Videos

Clinical Practice Guideline for the Diagnosis and Management of Faltering Weight

How can clinicians identify and manage faltering weight earlier using updated definitions, z-scores, and evidence-based interventions?

Presenter(s): Praveen S Goday, MD, PhD; John T Stutts, MD, MPH, FAAP 

Publication Date: 04 September 2026

Summary:

This Clinical Nutriton Conversations videocast features Praveen S Goday, MD, PhD, Director of Nutriton at Nationwide Children’s Hospital, and John T Stutts, MD, MPH, FAAP, Pediatric Medical Director at Abbott, discussing the newly published clinical practice guideline released by the American Academy of Pediatrics (AAP) and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) entitled Clinical Practice Guideline for Diagnosis and Management of Faltering Weight. The guideline represents an important shift away from the historically used term "failure to thrive" toward a more clinically precise, less stigmatizing framework for identifying children at risk of undernutrition.

The discussion highlights the rationale for the updated definition and the adoption of z-scores as the preferred method for growth assessment.  Faltering weight is defined using three primary criteria:  weight-for-length, or BMI-for-age less than -1.65 z-score; or in children younger than 2 years, weight gain velocity less than -2 z-score for age; or decline in weight, weight-for-length, or BMI greater than or equal to 1 z-score.

The speakers emphasize the importance of identifying growth concerns early, before declines in linear growth occur, and explain why height measurements alone were excluded from the faltering weight definition. They also discuss practical implementation of z-scores, socioeconomic factors, appropriate use of diagnostic testing, nutritional interventions, oral nutritional supplementation, feeding therapy referrals, and barriers to guideline implementation in clinical practice.

This educational resource helps pediatric healthcare professionals understand evolving terminology, apply growth assessment tools more consistently, and implement targeted interventions to improve nutritional outcomes and growth trajectories in infants and children.

Key Takeaways:
  • The American Academy of Pediatrics (AAP), in collaboration with the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN), has published a guideline for health care professionals that recommends retiring the term “failure to thrive” and replacing it with the updated terminology of “faltering weight.”
  • Faltering weight includes any of the following: weight-for-length, or BMI-for-age less than -1.65 z-score; or in children younger than 2 years, weight gain velocity less than -2 z-score for age; or decline in weight, weight-for-length, or BMI greater than or equal to 1 z-score.
  • The guideline recommends using the z-score measurement over percentiles when evaluating growth in children because z-scores help quantify the severity of growth deviation, allow clinicians to monitor meaningful changes over time, and facilitate comparisons across populations for research studies.
Related Questions & Answers:

What is the definition for the term "faltering weight"?

  • Children whose weight-for-length, or BMI-for-age <-1.65 z score (5th percentile); or
  • Children younger than 2 years, weight gain velocity less than -2 z score for age (2.3rd percentile); or 
  • Decline in weight, weight-for-length, or BMI >1 z scorex

Why did the panel exclude height measurements in isolation from the new definition of faltering weight?

Faltering weight is like a screening definition. Measuring the z score is more precise and will identify patients earlier before you see a drop in percentiles of height and head circumference.

What are the guidelines recommendations for managing faltering weight?
Nutritional support is important for children with faltering weight. The guideline panel recommends the use of increased calories of food/energy rather than no increased calories of food/energy and the use of oral nutritional supplements (ONS) rather than no ONS.  Additionally, in children with faltering weight who have documented feeding issues, the panel suggests therapy for pediatric feeding disorders rather than no therapy for pediatric feeding disorders.

Presenter Bio(s):

Praveen S Goday, MD, PhD

Pediatric Gastroenterologist 
Director of the Nutrition and Feeding Programs 
Nationwide Children’s Hospital 
Columbus, Ohio, USA

Praveen Goday, MD, PhD, is a pediatric gastroenterologist at Nationwide Children’s Hospital. He is the Director of the Nutrition and Feeding Programs, which provide nutrition care throughout the hospital system and care to children with feeding problems. He is a clinical professor of Pediatrics at The Ohio State University.

Dr Goday is a graduate of Madras Medical College in India. He is board certified in Pediatric Gastroenterology and Nutrition. He is active at the national level in promoting pediatric nutrition. He is currently serving on the Committee on Nutrition of the American Academy of Pediatrics and the board of the American Society for Parenteral and Enteral Nutrition (ASPEN). He has been recognized by several societies for his work in pediatric nutrition and has received the Distinguished Nutrition Support Physician Service Award from ASPEN (2018), the Master Educator Award for sustained educational scholarship from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) (2021), and Honorary Membership of the Academy of Nutrition and Dietetics for distinguished contributions to the field of nutrition (2022). Dr Goday’s research interests include multiple efforts to improve feeding, nutrition, and growth in children with a range of diseases.

In 2019, Dr Goday was the lead author of the paper that defined Pediatric Feeding Disorder, which has served to unify this common but understudied condition. This was followed by a paper that identified the prevalence of this condition. He has also co-authored important publications, including the original paper that identified the key concepts of pediatric malnutrition and the guidelines for the provision of nutrition to critically ill children. He has also edited two books: Pediatric Critical Care Nutrition and Pediatric Nutrition for Dietitians. Additionally, in 2026, he was an author on the new clinical practice guideline for diagnosis and management of faltering weight.

John Stutts, MD, MPH, FAAP

Medical Director, Pediatric Nutrition 
Abbott Nutrition 
Columbus, OH, USA

John Stutts, MD, MPH, FAAP, is the Medical Director of Pediatric Nutrition at Abbott. He has participated in numerous clinical trials in his tenure, including many studies with the Norton Children’s Pediatric Clinical Research Unit. He is a past member of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Professional Education, Public Education, and Professional Development Committees. Dr Stutts earned his Bachelor of Science from Purdue University and his Doctor of Medicine from the University of Louisville. He completed his Pediatric Residency, Pediatric Gastroenterology Fellowship, and Master of Public Health from Vanderbilt University.

Category
Pediatric Growth & Development
References:
  • Kersten HB, Goday PS, et al. Pediatrics. 2026;157(4):e2025075764. 
  • Olsen EM, et al. Arch Dis Child. 2007;92(2):109-114.X