New clinical guidelines aimed at improving the diagnosis and treatment of poor weight gain in children have been released by the American Academy of Pediatrics in collaboration with the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. The recommendations, published in the journal Pediatrics, introduce updated terminology and a more comprehensive approach to care.

The guidelines replace the term “failure to thrive” with “faltering weight,” reflecting a shift toward more precise and less stigmatizing language. Developed by a team led by Hans B. Kersten of St. Christopher’s Hospital for Children, the framework is designed to help healthcare providers better identify and manage children experiencing inadequate weight gain.

Under the new criteria, faltering weight is defined using standardized growth measurements. These include significantly low weight relative to height or age, slower-than-expected weight gain in children under two years old, or a notable decline in weight indicators over time. The guidance emphasizes the use of z-scores to ensure consistent and objective assessment.

The recommendations outline a structured approach to care, including key action steps and additional best-practice advice. Diagnostic testing is not routinely required for all children; instead, it is reserved for cases where specific medical conditions are suspected or when weight issues persist despite initial interventions. In such cases, more advanced procedures, including endoscopy with biopsy, may be considered to identify underlying causes.

Treatment strategies focus on improving nutritional intake and addressing feeding challenges. These include increasing caloric intake, providing oral nutritional supplements, and offering therapy for pediatric feeding disorders when needed. The goal is to support healthy growth while minimizing unnecessary medical procedures.

Experts involved in the guideline stress that managing faltering weight goes beyond physical health. The recommendations highlight the importance of a child’s overall environment, noting that stable, supportive, and nurturing relationships are essential for normal growth and development.

The updated guidance aims to help clinicians make accurate diagnoses, reduce excessive testing, and use healthcare resources more effectively while ensuring children receive appropriate and timely care.