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The diagnosis of weight faltering can be challenging and often controversial. The determination should be made based on careful evaluation of growth parameters, including longitudinal patterns plotted on age- and gender-appropriate growth charts. For children with suspected or diagnosed weight faltering, the initial work-up should be limited, with laboratory tests and studies directed by findings on history and physical examination. Treatment should include nutritional counselling, familial support, and close outpatient follow-up. Hospitalisation may be useful in some cases but should not be used routinely to assist in the diagnostic work-up. Patients with limited response to these interventions may require further evaluation.