SGEM#523: Everything Grows and Grows…Until it Doesn’t. Clinical Practice Guidelines for Faltering Weight
Summary
Host Dennis Wren and guest Dr. Selena Kuchel discuss the new AAP/NASPGAN guideline renaming "failure to thrive" to "faltering weight." They review the shift from percentiles to Z-scores and the recommendation against routine diagnostic testing in stable, well-appearing infants. The episode highlights the need for accurate anthropometrics and targeted evaluation based on specific red flags rather than broad workups. Kuchel provides practical guidance on emergency department disposition, emphasizing that admission should be driven by acute medical instability or unsafe follow-up rather than i…
Topics discussed
Introduction and guest bio
Case presentation: 7-month-old with poor weight gain
Terminology shift: Failure to thrive vs. faltering weight
New diagnostic criteria using Z-scores
Moving beyond organic vs. non-organic causes
Guideline scope, target audience, and clinical questions
PICO framework: Population, interventions, and outcomes
Author conclusions and implementation challenges
Quality checklist: Evidence, balance, and conflicts
Five key ED recommendations from the guideline
Nerdy point: GRADE methodology and strong recommendations
Nerdy point: Surrogate outcomes and missing harms
Nerdy point: Practicality and validation of Z-scores
Nerdy point: ED testing and GI red flags
Nerdy point: Multidisciplinary panel and ED gaps
Admission criteria vs. outpatient management
SGM conclusion and bottom line for ED clinicians
Case resolution and clinical application
Family communication and closing remarks
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