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.
Kersten et al. (2026) studied this question.