AAP & NASPGHAN: Practice Guideline for Faltering Weight

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HB Kersten, PS Goday et al. PEDIATRICS Volume 157, Issue 4, April 2026:e2025075764. Open Access! PDF: Clinical Practice Guideline for Diagnosis and Management of Faltering Weight

The AAP in partnership with the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) has published its first clinical practice guideline on diagnosis and management of “faltering weight,” a condition formerly described as “failure to thrive” that affects 5%-10% of young pediatric patients in the primary care setting.

  • The clinical practice guideline (CPG) explains that the prior term, failure to thrive (FTT), has never been well-defined. In addition, “the term FTT has also been fraught with controversy that has contributed to the difficulty in determining the criteria used to define it. The word “failure” has led caregivers to feel blamed for their child’s condition. The term has also
    been inconsistently applied, which may exacerbate existing health care inequities.”
  • “When evaluating a child who has been hospitalized for faltering weight, consider the 5 most-common co-occurring conditions…congenital heart disease, gastroesophageal reflux disease (GERD), swallow dysfunction, neurologic disease, genetic abnormalities/congenital syndrome.”
  • “When evaluating a child in the outpatient setting for faltering weight, consider the 5 most-common co-occurring conditions….gastrointestinal disease, pulmonary disease, food allergy, genetic abnormalities/congenital syndrome, neurologic disease.”

My take: Overall, this is a useful guideline. A couple comments:

  1. For several decades I have avoided the term ‘failure to thrive’ (for the reasons given in the CPG) and typically have used terms like poor weight gain or growth failure.
  2. Most pediatric patients with faltering weight need to ingest more calories and do not need extensive testing. I agree that endoscopy should not be part of the routine workup for faltering weight in the absence of other indications
  3. “Gastroesophageal reflux disease” is often attributed as a reason for faltering weight as well as choking. However, isolated reflux is unlikely to cause these presentations in the absence of other factors (e.g. pyloric stenosis, malrotation, swallow dysfunction)

Additional Links:

Clinical Practice Guideline

Technical Reports

AAP News coverage

Information for Families from HealthyChildren.org

  • Faltering Weight in Children: Parent FAQs, in English and Spanish
  • Understanding Growth Charts: A Parent’s Guide to Percentiles & Z-Scores, in English and Spanish

Further reading

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