Symptomdx.

Get Started

Failure to ThriveMANAGEMENT

PSYCHIATRIC PRESENTATIONS · 12 SECTIONS

⚲

780 items

☷ Legend

⚲

Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Acute anxiety Acute psychosis Agitation-behavioral emergency Anorexia Nervosa (Medical Complications)Bipolar disorder Bipolar Disorder (Depressive Episode)Bipolar Disorder (Manic Episode)Bulimia Nervosa (Medical Complications)Catatonia Conversion disorder Dementia and behavioral crisis Factitious Disorder Failure to Cope (Social)Failure to Thrive Generalized Anxiety Disorder Homicidal Ideation Major Depressive Disorder Major depressive episode Malingering Neuroleptic malignant syndrome Panic Attack Post-Traumatic Stress Disorder (Acute)Schizophrenia Exacerbation Suicidal Ideation Suicidal ideation and attempt Suicide Attempt

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp43

Immediate priorities

›Severity assessment triggers

›Severe malnutrition z-score at or below -3

›Immediate nutritional rehabilitation planning

›Refeeding syndrome risk evaluation

›Signs of acute decompensation

›Lethargy or unresponsiveness

›Severe dehydration with sunken fontanelle and poor skin turgor

›Suspected non-accidental trauma or neglect

›Child protective services notification threshold

›Safe environment assessment before discharge

›If cardiovascular instability present, initiate resuscitation

›IV or IO access

›Normal saline 10 to 20 ml/kg bolus for dehydration

Monitoring and targets

›Growth and nutritional monitoring targets

›Weight plotted on WHO chart for children under 2 years

›Catch-up weight gain target 2 to 3 times expected daily increment

›Re-measure weekly in infants with moderate to severe faltering

›Length and head circumference trends

›Declining head circumference is a late and severe finding

›Short stature with faltering weight may indicate genetic or endocrine cause

›Vital sign monitoring for refeeding risk

›Electrolytes phosphate potassium magnesium at 24 to 48 hours after nutrition restart

›Cardiac monitoring in severe malnutrition during nutritional rehabilitation

›Escalation triggers

›Weight loss despite adequate documented intake

›Malabsorption or hypermetabolic state investigation

02History/hx81

Feeding history

›Infant feeding details

›Breast or formula feeding

›Latch difficulties or maternal milk supply concerns

›Correct formula preparation confirmation

›Formula concentration

›Standard 19 to 20 kcal per oz

›Signs of overdilution causing hyponatremia risk

›Frequency and duration of feeds

›Number of feeds per 24 hours

›Feed duration and volume consumed

›Older child diet

›24-hour dietary recall or food diary

›Total caloric intake estimate

›Macronutrient distribution

›Juice and free water intake

›Excessive juice displacing caloric intake

›Free water hyponatremia risk in infants

›Picky eating and food aversion patterns

›Sensory aversions to texture or color

›ARFID screening in adolescents

Symptom review

›Gastrointestinal symptoms

›Vomiting

›Frequency and relationship to feeds

›Projectile pattern suggesting pyloric stenosis

›Diarrhea or steatorrhea

›Celiac or malabsorption pattern

›Infectious cause if acute onset

›Constipation and abdominal distension

›Hirschsprung disease concern in neonates

›Hypothyroidism consideration

›Respiratory symptoms

›Chronic cough or recurrent pneumonia

›Aspiration risk with swallowing dysfunction

›Cystic fibrosis or bronchopulmonary dysplasia

›Diaphoresis with feeds or cyanosis

›Congenital heart disease concern

›Increased metabolic demand

›Neurodevelopmental symptoms

›Developmental milestone delays

›Oral motor skill development

›Cognitive and motor trajectory

›Behavioral feeding refusal

›Autism spectrum disorder association

›Sensory processing disorder overlap

Risk factors and social history

›Socioeconomic and family factors

›Food insecurity screening

›Up to 14% of households in food-insecure environments

›SNAP WIC participation status

›Caregiver mental health

›Postpartum depression

›Substance use or domestic violence

›Cultural or religious dietary restrictions

›Dietary exclusions limiting caloric variety

›Refugee or immigrant status nutritional context

›Perinatal and medical history

›Prematurity and low birth weight

›Intrauterine growth restriction history

›Neonatal ICU course and length

›Chronic medical conditions

›Congenital cardiac or pulmonary disease

›Genetic syndromes Down syndrome cerebral palsy

›Medication history

›Stimulant medications suppressing appetite

›Chronic corticosteroid effects on growth

›Family history

›Parental heights for mid-parental height calculation

›Constitutional growth delay pattern

›Familial short stature consideration

›GI disease in family

›Celiac disease

›Inflammatory bowel disease

Onset and timeline

›Growth trajectory context

›Age at onset of faltering

›Prenatal onset suggests intrauterine growth restriction

›Postnatal onset most commonly nutritional

›Relationship to dietary transitions

›Introduction of gluten and celiac onset

›Cow's milk transition and protein intolerance

›Duration of faltering

›Acute versus chronic pattern distinction

›Three or more months persistent despite intervention

03Physical Exam/exam88

Anthropometrics and vitals

›Growth parameter measurement

›Weight

›Plot on WHO chart for under 2 years or CDC chart for 2 years and older

›Convert to z-score for severity classification

›Length or height

›Length board required for children under 2 years

›Z-score for length or height

›Head circumference

›Plot for children under 3 years

›Declining trend as late sign of severe or prolonged malnutrition

›Mid-upper arm circumference

›Rapid assessment of acute malnutrition

›Under 12.5 cm indicates severe acute malnutrition in 1 to 5 year olds

›Vital signs

›Heart rate

›Tachycardia suggesting cardiac or infectious cause

›Bradycardia in severe malnutrition

›Respiratory rate

›Tachypnea with cardiac or pulmonary disease

›Respiratory distress during feeds

General and nutritional assessment

›Nutritional status signs

›Subcutaneous fat distribution

›Temporal wasting and cheek fat loss

›Loss of gluteal and thigh fat stores

›Muscle mass assessment

›Temporal muscle wasting

›Extremity muscle bulk reduction

›Skin and hair findings

›Hair thinning or flag sign of protein deficiency

›Dermatitis or rash suggesting zinc or essential fatty acid deficiency

›Hydration status

›Mucous membrane moisture

›Dry tongue and lips

›Anterior fontanelle depression in infants

›Skin turgor

›Prolonged return indicating dehydration

›Assess over abdomen or thigh in infants

Organ system exam

›Head eyes ears nose throat

›Fontanelle assessment

›Sunken as dehydration marker

›Bulging suggesting elevated intracranial pressure

›Oral cavity

›Cleft lip or palate affecting feeding mechanics

›Dental caries from nutritional neglect

›Dysmorphic features

›Genetic syndrome features

›Tonsillar hypertrophy affecting swallowing

›Cardiac exam

›Murmur

›Congenital heart disease increasing metabolic demand

›Echocardiography indication

›Hepatomegaly

›Congestive heart failure sign

›Metabolic storage disorder

›Abdomen

›Distension

›Malabsorption syndromes

›Hirschsprung disease in neonates

›Organomegaly

›Liver and spleen assessment

›Infectious or metabolic cause

›Neurological exam

›Tone assessment

›Hypotonia suggesting genetic or metabolic disorder

›Hypertonia in cerebral palsy

›Developmental assessment

›Oral motor skills for feeding competence

›Gross and fine motor milestones

Feeding observation

›Observed feeding assessment

›Caregiver-infant interaction quality

›Attunement and responsiveness

›Signs of force feeding or food avoidance dynamics

›Suck-swallow coordination

›Choking or gagging during feed

›Diaphoresis suggesting cardiac effort

›Feeding efficiency

›Volume consumed per feed

›Time required per feed

PITFALLS

›Common assessment errors

›Using percentile instead of z-score

›Z-score captures severity below 3rd percentile more precisely

›Percentile-based diagnosis leads to delayed identification

›Dismissing social and behavioral causes

›Organic cause identified in only 18 to 31% of cases

›Psychosocial cause identified in 45 to 89% of cases

›Ordering extensive labs without clinical indication

›Only 1 to 7% of routine labs reveal diagnosis in absence of clinical clues

›Targeted testing guided by history and exam

04Differential Diagnosis/ddx63

Inadequate intake causes

›Nutritional and behavioral causes

›Improper formula preparation

›Overdilution reducing caloric density

›ICD-10 Z71.3 dietary counseling

›Insufficient breast milk supply

›Poor latch or transfer

›Maternal factors including stress and medications

›Neglect or food insecurity

›ICD-10 T74.02 child neglect

›Social determinants assessment

›Eating disorders

›ARFID avoidant restrictive food intake disorder

›Anorexia nervosa in adolescents

›Anatomic and neuromuscular causes

›Cleft lip or palate

›Feeding mechanics impairment

›Surgical referral timing

›Cerebral palsy

›Oral motor dysfunction

›Aspiration risk

›Tonsil and adenoid hypertrophy

›Obstructive feeding difficulty

›Sleep-disordered breathing

Malabsorption causes

›GI tract disorders

›Celiac disease

›ICD-10 K90.0

05Laboratory Tests/lt68

Initial targeted labs

›Routine labs not recommended without clinical indication

›2026 AAP guideline supports targeted testing only

›Only 1 to 7% of labs yield diagnosis without clinical clue

›Testing reserved for severe malnutrition z-score below -3

›Indications for laboratory workup

›Persistent faltering weight over 3 or more months

›Failure to respond to nutritional intervention

›Specific signs or symptoms suggesting organic etiology

Hematologic and inflammatory tests

›Complete blood count with differential

›Anemia

›Iron deficiency as most common nutritional deficiency

›B12 and folate deficiency in restrictive diets

›Leukopenia or leukocytosis

›Infection or immunodeficiency concern

›Malignancy consideration

›Inflammatory markers

›ESR and CRP

›Inflammatory bowel disease or chronic infection

›Limited specificity in isolation

›Iron studies

›Serum ferritin and transferrin saturation

›Lead level if environmental exposure risk

Metabolic and organ function tests

›Comprehensive metabolic panel

›Electrolytes

›Hyponatremia from formula overdilution

06Diagnostic Tests/dt77

Scoring Systems

›Malnutrition severity z-score classification

›Mild malnutrition

›Z-score -1 to -1.9

›Outpatient management appropriate

›Moderate malnutrition

›Z-score -2 to -2.9

›Close outpatient monitoring or inpatient if not responding

›Severe malnutrition

›Z-score at or below -3

›Hospitalization indication

›WHO weight gain velocity standards

›Validated for children under 2 years

›Available at 1 2 3 4 and 6 month intervals

›Decline in weight gain velocity below -2 z-score is diagnostic criterion

›Weight-for-length or BMI-for-age z-score cutoff

›Below -1.65 z-score equivalent to below 5th percentile

›Decline of 1 or more z-score in weight trajectory also diagnostic

›Autism screening

›Modified Checklist for Autism in Toddlers M-CHAT-R/F

›Validated at 18 months and older

›ASD associated with 4-fold higher incidence of GI symptoms and feeding difficulties

›Developmental screening tools

›ASQ-3 Ages and Stages Questionnaire

›Identifies oral motor and developmental delays affecting feeding

MRI

›MRI indications in faltering weight

›Brain MRI for neurological causes

›Suspected intracranial tumor causing poor appetite or vomiting

›Neurological regression or hypotonia workup

›Abdominal MRI for complex GI anatomy

›Problem solving after inconclusive ultrasound or CT

›Avoid radiation exposure when feasible in children

›Limitations

›Requires sedation in young children

›Availability constraints in acute setting

›Not routinely indicated in standard FTT evaluation

›CT chest indications

›Chronic respiratory symptoms not explained by plain film

›Cystic fibrosis pulmonary involvement

›Interstitial lung disease

›CT head if neurological concern

›Rule out mass lesion or hydrocephalus

›Suspected non-accidental trauma with intracranial injury

›Radiation minimization principle

›ALARA principle in pediatric imaging

›Prefer ultrasound or MRI when equivalent diagnostic yield

›CT abdomen when indicated

›Suspected abdominal mass or organomegaly on exam

›Wilms tumor or neuroblastoma in differential

›Hepatosplenomegaly workup

›Not routinely indicated for standard faltering weight evaluation

›Reserve for specific clinical concern

›Pediatric radiology consultation for protocol optimization

Ultrasound

›Abdominal ultrasound indications

›Pyloric stenosis in infants 3 to 8 weeks with projectile vomiting

›Pyloric muscle thickness above 4 mm and length above 14 mm diagnostic

›Sensitivity above 95% specificity above 99%

›Hepatobiliary assessment

›Liver size and echogenicity

›Biliary atresia in neonatal jaundice

›Renal ultrasound

›Hydronephrosis or structural anomaly

›Recurrent UTI investigation

›Echocardiography

›Cardiac murmur on auscultation

›Congenital heart disease with increased metabolic demand

›Structural defect requiring surgical planning

›Signs of heart failure

›Hepatomegaly tachycardia tachypnea

›Poor weight gain despite adequate intake

›Upper GI fluoroscopy

›Swallowing dysfunction suspected

›Aspiration assessment during feeds

›Anatomic abnormality evaluation

›Structural causes

›Pyloric stenosis if ultrasound inconclusive

›Malrotation and volvulus concern

›Tracheoesophageal fistula

07Disposition/dispo49

Outpatient management criteria

›Criteria for safe outpatient management

›Malnutrition severity

›Mild to moderate malnutrition z-score above -3

›Clinically stable without acute decompensation

›Caregiver and social factors

›Reliable caregivers with access to food

›Ability to attend frequent follow-up appointments

›Response to initial intervention

›Weight gain with nutritional guidance in clinic

›Caregiver understanding of feeding plan

›Follow-up frequency

›Infants 1 to 6 months: weekly weight checks

›Office or home visiting nurse weight monitoring

›Lactation support as needed

›Infants 6 to 12 months: every 2 weeks

›Growth chart trajectory reassessment

›Dietary intake diary review

›Older children: monthly until catch-up growth documented

›Return to routine well-child schedule after sustained improvement

Hospitalization indications

›Clinical indications for admission

›Severe malnutrition z-score at or below -3 with instability

›Hemodynamic instability

›Severe dehydration requiring IV fluid resuscitation

›Outpatient treatment failure

›No weight gain despite documented adequate intake and support

›Persistent or worsening faltering over 3 or more months

08Treatment/t111

Caloric rehabilitation

›Catch-up growth caloric targets

›Estimated energy requirement calculation

›Recommended dietary allowance for expected weight not actual weight

›Add 50 to 100% extra calories for catch-up growth

›Target catch-up weight gain rates

›Infants 0 to 3 months: 26 to 31 g per day expected

›Infants 3 to 6 months: 17 to 18 g per day expected

›Infants 6 to 12 months: 12 to 13 g per day expected

›Children 1 to 3 years: 7 to 9 g per day expected

›Monitoring for refeeding syndrome in severe malnutrition

›Phosphate potassium magnesium within 24 to 48 hours of refeeding

›Cardiac monitoring if severe malnutrition on nutritional rehabilitation

Infant feeding interventions

›Breastfed infant management

›Lactation assessment by trained professional

›Latch and milk transfer evaluation

›Maternal milk supply strategies

›Supplementation approach

›Expressed breast milk after feeds

›Formula supplementation if breast milk insufficient

›Breastfeeding support before formula introduction

›2026 AAP guideline recommends thorough lactation assessment first

›Class I recommendation for lactation support intervention

›Formula-fed infant management

›Correct preparation verification

›Standard formula 19 to 20 kcal per oz

›Overdilution correction counseling

›Concentrated formula for catch-up growth

›22 to 27 kcal per oz concentrations

›Dietitian guidance on safe concentration methods

›Specialized formulas when indicated

›Elemental formula for protein intolerance

›MCT-enriched formula for fat malabsorption

Older child nutritional interventions

›Calorie-dense food strategies

›Healthy fat supplementation

›Nut butters avocado olive oil additions

›Full-fat dairy products

›Protein optimization

›Meat eggs legumes at each meal

›Protein supplementation if appetite poor

›Limiting calorie-displacing foods

›Juice limited or eliminated

›Excessive free water restriction

›Added sugars below 6 teaspoons per day in children over 2 years

›Structured mealtime behavioral strategies

›Consistent meal schedule

›Three meals and two to three snacks per day

›Minimize grazing behavior

›Minimize mealtime distractions

›No screens during meals

›Positive mealtime environment

›Picky eating management

›Division of responsibility feeding model

›Feeding therapist referral for sensory aversions

Nutritional supplementation

›Micronutrient supplementation

›Vitamin D

›400 IU per day for all breastfed infants

›600 to 1000 IU per day for deficient children

›Iron

›Elemental iron 3 to 6 mg per kg per day for deficiency

›Recheck hemoglobin in 4 weeks

›Zinc

›1 to 2 mg per kg per day elemental zinc for deficiency

›Benefits demonstrated in cystic fibrosis and some FTT populations

›Multivitamin

›Indicated when dietary variety severely restricted

›Age-appropriate formulation

›Appetite stimulants

›Cyproheptadine

›Evidence supports use in excessive energy metabolism states such as cystic fibrosis

›Benefit in general FTT is unclear

›Dose 0.25 mg per kg per day divided twice daily

›Routine appetite stimulant use not recommended

›Nutritional intervention is first-line

›Underlying cause treatment preferred

Enteral and parenteral nutrition

›Nasogastric tube feeding indications

›Refractory disease despite oral optimization

›Volume of oral intake insufficient for catch-up

›Significant comorbidity preventing adequate oral intake

›Protocol for NG supplementation

›Nocturnal continuous infusion while maintaining daytime oral feeds

›Gradual increase to avoid refeeding syndrome

›Monitor for complications

›Tube displacement and aspiration

›Electrolyte abnormalities

›Parenteral nutrition

›Reserved for severe GI dysfunction

›Short bowel syndrome

›Severe malabsorption with enteral intolerance

›Requires specialist management

›Pediatric gastroenterology or nutrition team

›Central venous access management

Treatment of underlying causes

›Organic cause treatment

›Celiac disease

›Strict gluten-free diet

›Dietitian guidance for complete exclusion

›Hypothyroidism

›Levothyroxine weight-based dosing

›TSH monitoring every 4 to 6 weeks until stable

›Congenital heart disease

›Cardiology-guided caloric optimization

›Surgical correction timing for growth improvement

›Cystic fibrosis

›Pancreatic enzyme replacement therapy

›High-fat calorie-dense diet

›Psychosocial intervention

›Food insecurity resources

›WIC SNAP TANF enrollment assistance

›Food bank and community resources

›Caregiver mental health support

›Postpartum depression treatment

›Parenting skills program referral

09Special Populations/sp66

Pregnancy

›Maternal malnutrition and fetal growth

›Intrauterine growth restriction risk

›Severe maternal malnutrition associated with IUGR

›Low birth weight defined below 2500 g

›Nutritional needs in pregnancy

›Folate 400 to 800 mcg per day preconception and first trimester

›Iron 27 mg per day in pregnancy

›Breastfeeding nutritional considerations

›Maternal caloric deficit reduces milk supply and quality

›Maternal vitamin D status affects breast milk vitamin D content

›Gestational diabetes and infant weight

›Large for gestational age infant with later FTT paradox

›Metabolic programming from gestational diabetes

Geriatric

›Failure to thrive in older adults

›Distinct from pediatric FTT in etiology

›Multifactorial including medical psychiatric functional social

›ICD-10 R62.7 adult failure to thrive

›Prevalence and mortality

›Affects up to 35% of community-dwelling older adults

›Associated with increased 1-year mortality

›Key contributing factors

›Depression and social isolation

›Polypharmacy affecting appetite and absorption

›Geriatric assessment components

›Mini Nutritional Assessment MNA score

›Functional capacity ADL and IADL evaluation

10Background/b71

Epidemiology

›Prevalence and incidence

›Affects 5 to 10% of children in primary care settings

›Most common in the first 2 years of life

›Higher rates in low-income and food-insecure populations

›Developmental delay co-occurrence

›Present in up to 39% of outpatient FTT cases

›Bidirectional relationship between malnutrition and development

›Food insecurity association

›Up to 14% of US households are food insecure

›Strongest epidemiologic risk factor for FTT

›Outcome data

›Sustained undernutrition in first 2 years

›Associated with decreased adult height

›Associated with decreased cognitive potential

›Organic etiology rates

›Organic cause identified in 18 to 31% of cases

›Nonorganic or psychosocial cause in 45 to 89% of cases

›Mixed multifactorial cause common

›Prematurity contribution

›Low birth weight and IUGR as risk factors

›Catch-up growth expected by 2 to 3 years in many

Pathophysiology

›Mechanisms of faltering growth

›Inadequate caloric intake pathway

›Most common mechanism

›Negative energy balance relative to growth needs

›Malabsorption pathway

›Normal or adequate intake with insufficient absorption

›Celiac disease cystic fibrosis inflammatory bowel disease

›Increased metabolic demand pathway

›Elevated resting energy expenditure

›Congenital heart disease chronic infections hypermetabolic states

›Nutritional deficiency sequelae

›Protein energy malnutrition effects

›Impaired immune function increasing infection susceptibility

›Delayed brain development in first 1000 days of life

›Specific micronutrient deficiency effects

›Iron deficiency causing cognitive impairment and anemia

›Zinc deficiency causing growth retardation and dermatitis

›Vitamin D deficiency causing rickets and bone fragility

›Refeeding syndrome mechanism

›Shift of phosphate intracellularly with carbohydrate reintroduction

›Hypophosphatemia causing cardiac and neuromuscular dysfunction

›Risk highest in severe malnutrition z-score below -3

›Electrolyte monitoring strategy

›Phosphate potassium magnesium checked within 24 to 48 hours

›Gradual caloric increase to minimize risk

Therapeutic Considerations

›Nomenclature update and clinical implications

›2026 AAP and NASPGHAN guideline shift to faltering weight

›Avoids stigmatizing term failure

›Preferred communication with families

›Diagnostic criteria now z-score based not percentile based

›Weight-for-length or BMI-for-age below -1.65 z-score

›Weight gain velocity below -2 z-score

›Decline in weight or BMI z-score of 1 or more units

›Abandonment of organic vs nonorganic dichotomy

›Multifactorial etiology the norm

›Medical nutritional and psychosocial factors coexist in most cases

›Integrated biopsychosocial assessment required

›Targeted testing over shotgun approach

›Routine labs not recommended without clinical clue

›Test directed by history and physical examination findings

›Nutritional rehabilitation evidence

›Caloric supplementation is first-line intervention

›Class I recommendation for nutritional intervention as primary treatment

›Behavioral intervention concurrent with nutritional optimization

›Multidisciplinary team superiority

›Dietitian feeding therapist psychologist pediatrician collaboration

›Better outcomes with team approach versus single clinician

›Hospitalization as last resort

›Outpatient management preferred when safe

›Inpatient only for severe instability safety concern or refractory cases

11Patient Discharge Instructions/pdi36

copy discharge instructions

›Faltering weight home care instructions

›Feeding plan to follow exactly as prescribed by your care team

›Breast milk or formula amount and frequency

›Concentrated formula instructions if prescribed

›Food and calorie goals for older children

›High-calorie food additions recommended by your dietitian

›Limit juice and excessive water or milk

›Vitamin and supplement schedule

›Give vitamin D iron zinc as prescribed

›Do not stop supplements without asking your doctor

›Follow-up schedule

›Return for weight check as instructed

›Infants under 6 months: weekly weight checks

›Infants 6 to 12 months: every 2 weeks

›Older children: monthly until growth improved

›Keep all specialist appointments

›Dietitian for feeding plan adjustment

›Feeding therapist if swallowing concerns

›Return to emergency department warning signs

›Signs requiring immediate return

›Decreased feeding or complete refusal to eat

›Fewer than 4 to 6 wet diapers per day in infants

›Lethargy extreme sleepiness or hard to wake

›Persistent vomiting or diarrhea

›Weight loss after starting the plan

›Fever above 38.5 degrees Celsius

›Bloody stools or severe abdominal pain

12References/r27

Guidelines and key sources

›Primary guidelines

›2026 AAP NASPGHAN Clinical Practice Guideline for Diagnosis and Management of Faltering Weight

›Kersten HB Goday PS Abdelhadi R et al. Pediatrics 2026

›Establishes z-score based diagnostic criteria and abandons organic vs nonorganic dichotomy

›Goodwin ET Buel KL Cantrell LD. Growth Faltering and Failure to Thrive in Children. American Family Physician 2023

›PMID 37327159

›Practical guidance for primary care management

›Homan GJ. Failure to Thrive A Practical Guide. American Family Physician 2016

›PMID 27548594

›Classic reference for structured evaluation approach

›Supporting evidence

›El Mikati IK et al. Benefits and Harms of Endoscopy and Diagnostic Tests in Faltering Weight. Pediatrics 2026

›PMID 41833320

›Technical report supporting targeted testing recommendation

›Tiwari M Khan WK Poulton A et al. Biopsychosocial Characteristics of Children Admitted With Failure to Thrive. Journal of Paediatrics and Child Health 2023

›PMID 37382081

›Epidemiology and hospitalization characteristics

›Wit JM Kamp GA Oostdijk W. Towards a Rational and Efficient Diagnostic Approach in Children Referred for Growth Failure. Hormone Research in Paediatrics 2019

›PMID 31195397

›Diagnostic framework for growth failure evaluation

Coding references

›ICD-10 codes

›R62.51 Failure to thrive child

›Z-score based malnutrition grading preferred

›E44.0 Moderate protein-calorie malnutrition

›E44.1 Mild protein-calorie malnutrition

›E43 Unspecified severe protein-calorie malnutrition for z-score below -3

Learn More: Failure to Thrive→

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.