Today we are outlining the key recommendations from the American Academy of Pediatrics (AAP) guideline Diagnosis and Management of Faltering Weight. Previously referred to as “failure to thrive,” faltering weight is a common concern in the pediatric care setting but lacks a consistent definition and standardized approach to evaluation and management. The new AAP guideline provides recommendations to support clinicians in the diagnosis and management of faltering weight, with the goal of improving diagnostic consistency and standards of care. 

Listed below are the eight key action statements included in the AAP clinical practice guideline on faltering weight. The recommendations span across categories including diagnostic tests, endoscopy, therapy, and more. View the full-text version for the most thorough explanation of these faltering weight management recommendations. 

Key Action Statements from the 2026 AAP Faltering Weight Guideline:

Socioeconomic Status:

  • The AAP Guideline Panel suggests against using socioeconomic status as an assigned risk factor when diagnosing faltering weight.

Diagnostic Tests:

  • In children who have certain conditions that suggest a focal evaluation (ie, severity of malnutrition, time since diagnosis, family history, additional signs or symptoms) or have persistent faltering weight, the AAP Guideline Panel suggests diagnostic testing rather than no testing.
  • In children without specified conditions that suggest a focal evaluation, the AAP Guideline Panel recommends against diagnostic testing as part of the initial routine workup for faltering weight.

Endoscopy:

  • In children with faltering weight, the AAP Guideline Panel recommends against endoscopy as part of the initial routine workup.
  • In children with persistent faltering weight or who have concerns for conditions that cannot be diagnosed without endoscopy, the AAP Guideline Panel suggests endoscopy with biopsy rather than no endoscopy.

Increased Calories:

  • In children with faltering weight, the AAP Guideline Panel recommends the use of increased calories of food/energy rather than no increased calories of food/energy.

Oral Supplementation:

  • In children with faltering weight, the AAP Guideline Panel suggests the use of oral nutritional supplementation rather than no oral nutritional supplementation.

Therapy:

  • In children with faltering weight who have documented feeding issues, the AAP Guideline Panel suggests therapy for pediatric feeding disorder rather than no therapy for pediatric feeding disorder.

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