Faltering weight

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AssessmentChoose one

HistoryChoose any

Focal signs presentChoose any

Focal signs absentChoose any

TestingChoose one

CaloriesChoose any

Additional planChoose any

DispositionChoose one

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling

Most children with slow weight gain need more calories rather than tests, and weight checks show whether the plan is working. Recommended supportive care with an emphasis on frequent feeds or meals, following any mixing instructions exactly, and calm, pressure-free feeding times. Return precautions given including poor feeding, fewer wet diapers, vomiting, unusual sleepiness, breathing trouble with feeds, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Discussed the reasons for hospital admission. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Faltering weight
• Faltering weight with a decline in weight-for-length
• Detailed feeding history reviewed, including breastfeeding effectiveness, formula preparation, volumes, and juice or grazing
• Development and oral-motor skills reviewed
• No vomiting, diarrhea, developmental delay, breathing or heart symptoms with feeds, or signs of nutrient deficiency
• No routine labs given no focal signs, per the AAP faltering weight guideline
• Feeds every 2-3 hours day and night
• Formula concentrated to 22 kcal/oz with a mixing sheet given
• Outpatient management with close weight checks
• Follow up in 2-3 days to recheck weight

Most children with slow weight gain need more calories rather than tests, and weight checks show whether the plan is working. Recommended supportive care with an emphasis on frequent feeds or meals, following any mixing instructions exactly, and calm, pressure-free feeding times. Return precautions given including poor feeding, fewer wet diapers, vomiting, unusual sleepiness, breathing trouble with feeds, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Faltering weight vs slow gain
Feeding history; developmental evaluation
Focal signs
No routine labs vs targeted vs persistent
Increased calories; supplements
Feeding therapy; WIC; social needs

Used to decide, kept out of the note

No endoscopy

Return precautions in the template

poor feedingfewer wet diapersvomitingunusual sleepinessbreathing trouble with feeds

Sources

AAP Clinical Practice Guideline for Diagnosis and Management of Faltering Weight. Pediatrics 2026;157(4):e2025075764