline (CPG) panel updates the term "failure to thrive" to "faltering weight" and using z score cutoffs rather than percentiles as diagnostic criteria. A diagnosis of faltering weight includes any of the following: (1) weight-for-length or body mass index (BMI)-for-age less than -1.65 z score (5th percentile); (2) in children younger than 2 years, weight gain velocity less than -2 z score for age (2.3rd percentile); or (3) decline in weight, weight-for-length, or BMI greater than or equal to 1 z score. This definition was formulated by the guideline panel through an iterative process of discussion and voting to reach consensus. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to formulate recommendations and good practice statements, including GRADE Evidence-to-Decision frameworks, which were reviewed by internal and external contributors. The CPG provides 8 Key Action Statements (recommendations) and articulates 4 Good Practice Statements for additional guidance. Diagnostic testing is only recommended for children who have specific conditions that suggest a focal evaluation or persistent faltering weight. In children with persistent faltering weight or who have concerns for conditions that cannot be diagnosed without endoscopy, the CPG suggests endoscopy with biopsy. The CPG recommends the use of increased calories of food/energy; oral nutritional supplementation; and therapy for pediatric feeding disorder. When implemented, the CPG is intended to reduce confusion about diagnostic criteria and improve diagnostic accuracy, decrease overutilization of laboratory testing and imaging in children with faltering weight, and enhance health care utilization.
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Details
- Title
- Clinical Practice Guideline for Diagnosis and Management of Faltering Weight
- Creators
- Hans B Kersten - Drexel University, PediatricsPraveen S Goday - Nationwide Children's HospitalRuba Abdelhadi - University of Missouri-Kansas City School of Medicine, Kansas City, MissouriSoukaina Adolphe - Boston Medical CenterNicole Anania - Children's Hospital of WisconsinDavid S Bennett - Drexel University, PsychiatryLeah W Burke - University of VermontCatherine Larson-Nath - University of MinnesotaTeresa M Lee - Shriners Hospitals for Children Medical Center - LexingtonMichael G Leu - Seattle Children's HospitalShelly Mercer - Tulsa Community CollegeTimothy Sentongo - University of Illinois ChicagoJoyee Goswami Vachani - Texas Children's HospitalEmily Senerth - Cleveland FoundationLauren Pilcher - American Academy of PediatricsSusan K Flinn - SimulConsultKymika Okechukwu - American Academy of PediatricsReem A Mustafa - Cleveland FoundationRebecca L Morgan - Cleveland Foundation
- Publication Details
- Pediatrics (Evanston), v 157(4), e2025075764
- Publisher
- AMER ACAD PEDIATRICS
- Number of pages
- 29
- Grant note
- American Academy of Pediatrics Department of Pediatrics and Public Health Sciences, Penn State Health Milton S. Hershey Medical Center University of Texas Health Science Center at Houston Cizik School of Nursing
Pia Daniels, MPH, PMP, Manager, Department of Primary Care & Medical Subspecialties, American Academy of Pediatrics. Joanna King, Project Manager, Department of Education & Global Health, American Academy of Pediatrics. Carrie Daymont, MD, MSCF, FAAP, Department of Pediatrics and Public Health Sciences, Penn State Health Milton S. Hershey Medical Center. Karen DiValerio Gibbs, PhD, MSN/MPH, RN, CPN, Assistant Professor, University of Texas Health Science Center at Houston Cizik School of Nursing. Kymika Okechukwu, MPA, Senior Manager, Evidence-Based Medicine Initiatives, American Academy of Pediatrics, when the work described in the article was conducted. Cathleen Guch, MPH, Sr Manager, QI & Certification Initiatives, Department of Child Health Finance & Quality, American Academy of Pediatrics. Sarah Hizon, MPH, Project Manager, QI & Certification Initiatives, Department of Child Health Finance & Quality, American Academy of Pediatrics.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Psychiatry; Pediatrics
- Web of Science ID
- WOS:001752471600018
- Scopus ID
- 2-s2.0-105035095049
- Other Identifier
- 991022170458504721