GoTo Telemed, the nation's leading integrated telehealth ecosystem serving over 10 million patients nationwide, today announced the launch of its dedicated Pediatric Faltering Weight Program, a comprehensive virtual care service designed to address the complex nutritional and developmental needs of infants and children with inadequate weight gain through evidence-based assessment, structured nutritional intervention, and family-centered support. Delivered by a multidisciplinary network of pediatricians, registered dietitians, feeding specialists, and behavioral health providers, this program brings expert care directly to families nationwide.

Pediatric growth faltering—formerly known as "failure to thrive"—affects an estimated 5% to 10% of children in primary care settings, with higher rates among those with medical complexity or socioeconomic vulnerability. The condition is defined as a height or weight for length or body mass index below expected measurement, or crossing of two percentile lines on age- and sex-specific growth charts after previous typical growth. The American Academy of Pediatrics has released its first guideline on diagnosing and managing faltering weight in children, recommending the use of z-scores rather than percentiles as diagnostic criteria and emphasizing evidence-based treatments. Despite its prevalence and potential for long-term consequences—including developmental delays, cognitive impairment, and poor quality of life—access to multidisciplinary nutritional support remains limited, particularly in rural and underserved communities. GoTo Telemed's program eliminates these barriers while delivering care that meets or exceeds AAP clinical standards.

"Pediatric growth faltering is not a failure of the child or the parent—it is a medical condition requiring systematic evaluation and compassionate support," said a GoTo Telemed spokesperson. "Our Pediatric Faltering Weight Program brings together pediatricians, dietitians, and feeding specialists to provide structured nutritional assessment and family-centered intervention through telehealth. Whether addressing inadequate caloric intake, malabsorption, increased metabolic demands, or feeding difficulties, we help families identify root causes and implement sustainable solutions that promote healthy growth and development—all from the convenience and privacy of home."

Comprehensive Definition and Diagnostic Framework

The program follows the updated AAP clinical practice guideline, which replaces the term "failure to thrive" with "faltering weight" to avoid negative connotations and emphasize the dynamic, treatable nature of the condition. Diagnostic criteria include:

Diagnostic Criterion Description
Weight-for-length or BMI z-score Below -2 standard deviations (approximately below the 3rd percentile) for age and sex
Decline in weight-for-length or BMI z-score Decrease of ≥1 standard deviation over a defined period
Weight gain velocity Less than expected based on age and sex norms
Crossing of percentile lines Drop across two major percentiles on growth charts
The presence of any one of these criteria warrants further evaluation for faltering weight. For infants, clinical assessment is recommended for babies who lose more than 10% of their birth weight or do not return to their birth weight after three weeks. The program emphasizes that faltering weight is a clinical observation, not a diagnosis in itself, and requires systematic evaluation to identify underlying causes.

Etiology and Risk Factors

The program guides providers through a structured evaluation of the three primary mechanisms underlying faltering weight:

Mechanism Description and Contributing Factors
Inadequate Caloric Intake Insufficient volume or concentration of feedings due to breastfeeding difficulties, formula preparation errors, poor appetite, feeding resistance, oral-motor dysfunction, neglect, or lack of access to nutritious food
Malabsorption Inability to absorb adequate calories due to cystic fibrosis, celiac disease, food protein-induced enterocolitis syndrome, short gut syndrome, or other gastrointestinal conditions
Increased Metabolic Demand Elevated caloric requirements due to chronic illness (congenital heart disease, bronchopulmonary dysplasia), recurrent infections, hyperthyroidism, or malignancy
Mild to moderate growth faltering is treated with nutritious, high-calorie feedings or meals given on a regular schedule. Medical disorders and a lack of proper nutrition are the primary causes of faltering growth, with the differential further stratified by acuity and pathophysiology.

Comprehensive Nutritional Assessment Protocol

The program implements a structured, family-centered assessment protocol to evaluate nutritional status, identify contributing factors, and establish baseline parameters for intervention:

Assessment Component Description
Detailed Feeding History Systematic evaluation of breastfeeding or formula-feeding practices (frequency, duration, volume, preparation), introduction and acceptance of complementary foods, feeding behaviors (pacing, responsiveness), mealtime environment, and parental feeding strategies
24-Hour Dietary Recall Comprehensive review of all foods, beverages, and supplements consumed in the preceding 24 hours to estimate caloric intake and identify nutritional gaps
Anthropometric Measurements Serial weight, length/height, and head circumference measurements plotted on WHO or CDC growth charts. Weight gain velocity calculated to assess trend over time
Feeding Strategies Questionnaire (FSQ) Validated assessment tool to identify problematic feeding behaviors, parent-child interactions during meals, and strategies that may inadvertently reinforce resistance
Psychosocial Assessment Evaluation of family stressors, food security, caregiver mental health, social support, and access to resources—factors that significantly impact nutritional status
Physical Examination Virtual assessment of general appearance, hydration status, muscle wasting, subcutaneous fat stores, and signs of underlying medical conditions
Targeted Laboratory Evaluation When indicated, coordination of laboratory testing at local facilities, including complete blood count, comprehensive metabolic panel, celiac serology, thyroid function tests, and inflammatory markers
The program also incorporates the Pediatric Inventory for Parents (PIP) and PedsQL Family Impact Module (PedsQL FIM) to assess caregiver stress and family functioning, recognizing that the emotional burden of managing faltering weight can significantly impact treatment adherence and outcomes.

Evidence-Based Nutritional Intervention Protocol

Following comprehensive assessment, the program implements a structured, evidence-based nutritional intervention protocol aligned with AAP guidelines and current best practices:

Intervention Level Description
Caloric Prescription Children with growth faltering typically require 150% of the recommended daily allowance (RDA) of calories to achieve catch-up growth. The program calculates personalized caloric targets based on expected weight for age, not actual weight, with adjustments for individual needs
Formula and Breastfeeding Optimization For formula-fed infants, guidance on appropriate concentration, volume per feeding, and feeding frequency. For breastfed infants, lactation support to assess milk transfer, strategies to increase milk production, and recommendations for supplementation when indicated
High-Calorie Fortification Structured protocols for fortifying breast milk or formula with modular components (fat, carbohydrate, protein) to increase caloric density without increasing volume. For older children, incorporation of calorie-dense, nutrient-rich foods into meals and snacks
Structured Feeding Schedule Implementation of regular, predictable meal and snack times to establish consistent eating patterns and reduce grazing. Limit snacks to avoid reducing appetite for regular meals
Feeding Behavior Guidance Parent training in responsive feeding techniques, avoidance of pressure and coercion, strategies to manage food refusal, and positive reinforcement for desired eating behaviors
Oral-Motor and Swallowing Support For children with identified oral-motor dysfunction or feeding difficulties, referral to feeding specialists or speech-language pathologists within GoTo Telemed's network for virtual assessment and intervention
Nutritional Supplementation When oral intake remains inadequate despite structured interventions, guidance on use of commercial pediatric nutritional supplements (e.g., PediaSure, Pediasure) to bridge caloric gaps
Medical Treatment Coordination Warm handoffs to pediatric gastroenterology, endocrinology, pulmonology, or other specialists when underlying medical conditions are identified as contributing factors
Family-Centered Care and Caregiver Support

The program recognizes that effective management of faltering weight requires addressing the emotional and practical challenges faced by families:

Reducing Stigma and Blame: The program emphasizes that faltering weight is a medical condition, not a reflection of parental competence. Providers use non-judgmental, supportive communication to build trust and engagement

Addressing Feeding Stress: Many families experience significant anxiety around feeding, which can perpetuate dysfunctional mealtime interactions. The program provides strategies to reduce pressure and restore positive feeding relationships

Resource Navigation: For families facing food insecurity, the program connects caregivers with community resources, federal nutrition programs (WIC, SNAP), and food assistance organizations

Caregiver Mental Health Support: Recognition that caregiver depression, anxiety, or other mental health conditions may impact feeding practices and treatment adherence. Embedded behavioral health support addresses these concerns

Practical Problem-Solving: Providers work collaboratively with families to identify and overcome practical barriers to treatment adherence, including scheduling conflicts, transportation, cost, and cultural preferences

Telehealth-Enabled Growth Monitoring and Follow-Up

The program leverages GoTo Telemed's integrated digital health platform to support ongoing monitoring and timely intervention:

Digital Growth Chart Tracking: Secure platform for documenting serial weights, lengths/heights, and head circumference measurements. Automated plotting on WHO or CDC growth charts with z-score calculation and trend analysis

Remote Weight Monitoring: Guidance for families on obtaining accurate weights at home using infant scales or digital bathroom scales, with data transmitted through the patient portal

Video-Based Feeding Observation: Live or recorded feeding sessions reviewed by feeding specialists to assess oral-motor function, parent-child interaction, and feeding technique

Automated Follow-Up Scheduling: Structured follow-up intervals (typically 2-4 weeks) for weight checks and nutritional reassessment, with automated reminders to improve adherence

Secure Messaging and Support: Direct communication with the care team between visits for questions, troubleshooting, and reinforcement

Patient Education Library: Access to evidence-based resources on feeding practices, formula preparation, high-calorie recipes, and developmental milestones

Telehealth Effectiveness for Nutritional Management

The program is supported by growing evidence demonstrating the effectiveness of telehealth for pediatric nutritional management. A 2025 narrative review published in Healthcare found that pediatric tele-nutrition demonstrates clinical outcomes comparable to traditional in-person care across diverse populations including obesity management, diabetes, gastrointestinal disorders, feeding difficulties, metabolic conditions, and preventive nutrition services. Telemedicine has proven to be a promising instrument for improving pediatric patients' healthcare in several fields, including close monitoring of nutritional status in children with complex feeding problems.

Integration Within GoTo Telemed's Comprehensive Pediatric Ecosystem

The Pediatric Faltering Weight Program operates as a fully integrated component of GoTo Telemed's unified telehealth platform:

Unified Health Record: All growth measurements, feeding assessments, laboratory results, and intervention documentation are incorporated into the patient's lifetime electronic health record, accessible to all authorized providers

Seamless Care Coordination: Warm handoffs to pediatric specialists including gastroenterology, endocrinology, pulmonology, genetics, and developmental pediatrics when indicated

Integrated Feeding Support: Direct referral to feeding specialists, speech-language pathologists, and occupational therapists within GoTo Telemed's network for oral-motor and swallowing assessment

Lactation Consultation: Coordination with certified lactation consultants for breastfeeding support and milk transfer assessment

Laboratory and Pharmacy Integration: Electronic orders for laboratory testing at local facilities and prescriptions for nutritional supplements transmitted to patient-selected pharmacies

Addressing Critical Gaps in Pediatric Nutritional Care

The Pediatric Faltering Weight Program directly confronts persistent barriers to optimal nutritional management:

Geographic Access Disparities: Pediatric dietitians and feeding specialists are concentrated in academic medical centers. Telehealth eliminates geographic barriers, connecting families with expert providers regardless of location

Multidisciplinary Gaps: Faltering weight often requires input from multiple disciplines (pediatrics, nutrition, feeding, behavioral health). The program's integrated model ensures coordinated, comprehensive care

Caregiver Burden: Frequent in-person weight checks impose transportation, time, and financial burdens. Remote monitoring reduces these barriers while maintaining close follow-up

Diagnostic Uncertainty: Primary care providers may lack confidence in evaluating faltering weight. The program's structured algorithm supports systematic assessment and appropriate intervention

Early Intervention Access: Timely identification and treatment of faltering weight prevents long-term consequences including developmental delays, cognitive impairment, and poor quality of life




Media Contact:
GoTo Telemed Media Relations
[email protected]
(660) 628-1660
www.gototelemed.com