2.13 Nutrition Risk Criteria

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2.0       Eligibility/Certification

2.13     Nutrition Risk Criteria (Rev 9/21)

Definitions:

  • Self-Reporting: Self‐reporting of a diagnosis by a medical professional should not be confused with self‐diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self‐reported medical diagnosis (“My doctor says that I have/my son or daughter has…”) should prompt staff to validate the presence of the condition by asking more pointed questions related to that diagnosis.

South Dakota Nutrition Risk Codes:

100 Risk Series – Anthropometric Risk

RISK:   10101 – Underweight (Women)

  • CATEGORY: PG, NPP, BE, BP
  • ASSIGNMENT:  Auto-assigned based on calculated BMI
  • CRITERIA: 
    • Pregnant: Prepregnancy Body Mass Index (BMI) <18.5
    • Postpartum:
      • Non-Breastfeeding Women
        • Prepregnancy or current Body Mass Index (BMI) <18.5
      • Breastfeeding Women less than 6 months postpartum
        • Prepregnancy or current Body Mass Index (BMI) <18.5
      • Breastfeeding Women 6 months postpartum or more
        • Current Body Mass Index (BMI) <18.5
Height (Inches) Underweight
  BMI<18.5
Normal Weight
BMI18.5-24.9
 Overweight
 BMI 25.0-29.9 
 Obese
 BMI ≥30.0
58″<8989-118119-142>142
59″<9292-123124-147>147
60″<9595-127128-152>152
61″<9898-131132-157>157
62″<101101-135136-163>163
63″<105105-140141-168>168
64″<108108-144145-173>173
65″<111111-149150-179>179
66″<115115-154155-185>185
67″<118118-158159-190>190
68″<122122-163164-196>196
69″<125125-168169-202>202
70″<129129-173174-208>208
71″<133133-178179-214>214
72″<137137-183184-220>220

RISK: 10301 – Underweight (Infants and Children)
HIGH RISK

  • CATEGORY: IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:  Auto-assigned based on calculated weight-for-length or BMI-for-age percentile
  • CRITERIA:
    • Birth to < 24 months:    <2.3rd percentile weight-for-length as plotted on the WHO Birth to 24 months gender specific growth charts based on 2006 WHO international growth standards.
    • 2-5 years:  <5th percentile BMI-for-age as plotted on the 2000 CDC 2-20 years gender specific growth charts.
    • NOTE: For premature infants and children (born at < 36 weeks gestation) up to 2 years of age, assignment of this risk criterion will be based on adjusted gestational age.

RISK: 10401 – At Risk of Underweight (Infants and Children)

  • CATEGORY: IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on calculated weight-for-length or BMI-for-age percentile
  • CRITERIA: 
    • Birth to < 24 months:  >2.3rd percentile and <5th percentile weight-for-length as plotted on the WHO Birth to 24 months gender specific growth charts based on 2006 WHO international growth standards.
    • 2-5 years:  > 5th percentile and <10th percentile BMI-for-age as plotted on the 2000 CDC 2-20 years gender specific growth charts.
    • NOTE: For premature infants and children (born at < 36 weeks gestation) up to 2 years of age, assignment of this risk criterion will be based on adjusted gestational age

RISK: 11101 – Overweight (Women)

  • CATEGORY: PG,NPP, BE, BP
  • ASSIGNMENT: Auto-assigned based on calculated BMI
  • CRITERIA: 
    • Pregnant:
      •  Prepregnancy Body Mass Index (BMI) > 25.0  
    • Postpartum:
      • Non-Breastfeeding Women
        • Prepregnancy Body Mass Index (BMI) > 25.0
      • Breastfeeding Women less than 6 months postpartum
        • Prepregnancy Body Mass Index (BMI) > 25.0
      • Breastfeeding Women 6 months postpartum or more
        • Current Body Mass Index (BMI) > 25.0

RISK: 11301 – Obese (Children 2-5 Years of Age)
HIGH RISK

  • CATEGORY: C2-C4
  • ASSIGNMENT: Auto-assigned based on calculated BMI-for-age percentile
  • CRITERIA: 
    • 2-5 years:  ≥ 95th percentile Body Mass Index (BMI) or ≥95th percentile weight-for-stature as plotted on the 2000 CDC 2-20 years gender specific growth charts.
    • The cut-off is based on standing height measurements.  Therefore, recumbent length measurements may not be used to determine risk.
    • Clarification: The 2000 CDC Birth to 36 months growth charts cannot be used as a screening tool for the purpose of assigning this risk because these charts are based on recumbent length rather than standing height data. However, these charts may be used as an assessment tool for evaluating growth in children aged 24-36 months who are not able to be measured for the standing height required for the 2000 CDC 2-20 years gender specific growth charts.

RISK: 11401 – Overweight (Children 2-5 Years of Age)

  • CATEGORY: C2-C4
  • ASSIGNMENT: Auto-assigned based on calculated BMI-for-age percentile
  • CRITERIA:   
    • 2-5 years:   ≥85th and <95th percentile BMI-for-age or percentile weight-for-stature as plotted on the 2000 CDC 2-20 years gender specific growth charts.
    • Clarification: The 2000 CDC Birth to 36 months growth charts cannot be used as a screening tool for the purpose of assigning this risk because these charts are based on recumbent length rather than standing height data. However, these charts may be used as an assessment tool for evaluating growth in children aged 24-36 months who are not able to be measured for the standing height required for the 2000 CDC 2-20 years gender specific growth charts.

RISK: 11402- At Risk of Overweight (Infants and Children) 

  • CATEGORY: IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on calculated parent BMI
  • CRITERIA:
    • <12 months (infant of obese mother):  Biological mother with BMI ≥ 30 at the time of conception or at any point in the first trimester of pregnancy.  [BMI must be based on self-reported weight and height by the parent in attendance (i.e., one parent may not “self-report” for the other parent) or weight and height measurements taken by staff at the time of certification.]
    • >12 months (child of obese mother):  Biological mother with BMI ≥ 30 at the time of certification.  [BMI must be based on self-reported weight and height by the parent in attendance (i.e., one parent may not “self-report” for the other parent) or weight and height measurements taken by staff at the time of certification.] (If the mother is pregnant or has had a baby within the past 6 months, use her preconception weight to assess for obesity since her current weight will be influenced by pregnancy-related weight gain.)
    • Birth to 5 years (infant or child of obese father):  biological father with a BMI ≥30 at the time of certification.  [BMI must be based on self-reported weight and height by the parent in attendance (i.e. one parent may not “self-report” for the other parent) or on weight and height measurements taken by staff at the time of certification.]

RISK: 11501 – High Weight-for-Length (Infants and Children < 24 Months of Age)

  • CATEGORY: IBE, IBP, IFF, C1
  • ASSIGNMENT:Auto-assigned based on calculated weight-for-length percentile
  • CRITERIA: 
    • Birth to < 24 months:  ≥ 97.7th  percentile weight-for-length as plotted on the WHO Birth to 24 months gender specific growth charts based on the 2006 WHO international growth standards.
    • NOTE: For premature infants and children (with a history of prematurity) up to 2 years of age, assignment of this risk criterion will be based on adjusted gestational age.

RISK: 12101 – Short Stature (Infants and Children)

  • CATEGORY:  IBE, IBP, IFF, C1-C4                                                                                            
  • ASSIGNMENT: Auto-assigned based on calculated length-for-age percentile or stature-for-age percentile
  • CRITERIA:           
    • Birth to <24 months:  ≤ 2.3rd percentile length-for-age as plotted on the CDC Birth to 24 months gender specific growth charts based on the 2006 WHO international growth standards.
    • 2-5 Years:  ≤ 5th percentile stature-for-age as plotted on the 2000 CDC age/gender specific growth charts
    • NOTE:  For premature infants and children (with a history of prematurity) up to 2 years of age, assignment of this risk criterion will be based on adjusted gestational age.

RISK: 12201 –At Risk of Short Stature (Infants and Children)

  • CATEGORY: IBE, IBP, IFF, C1-C4                                                                                            
  • ASSIGNMENT: Auto-assigned based on calculated length-for-age percentile or stature-for-age percentile
  • CRITERIA: 
    • Birth to <24 months:  > 2.3rd percentile and ≤ 5th percentile length-for-age as plotted on the CDC Birth to 24 months gender specific growth charts based on the 2000 WHO international growth standards.
    • 2-5 Years:  > 5th percentile and ≤ 10th percentile stature-for-age as plotted on the 2000 CDC age/gender specific growth charts
    • NOTE:  For premature infants and children (with a history of prematurity) up to 2 years of age, assignment of this risk criterion will be based on adjusted gestational age.

RISK: 13101 – Low Maternal Weight Gain
HIGH RISK

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on report of weight loss during pregnancy or any plot point below desired range on appropriate prenatal weight gain grid during 2nd and 3rd trimesters, or low total weight gain at any point in pregnancy.
  • CRITERIA: 
  • 1.  A low rate of weight gain, such that in the 2nd and 3rd trimesters, for singleton pregnancies:
Prepregnancy Weight CategoryBMITotal Weight Gain (lbs)/week
Underweight<18.5<1
Normal Weight18.5 to 24.9<0.8
Overweight25.0 to 29.9<0.5
Obese> 30<0.4
Multi-fetal PregnanciesSee justification in 2.13B for more information
Note: A BMI table is attached to assist in determining weight classifications. Also, until research supports the use of different BMI cut-offs to determine weight categories for adolescent pregnancies, the same BMI cut-offs will be used for all women, regardless of age, when determining WIC eligibility. (See Justification in 2.13B for a more detailed explanation.)
  • 2.   Low weight gain at any point in pregnancy, such that using a National Academies of Sciences, Medicine, and Engineering (NASEM-formerly known as the Institute of Medicine) based weight gain grid, a pregnant woman’s weight plots at any point beneath the bottom line of the appropriate weight gain range for her respective prepregnancy weight category, as follows:
Prepregnancy Weight CategoryBMITotal Weight Gain Range (lbs)
Underweight<18.528-40
Normal Weight18.5 to 24.925-35
Overweight25.0 to 29.915-25
Obese> 3011-20
Multi-fetal PregnanciesSee justification in 2.13B for more information
Note: A BMI table is attached to assist in determining weight classifications. Also, until research supports the use of different BMI cut-offs to determine weight categories for adolescent pregnancies, the same BMI cut-offs will be used for all women, regardless of age, when determining WIC eligibility. (See Justification in 2.13B for a more detailed explanation.)

RISK: 13301 – High Maternal Weight Gain

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on any plot point above desired range on appropriate prenatal weight gain grid during 2nd and 3rd trimesters and/or calculated weight gain > 7# per month for PG category. Auto-assigned based on reported total weight gain during pregnancy for BE, BP, and NPP categories.
  • CRITERIA: 
    • 1.  A high rate of weight gain, such that in 2nd and 3rd trimesters, for singleton pregnancies:
Prepregnancy Weight CategoryBMITotal Weight (lbs)/week
Underweight<18.5>1.3
Normal Weight18.5 to 24.9>1
Overweight25.0 to 29.9>0.7
Obese> 30>0.6
  • 2. High weight gain at any point in pregnancy, such that using an IOM-based weight gain grid, a pregnant woman’ s weight plots at any point above the top line of the appropriate weight gain range for her respective prepregnancy weight category.
    •  Breastfeeding or Non-Breastfeeding Women (most recent pregnancy only):  Total gestation weight gain exceeding the upper limit of the IOM’s recommended range based on BMI for singleton pregnancies:
 Prepregnancy Weight CategoryBMITotal Weight Gain Range (lbs)
Underweight<18.5>40
Normal Weight18.5 to 24.9>35
Overweight25.0 to 29.9>25
Obese> 30>20

RISK: 13401 – Failure to Thrive
HIGH RISK

  • CATEGORY: IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: Presence of failure to thrive diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 13501 – Slowed/Faltering Growth Pattern
HIGH RISK

  • CATEGORY: IBE, IBP, IFF less than or equal to 6 months of age
  • ASSIGNMENT: Auto-assigned based on the following criteria:
  • CRITERIA:           
    • 1. Infants from birth to <2 weeks of age:
      • Excessive weight loss after birth; defined as weight loss of ≥ 7% of birth weight
    • 2. Infants from ≥2 weeks to 6 months of age:
      •  Any weight loss. Use two separate weight measurements taken at least eight weeks apart.
Average Mean Values for Weight Gain for Healthy IBE
Interval (mo)Girls (g/day)Boys (g/day)
0-13033
1-22834
2-32223
3-41920
4-51516
5-61314
6-71211
Baby Weight Loss Table
Birth Weight
(lb-oz)
7% weight loss
(lb-oz)
 Birth Weight
(lb-oz)
7% weight loss
(lb-oz)
 Birth Weight
(lb-oz)
7% weight loss
(lb-oz)
5-04-10 7-06-8 9-08-6
5-14-11 7-16-9 9-18-7
5-24-12 7-26-10 9-28-8
5-34-14 7-36-11 9-38-9
5-44-15 7-46-12 9-48-10
5-55-0 7-56-13 9-58-11
5-65-0 7-66-14 9-68-12
5-75-1 7-76-15 9-78-12
5-85-2 7-87-0 9-88-13
5-95-3 7-97-1 9-98-14
5-105-4 7-107-1 9-108-15
5-115-5 7-117-2 9-119-0
5-125-6 7-127-3 9-129-1
5-135-6 7-137-4 9-139-2
5-145-7 7-147-5 9-149-3
5-155-8 7-157-6 9-159-4
6-05-9 8-07-7 10-09-5
6-15-10 8-17-8 10-19-6
6-25-11 8-27-9 10-29-7
6-35-12 8-37-10 10-39-8
6-45-13 8-47-11 10-49-9
6-55-14 8-57-12 10-59-9
6-65-15 8-67-13 10-69-10
6-76-0 8-77-14 10-79-11
6-86-1 8-87-14 10-89-12
6-96-2 8-97-15 10-99-13
6-106-3 8-108-0 10-109-14
6-116-4 8-118-1 10-119-15
6-126-4 8-128-2 10-1210-0
6-136-5 8-138-3 10-1310-1
6-146-6 8-148-4 10-1410-2
6-156-7 8-158-5 10-1510-3
(Karin Cadwell & Cindy Turner-Maffei. Pocket Guide for Lactation Management. Second Edition. 2014)

RISK: 14101 – Low Birth Weight (LBW) and Very Low Birth Weight (VLBW)
HIGH RISK

  • CATEGORY: IBE, IBP, IFF, C1
  • ASSIGNMENT: Auto-assigned based on entered birth weight
  • CRITERIA: 
    • Low birth weight and < 24 months of age
      • Birth weight ≤ 2500 gm (≤ 5 lb. 8 oz.)
    • Very Low birth weight and < 24 months of age
      • Birth weight ≤ 1500 gm (≤ 3 lb. 5 oz.)
  • Infant Health and Development Program LBW/VLBW growth charts can be used for educational purposes until the infant reaches 40 weeks gestational age. See policy 2.14.

RISK: 14201 – Preterm Delivery
HIGH RISK

  • CATEGORY: IBE, IBP, IFF, C1
  • ASSIGNMENT: Auto-assigned based on entered weeks of gestation
  • CRITERIA: 
    • Preterm: Delivery of an infant born ≤36 6/7 weeks gestation.
  • Infant Health and Development Program LBW/VLBW growth charts can be used for educational purposes until the infant reaches 40 weeks gestational age. See policy 2.14.

RISK: 14202 – Early Term Delivery

  • CATEGORY: IBE, IBP, IFF, C1
  • ASSIGNMENT: Auto-assigned based on entered weeks of gestation
  • CRITERIA:
    • Early Term: Delivery of an infant born ≥37 0/7 and ≤38 6/7 weeks.
  • Infant Health and Development Program LBW/VLBW growth charts can be used for educational purposes until the infant reaches 40 weeks gestational age. See policy 2.14.

RISK: 15101 – Small for Gestational Age (SGA)
HIGH RISK

  • CATEGORY: IBE, IBP, IFF, C1
  • ASSIGNMENT: Auto-assigned based on reported birth weight and/or current and diagnosed medical conditions
  • CRITERIA: 
    • Babies with birth weight below the 10th percentile for babies of the same gestational age.
    • Infants and children < 24 months of age diagnosed as small for gestational age. Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.
  • Infant Health and Development Program LBW/VLBW growth charts can be used for educational purposes until the infant reaches 40 weeks gestational age. See policy 2.14.

RISK: 15201 – Low Head Circumference (Infants and Children < 24 months of age)
HIGH RISK

  • CATEGORY: IBE, IBP, IFF, C1
  • ASSIGNMENT: Auto-assigned based on calculated head circumference-for-age percentile
  • CRITERIA: 
    • Birth to < 24 months:  < 2.3rd percentile head circumference-for-age as plotted on the WHO Birth to 24 months gender specific growth charts
  • Note: For premature infants and children (with a history of prematurity) up to 2 years of age, assignment of this risk criterion will be based on adjusted gestational age.

RISK: 15301 – Large for Gestational Age
HIGH RISK

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT: Auto-assigned based on reported birth weight and/or current and diagnosed medical conditions
  • CRITERIA: 
    • Birth weight ≥ 9 pounds (≥ 4000 g); OR
    • Infants diagnosed as large for gestational age. Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

200 Risk Series – Biochemical Risk

RISK: 20101 – Low Hematocrit/Low Hemoglobin

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on age, trimester, Hgb or Hct, altitude of clinic the client is assigned to, and smoking.
  • CRITERIA: 
    • Hemoglobin or hematocrit concentration below the 95 percent confidence interval for healthy, well-nourished individuals of the same age, sex, and stage of pregnancy.
    • *Spearfish, Rapid City, Belle Fourche, Buffalo Gap, Edgemont, Ellsworth, Hot Springs, Manderson, Porcupine, Martin, Pine Ridge, St. Onge, Sturgis, Whitewood

RISK: 21101 – Elevated Blood Lead Levels
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on entered lab data and/or current and diagnosed medical conditions
  • CRITERIA: 
    • Blood lead level > 5 micrograms per deciliter within the past 12 months.

300 Risk Series – Clinical/Health/Medical Risk

RISK: 30101 – Hyperemesis Gravidarum
HIGH RISK

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on reported diagnosed hyperemesis gravidarum for this pregnancy
  • CRITERIA: 
    • Hyperemesis Gravidarum (HG) is defined as severe and persistent nausea and vomiting during pregnancy which may cause more than 5% weight loss and fluid and electrolyte imbalances. This nutrition risk is based on a chronic condition, not single episodes. HG is a clinical diagnosis, made after other causes of nausea and vomiting have been excluded.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 30201 – Gestational Diabetes (GDM)
HIGH RISK

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on reported GDM for this pregnancy
  • CRITERIA: 
    • Any degree of glucose/carbohydrate intolerance with onset or first recognition during pregnancy.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 30301 – History of Gestational Diabetes Mellitus (GDM)

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on reported history of GDM in a previous pregnancy for PG category or for most recent pregnancy for BE, BP, and NPP categories.
  • CRITERIA: 
    • History of diagnosed GDM.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 30401 – History of Preeclampsia
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on reported history of preeclampsia in a previous pregnancy for PG category or for most recent pregnancy in BE, BP, and NPP categories.
  • CRITERIA:           
    • History of diagnosed preeclampsia.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 31001 – History of Preterm Delivery
HIGH RISK

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on reported preterm delivery on any previous pregnancy
  • CRITERIA:           
    • Preterm: Delivery of an infant born ≤36 6/7 weeks gestation.
      • Pregnant Women: any history of preterm delivery

RISK:31002 History of Early Term Delivery

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on reported early term delivery on any previous pregnancy
  • CRITERIA
    • Early Term: Delivery of an infant born ≥37 0/7 and ≤38 6/7 weeks.
      • Pregnant Women: any history of early term delivery

RISK: 31101 – History of Preterm Delivery

  • CATEGORY: BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on reported preterm delivery on most recent pregnancy
  • CRITERIA:           
    • Preterm: Delivery of an infant born ≤36 6/7 weeks gestation.
      • Breastfeeding/Non-Breastfeeding: most recent pregnancy

RISK: 31102 History of Early Term Delivery

  • CATEGORY: BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on reported early term delivery on most recent pregnancy
  • CRITERIA
    • Early Term: Delivery of an infant born ≥37 0/7 and ≤38 6/7 weeks.
      • Breastfeeding/Non-Breastfeeding: most recent pregnancy

RISK: 31201 – History of Low Birth Weight
HIGH RISK

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on reported LBW delivery on any previous pregnancy
  • CRITERIA: 
    • Birth of an infant weighing < 5 lb. 8 oz. (<2500 grams):
      • Pregnant Women: any history of low birth weight

RISK: 31301 – History of Low Birth Weight

  • CATEGORY: BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on reported LBW delivery on most recent pregnancy
  • CRITERIA:           
    • Birth of an infant weighing < 5 lb. 8 oz. (<2500 grams):
      • Breastfeeding/Non-Breastfeeding: most recent pregnancy

RISK: 32101 – History of Spontaneous Abortion, Fetal or Neonatal Loss

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT:   
    • Auto-assigned based on report of miscarriage, fetal death, or neonatal death
  • CRITERIA:           
    • Pregnant woman: any history of fetal or neonatal death OR 2 or more spontaneous abortions.
    • Breastfeeding woman: most recent pregnancy in which there was a multi fetal gestation with one or more fetal or neonatal deaths but with one or more infants still living.
    • Non-breastfeeding woman: Spontaneous abortion, fetal or neonatal loss in most recent pregnancy.
    • Spontaneous abortion, fetal and neonatal death are defined as follows:
    • Spontaneous abortion: The spontaneous termination of a gestation at < 20 weeks or of a fetus weighing < 500 grams.
      • Fetal death: Spontaneous termination of a gestation at > 20 weeks.
      • Neonatal death: Death of an infant within 0-28 days of life.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 33101 – Pregnancy at a Young Age

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on calculated age of conception
  • CRITERIA:           
    • Conception ≤20 years of age.
      • Pregnant Women: current pregnancy
      • Breastfeeding/Non-Breastfeeding: most recent pregnancy

RISK: 33201 – Short Interpregnancy Interval

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on calculated time between pregnancies
  • CRITERIA: 
    • Short Interpregnancy Interval (IPI), formerly known as Closely Spaced Pregnancies, is defined as an interpregnancy interval of less than 18 months from the date of a live birth (does not include losses) to the conception of the subsequent pregnancy for the following:
      • Pregnant Women: current pregnancy
      • Breastfeeding/Non-Breastfeeding: most recent pregnancy

RISK: 33401 – Lack of or Inadequate Prenatal Care

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on weeks gestation and month of first prenatal care visit, and/or total number of prenatal care visits.
  • CRITERIA:
    • Prenatal care beginning after the first trimester (after the 13th week), or based on an Inadequate Prenatal Care Index.
    • First prenatal visit in the third trimester (7-9 months) or:
Weeks GestationNumber of Prenatal Visits
14-210 or unknown
22-291 or less
30-312 or less
32-333 or less
34 or more4 or less

RISK: 33501 – Multifetal Gestation

  • CATEGORY:  PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on reported number of infants for BE, BP, NPP or report of twins or more for PG
  • CRITERIA:           
    • More than 1 fetus in a current pregnancy (Pregnant Women) or the most recent pregnancy (Breastfeeding and Non-Breastfeeding Women).

RISK:33601 – Fetal Growth Restriction (FGR)
HIGH RISK

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on report of FGR for this pregnancy
  • CRITERIA: 
    • Fetal Growth Restriction (FGR) may be diagnosed by a physician with serial measurements of fundal  height, abdominal girth and can be confirmed with ultrasonography.  FGR is usually defined as a fetal weight < 10th percentile for gestational age.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK:  33701 – History of Birth of a Large for Gestational Age Infant

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT:
    • Auto-assigned based on report of previous deliveries of infant 9 pounds or more for PG or in the most recent pregnancy for BE, BP, or NPP.
    • Manually assigned if report of infant birth weight 9 pounds or more in previous pregnancies for BE, BP, or NPP.
  • CRITERIA:
    • History of birth of a large for gestational age infant is defined as follows:
      • Pregnant Women: any history of giving birth to an infant weighing ≥ 9 lbs (4000 grams).
      • Breastfeeding/Non-Breastfeeding Women: most recent pregnancy, or history of giving birth to an infant weighing ≥ 9 lbs (4000 grams).
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 33801 – Pregnant Woman Currently Breastfeeding

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on report of PG currently breastfeeding an infant
  • CRITERIA:           
    • Pregnant woman who is currently breastfeeding.

RISK: 33901 – History of Birth with Nutrition Related Congenital or Birth Defect
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on report of birth defect in previous pregnancy
  • CRITERIA:           
    • A woman who has given birth to an infant who has a diagnosed congenital or birth defect linked to inappropriate nutritional intake (e.g. inadequate zinc, excessive vitamin A, inadequate folic acid).
      • Pregnant Women: any history of birth with nutrition-related congenital or birth defect
      • Breastfeeding/Non-Breastfeeding Women: most recent pregnancy
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 34101 – Nutrient Deficiency Diseases
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:  Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:
    • Any currently treated or untreated nutrient deficiency or disease.
    • Diseases include, but are not limited to:  
      • Protein Energy Malnutrition
      • Scurvy
      • Rickets
      • Beri Beri
      • Hypocalcemia
      • Osteomalacia
      • Vitamin K Deficiency
      • Pellagra
      • Xerophthalmia
      • Iron Deficiency                  
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 342 – Gastrointestinal Disorders
 HIGH RISK

  • CATEGORY:  PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions and/or report of following diet for bariatric surgery
  • CRITERIA: 
    • Disease(s) or condition(s) that interferes with the intake, digestion, and/or absorption of nutrients.
    • Includes but not limited to
      • 34201 – Gallbladder disease
      • 34202 – Liver disease
      • 34203 – Crohn’s disease
      • 34204 – Inflammatory Bowel Disease
      • 34205 – Ulcers, Stomach or Intestinal
      • 34206 – Short Bowel Syndrome/ Enterocolitis
      • 34207 – Pancreatitis
      • 34208 – Ulcerative Colitis
      • 34209 – Gastro Esophageal Reflux Disease
      • 34210 – Post-Bariatric Surgery

RISK: 34301 – Diabetes Mellitus
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Diabetes mellitus consists of a group of metabolic diseases characterized by inappropriate hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 344 – Thyroid Disorders
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Thyroid dysfunctions that occur in pregnant and postpartum women, during fetal development, and in childhood are caused by the abnormal secretion of thyroid hormones.  The medical conditions include, but are not limited to, the following:
      • 34401 Hypothyroidism:  Low secretion levels of thyroid hormone (can be overt or mild/subclinical).  Most commonly seen as chronic autoimmune thyroiditis (Hashimoto’s thyroiditis or autoimmune thyroid disease).  It can also be caused by severe iodine deficiency.
      • 34402 Hyperthyroidism:  Excessive thyroid hormone production (most commonly known as Graves’ disease and toxic multinodular goiter).
      • 34403 Congenital Hyperthyroidism:  Excessive thyroid hormone levels at birth, either transient (due to maternal Grave’s disease) or persistent (due to genetic mutation).
      • 34404 Congenital Hypothyroidism:  Infants born with an under active thyroid gland and presume to have had hypothyroidism in-utero
      • 34405 Postpartum Thyroiditis:  Transient or permanent thyroid dysfunction occurring in the first year after delivery based on an autoimmune inflammation of the thyroid.  Frequently, the resolution is spontaneous.
    •  Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 34501– Hypertension and Prehypertension
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions.
  • CRITERIA:
    • Hypertension is defined as high blood pressure which may eventually cause health problems and includes chronic hypertension during pregnancy, preeclampsia, eclampsia, chronic hypertension with superimposed preeclampsia, and gestational hypertension.
    • Prehypertension is defined as being at high risk for developing hypertension, based on blood pressure levels.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 34601 – Renal Disease
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:
    • Any renal disease including pyelonephritis and persistent proteinuria, but excluding urinary tract infections (UTI) involving the bladder.
    •  Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 34701 – Cancer
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • A chronic disease whereby populations of cells have acquired the ability to multiply and spread without the usual biologic restraints.  The current condition, or treatment for the condition, must be severe enough to affect nutritional status.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 348 – Central Nervous System Disorders
HIGH RISK

  • CATEGORY:  PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Conditions which affects energy requirements, ability to feed self, or alters nutritional status metabolically, mechanically, or both.
    •  Diseases include, but are not limited to:  
      • 34801 Epilepsy
      • 34802 Multiple sclerosis (MS)
      • 34803 Neural tube defects (NTD), such as spina bifida
      • 34804 Parkinson’s disease
      • 34805 Cerebral palsy                       
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 349 – Genetic and Congenital Disorders
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:           
    • Hereditary or congenital condition at birth that causes physical or metabolic abnormality.  The current condition must alter nutrition status metabolically, mechanically, or both.
    • Includes, but not limited to:         
      • 34901 Muscular dystrophy (MD)
      • 34902 Cleft lip or palate
      • 34903 Gastrointestinal abnormalities
      • 34904 Thalassemia major
      • 34906 Sickle cell anemia (not sickle cell trait)
      • 34907 Down syndrome
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 35101 – Inborn Errors of Metabolism
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Inherited metabolic disorders caused by a defect in the enzymes or their co-factors that metabolize protein, carbohydrate, or fat.
    • Inborn errors of metabolism generally refer to gene mutation or gene deletions that alter metabolism in the body, including, but not limited to:                     
      • Amino Acid Disorders
      • Organic Acid Metabolism Disorders
      • Fatty Acid Oxidation Disorders
      • Lysosomal Storage Diseases
      • Urea Cycle Disorders
      • Carbohydrate Disorders
      • Peroxisomal Disorders
      • Mitochondrial Disorders
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK:  352a – Infectious Disease- Acute
HIGH RISK

  • CATEGORY:PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:
    • Disease which is characterized by a single or repeated episode of relatively rapid onset and short duration. Infectious diseases come from bacteria, viruses, parasites, or fungi and spread directly or indirectly from person to person. Infectious diseases may also be zoonotic, which are transmitted from animals to humans, or vector-borne, which are transmitted from mosquitoes, ticks, and fleas to humans.
    • These diseases and/or conditions include, but are not limited to (an extensive listing of infectious diseases can be found at: http://www.nlm.nih.gov/medlineplus/infections.html):
      • 352.06 Bronchitis (3 episodes in last 6 months)
      • 352.09 Hepatitis A
      • 352.1   Hepatitis E
      • 352.11 Listeriosis
      • 352.01 Meningitis (Bacterial/Viral)
      • 352.02 Parasitic Infections
      • 352.08 Pneumonia
    • EXCLUDES frequent colds, ear infections
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK:  352b – Infectious Disease- Chronic
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:
    • Conditions likely lasting a lifetime and require long-term management of symptoms. Infectious diseases come from bacteria, viruses, parasites, or fungi and spread directly or indirectly, from person to person. Infectious diseases may also be zoonotic, which are transmitted from animals to humans, or vector-borne, which are transmitted from mosquitoes, ticks, and fleas to humans.
    • These diseases and/or conditions include, but are not limited to (an extensive listing of infectious diseases can be found at: http://www.nlm.nih.gov/medlineplus/infections.html):
      • 352.05 AIDS (Acquired Immunodeficiency Syndrome)
      • 352.04 HIV (Human Immunodeficiency Virus)
      • 352.12 Hepatitis B
      • 352.13 Hepatitis C
      • 352.14 Hepatitis D
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 35301 – Food Allergies
HIGH RISK

  • CATEGORY:  PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on determination of a diagnosed food allergy.
  • CRITERIA:
    • An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.
    • The only way to avoid a food allergy reaction is to eliminate the food. This requires the assistance of a nutritionist to help individuals obtain nutrients from other food sources.
    • The goal is to remove from the diet as many potential food allergens as possible while also providing optimal nutrition. Treatment of food allergies by a registered dietitian or CPA not only improves compliance by ensuring strict dietary avoidance through education and appropriate substitution, but also is essential for ensuring the nutritional adequacy of the diet.                           
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 35401 – Celiac Disease
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:  Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:  
    • Celiac disease is an autoimmune disease precipitated by the ingestion of gluten (a protein in wheat, rye, and barley) that results in damage to the small intestine and malabsorption of the nutrients from food.
    • Also known as:
      • Celiac Sprue
      • Gluten Enteropathy
      • Non-tropical Sprue.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 35501 – Lactose Intolerance

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Lactose intolerance is the syndrome of one or more of the following: diarrhea, abdominal pain, flatulence, and/or, bloating, that occurs after lactose ingestion.
    • Lactose intolerance occurs when there is an insufficient production of the enzyme lactase.  Lactase is needed to digest lactose.  Lactose in dairy products that is not digested or absorbed is fermented in the small intestine producing any or all of the following gastrointestinal disturbances: abdominal bloating, cramps, diarrhea, and nausea.  Lactose intolerance varies among and within individuals and ranges from mild to severe.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 35601 – Hypoglycemia
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:  Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in the blood drops below normal.
    • Presence of hypoglycemia diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 35701 – Drug Nutrient Interactions
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on determination of drug-nutrient interaction
  • CRITERIA: 
    • Use of prescription or over-the-counter drugs or medications that have been shown to interfere with nutrient intake, absorption, distribution, metabolism, or excretion to an extent that nutritional status is compromised.
    • Direct impacts or medications on nutritional status include changes to the following:
      • The absorption and the distribution of the nutrient
      • The metabolism of the nutrient
      • The rate at which the nutrient is excreted
    • These direct impacts of medications may be severe enough to lead to nutrient deficiency and/or nutrient toxicity, which can then impact bodily systems such as bone formation, immune system function, and energy metabolism.
    • Indirect impacts or medication on nutritional status include the following:
      • Changes to appetite
      • Changes to taste and smell
      • A dry or sore mouth
      • Epigastric distress, nausea, vomiting, diarrhea, and constipation
    • See 2.13D for more information and resources.

RISK: 358 – Eating Disorders  
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
    • CRITERIA: Eating disorders (anorexia nervosa and bulimia) are characterized by a disturbed sense of body image and morbid fear of gaining weight.
    • Includes, but not limited to: 
      • 35801 – Bulimia
      • 35802 – Anorexia nervosa
    • Symptoms are manifested by abnormal eating patterns, including, but not limited to:
      • Self-induced vomiting
      • Purgative abuse
      • Alternating periods of starvation
      • Use of drugs such as appetite suppressants, thyroid preparations or diuretics
      • Self-induced marked weight loss
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 35901 – Recent Major Surgery, Trauma, Burns
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:           
    • Major surgery (including C-sections), trauma or burns severe enough to compromise nutritional status
    • Any occurrence:
      • Within the past two (≤2) months may be self-reported
      • More than two (≤2) months previous must have the continued need for nutritional support diagnosed by a physician or a health care provider working under the orders of a physician

RISK: 360 – Other Medical Conditions
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:
    • Diseases or conditions with nutritional implications that is not included in any of the other medical conditions.  The current condition, or treatment for the condition, must be severe enough to affect nutritional status.
    •  Includes, but not limited to:
      • 36001 Asthma, persistent (moderate or severe) requiring daily medication
      • 36002 Cystic fibrosis
      • 36003 Heart disease
      • 36004 Cardiorespiratory diseases
      • 36005 Lupus erythematosus
      • 36006 Juvenile rheumatoid arthritis (JRA)
      • 36007 Medical Conditions-Other
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 36101 – Depression
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions and depression question.
  • CRITERIA: 
    • Presence of clinical depression diagnosed, documented, or reported by a physician, clinical psychologist,   or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.
  • Pregnancy and Depression
    Depression is common during pregnancy. Between 14 and 23 percent of pregnant women will experience depressive symptoms. Several studies have found that depression risk is highest during the last trimester of pregnancy. Women who experience depression during pregnancy are found to be less likely to seek prenatal care. They may also suffer from episodes of nausea/vomiting or initiate/increase the use of drugs, alcohol and nicotine. Pregnant women with depression may be at risk for preeclampsia, preterm delivery or delivery of low birth weight infants and have higher perinatal mortality rates.
     
  • Pregnant Adolescents
    In the United States, 10 percent of women become pregnant during adolescence. The prevalence of teen pregnancy is highest among African and Native Americans, lower socioeconomic groups, and those living in stressful family environments. The prevalence rate of depression among pregnant adolescents is between 16 and 44 percent, which is almost twice as high as among their adult counterparts and non-pregnant adolescents. Adolescence is a stage of rapid metabolic, hormonal, physiological and developmental changes. Depressive symptoms are likely to emerge when the physiologic and psychological changes that occur during pregnancy are superimposed upon normal developmental change.

    Teens who are under stress, lack social and/or family support, experience significant loss, or who have attention, learning or conduct disorders are at greater risk for developing clinical depression. Depression in young people often occurs with mental disorders, substance abuse disorders, or physical illnesses, such as diabetes. Pregnant adolescents with depressive symptoms are more likely to delay or refuse prenatal care and have subsequent, short interval pregnancies (within 24 months), both of which have shown to result in poor pregnancy outcomes.
     
  • Antidepressant Use in Pregnancy
    Negative consequences for the newborn such as fetal growth changes and shorter gestation periods have been associated with both depression symptoms and use of antidepressant medications during pregnancy. Although rare, some studies have linked fetal malformations, cardiac defects, pulmonary hypertension and reduced birth weight to antidepressant use during pregnancy, however, more research in this area is needed. For more information about specific drug therapies used for treating depression.

    A fetus exposed to antidepressants throughout pregnancy or during the last trimester may, in rare instances, experience temporary withdrawal symptoms— such as jitters or irritability — at birth. Some health care providers may suggest tapering dosages until after birth to minimize newborn withdrawal symptoms though it is unclear whether this method can reduce harmful effects. This strategy may also be unsafe for new mothers as they enter the postpartum period — a time of increased risk of mood swings and problems with anxiety. Therefore, it is imperative that prenatal women discuss the risks and benefits of antidepressant therapy with their health care provider.
     
  • Postpartum Depression and Related Mood Disorders
    Postpartum depression was historically hypothesized to be caused by low estrogen and progesterone levels immediately following birth, however, this hypothesis has been found to have limited scientific support. Emerging studies have found that reproductive hormones have an indirect relationship on depression because of the influence on stress hormones, immune markers or sleep quality. The incidence of postpartum depression in new mothers can range from approximately 12 to 25 percent, to up to 35 percent or more in some high-risk groups. High risk groups include: women of low income, younger age, low education level and histories of stressful life events or traumatic experiences. Some studies have higher percentage rates for depression because they include both subjects with diagnosed major depression and those with depressive symptoms, thus accounting for the wide range in rates.

    Postpartum depression is distinguished from “baby blues” – a common reaction following delivery – both by its duration and the debilitating effects of the indifference the mother has about herself and her children. ”Baby blues” are characterized by mild depressive symptoms, tearfulness (often for no discernible reason), anxiety, irritableness, mood fluctuations, increased sensitivity and fatigue. The “blues” typically peak four to five days after delivery, may last hours to days and resolve by the 10th postnatal day.
     
  • Inflammation and Depression
    Inflammation was once recognized as one of several risk factors for depression. New research has found that inflammation is not a risk factor—but rather it is the risk factor that underlies all others. This represents a shift in how inflammation contributes to depression. Emerging research has revealed that depression is associated with inflammation manifested by increased levels of proinflammatory cytokines. Common experiences of new motherhood sleep disturbances, postpartum pain or current psychological trauma, act as stressors that cause proinflammatory cytokine levels to rise. This finding may explain why psychological, behavioral and physical risk factors increase the risk of depression. Additionally, inflammation levels normally rise during the last trimester of pregnancy, which may explain, as stated in the Pregnancy and Depression section above, the higher risk for experiencing depression during pregnancy.
     
  • Breastfeeding and Depression
    Successful breastfeeding has a protective effect on maternal mental health because it attenuates stress and modulates the inflammatory response. Conversely, breastfeeding difficulties such as nipple pain can increase the risk of depression and should be addressed promptly.

RISK: 36201 – Developmental, Sensory or Motor Disabilities Interfering with the Ability to Eat
 HIGH RISK

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions and report of trouble swallowing (dysphagia)
  • CRITERIA: 
    • Developmental, sensory or motor disabilities that restrict the ability to intake, chew or swallow food or require tube feeding to meet nutritional needs.
    • Includes, but not limited to:
      • Birth injury
      • Brain damage
      • Feeding problems due to a developmental disability such as pervasive development disorder (PDD) which includes autism
      • Head trauma
      • Minimal brain function
      • Other disabilities

RISK: 36301 – Pre-Diabetes

  • CATEGORY:BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are referred to as pre-diabetes.These conditions are characterized by hyperglycemia that does not meet the diagnostic criteria for diabetes mellitus.
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK:  37101 – Nicotine and Tobacco Use

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT:  Auto-assigned based on any reported nicotine or tobacco use for pregnant clients and any current nicotine or tobacco use for postpartum.
  • CRITERIA: 
    • Any use of products that contain nicotine and/or tobacco to include but not limited to cigarettes, pipes, cigars, electronic nicotine delivery systems (e-cigarettes, vaping devices), hookahs, smokeless tobacco (chewing tobacco, snuff, dissolvables), or nicotine replacement therapies (gums, patches).

RISK:  37201 – Alcohol and Substance Use

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: 
    • Auto-assigned for
      • any drinking for PG
      • High Risk Drinking or Binge Drinking for BE, BP, NPP
      • any illegal substance use and/or abuse of prescription medications for PG, BE, BP, NPP
      • any marijuana use for PG, BE, BP
  • CRITERIA:  
    • Pregnant woman:
      • Any alcohol use.
      • Any illegal substance use and/or abuse of prescription medications.
      • Any marijuana use in any form.
    • Breastfeeding and Non-Breastfeeding woman:
      • Alcohol use:
        • High Risk Drinking: Routine consumption of ≥8 drinks per week or ≥ 4 drinks on any day.
        • Binge drinking: Routine consumption of ≥ 4 drinks within 2 hours.
        • Note: A serving or standard sized drink is:
          • 12 fluid ounces of beer or wine cooler
          • 5 ounces of wine
          • 1 1/2 fluid ounces of 80 proof distilled spirits (e.g. gin, rum, vodka, whiskey, cordials, or liqueurs)
        • Any illegal substance use and/or abuse of prescription medications.
        • Any marijuana use in any form (breastfeeding women only).

RISK: 38101 – Oral Health Conditions

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:  Auto-assigned based on presence of oral health conditions affecting eating or drinking.
  • CRITERIA: 
    • Includes, but not limited to:
      • Dental caries, often referred to as “cavities” or “tooth decay”, is a common chronic, infectious, transmissible disease resulting from tooth-adherent specific bacteria, that metabolize sugars to produce acid which, over time, demineralizes tooth structure
      • Periodontal diseases are infections that affect the tissues and bone that support the teeth. Periodontal diseases are classified according to the severity of the disease. The two major stages are gingivitis and periodontitis. Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis.
      • Tooth loss, ineffectively replaced teeth or oral infections which impair the ability to ingest food in adequate quantity or quality
    • Presence of oral health conditions diagnosed, documented, or reported by a physician, dentist, or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 38201 – Fetal Alcohol Spectrum Disorders
HIGH RISK

  • CATEGORY: IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA: 
    • Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother consumed alcohol during pregnancy. FASDs is an overarching phrase that encompasses a range of possible diagnoses, including fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol related birth defects (ARBD), alcohol-related neurodevelopmental disorder (ARND), and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE).
    • Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. See Definitions for more information about self-reporting a diagnosis.

RISK: 38301 – Neonatal Abstinence Syndrome (NAS)
HIGH RISK

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT: Auto-assigned based on current and diagnosed medical conditions
  • CRITERIA:
    • Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that occurs among drug-exposed (primarily opioid-exposed) infants as a result of the mother’s use of drugs during pregnancy. NAS is a combination of physiologic and neurologic symptoms that can be identified immediately after birth and can last up to 6 months after birth.
    • This condition must be present within the first 6 months of birth and diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by the infant’s caregiver. See Definitions for more information about self-reporting a diagnosis.

400 Risk Series – Dietary Risk

RISK: 40101 – Failure to Meet Dietary Guidelines for Americans

  • CATEGORY:  PG, BE, BP, NPP, C2-C4
  • ASSIGNMENT: Auto-assigned based on no other risk determined
  • CRITERIA:
    • Women and children 2 years of age and older who meet the eligibility requirements of income, categorical, and residency statues may be presumed to be at nutrition risk based on failure to meet Dietary Guidelines for Americans.  For this criterion, failure to meet Dietary Guidelines is defined as consuming fewer than the recommended number of servings from one or more of the basic food groups (grains, fruits, vegetables, milk products, and meat or beans) based on an individual’s estimated energy needs.
    • The risk may be assigned only to individuals (2 years and older) for whom a complete nutrition assessment (to include an assessment for risk #425, Inappropriate Nutrition Practices for Children, or #427, Inappropriate Nutrition Practices for Women) has been performed and for whom no other risk(s) are identified.

RISK: 411– Inappropriate Nutrition Practices (Infants)

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT: This is an overall category title and not a code that is assigned.
  • CRITERIA:
    • Routine use of feeding practices that may result in impaired nutrient status, disease or health problems.
    • For more information on infant nutrition and feeding, please see the Infant Nutrition and Feeding Guide for WIC on the WicWorks website Resources page: https://wicworks.fns.usda.gov/resources/infant-nutrition-and-feeding-guide

RISK: 41101 Routinely using a substitute(s) for breast milk or for FDA approved iron-fortified formula as the  primary nutrient source during the first year of life

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT: Manual-assigned based on report of routinely substituting other drinks for breast milk or formula.
  • CRITERIA:
    • Examples of substitutes (including but not limited to):
      • Low iron formula w/o iron supplementation
      • Cow’s milk, goat’s milk, sheep’s milk, (whole, reduced fat, low-fat, skim), canned evaporated or sweetened condensed milk); and
      • Imitation or substitute milks (such as rice- or soy-based beverages, non-dairy creamer), or other “homemade concoctions”

RISK: 41102  Routinely using nursing bottles or cups improperly

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT:  Auto-assigned based on report of providing sugar-sweetened beverages, adding food to the bottle or how bottles and cups are used based on the following criteria.
  • CRITERIA: 
    • Including, but not limited to:
      • Using a bottle to feed fruit juice
      • Feeding any sugar-containing fluids, such as soda/soft drinks, gelatin water, corn syrup solutions, and sweetened tea
      • Allowing the infant to fall asleep or be put to bed with a bottle at naps or bedtime
      • Allowing the infant to use the bottle without restriction (e.g., walking around with a bottle) or as a pacifier
      • Propping the bottle when feeding
      • Allowing an infant to carry around and drink throughout the day from a covered or training cup
      • Adding any food (cereal or other solid food) to the infant’s bottle

RISK: 41103  Routinely offering complementary foods* or other substances that are inappropriate in type or timing (*Complementary foods are any foods or beverages other than breast milk or infant formula.)

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT:  Auto-assigned based on report of how old infant was when offered items other than breast milk or formula, and/or inappropriate pacifier use.
  • CRITERIA:   
    • Complementary foods are any foods or beverages other than breast milk or infant formula.        
    •  Examples of inappropriate complementary foods (including but not limited to):
      • Adding sweet agents such as sugar, honey, or syrups to any beverage (including water) or prepared food, or used on a pacifier; and
      • Any food other than breast milk or iron-fortified infant formula before 6 months of age.

RISK: 41104  Routinely using feeding practices that disregard the developmental needs or stage of the infant

  • CATEGORY:  IBE, IBP, IFF
  • ASSIGNMENT: 
    • Auto-assigned based on report of how infant is fed, including not knowing baby’s signs of hunger and satiety, trying to make baby finish their food when they are not showing signs of hunger, not offering finger foods at ≥ 9 months, not offering any foods at > 7 months, and/or providing foods that are choking hazards.
    • Manual assignment if caregiver is using an inappropriate sign of hunger or satiety.
  • CRITERIA:           
    • Including, but not limited to:
      • Inability to recognize, insensitivity to, or disregarding the infant’s cues for hunger and satiety (e.g., forcing an infant to eat a certain type and/or amount of food or beverage or ignoring an infant’s hunger cues).
      • Not supporting an infant’s need for growing independence with self-feeding (e.g., solely spoon-feeding an infant who is able and ready to finger-feed and/or try self-feeding with appropriate utensils).
      • Feeding an infant food with inappropriate textures based on his/her developmental stage (e.g., feeding primarily pureed or liquid foods when the infant is ready and capable of eating mashed, chopped or appropriate finger foods).
      • Feeding foods of inappropriate consistency, size, or shape that put the infant at risk of choking
    • Exception: if developmentally child is not ready for solids or finger foods should be removed and documentation provided with reason for removal.

RISK: 41105  Feeding foods to an infant that could be contaminated with harmful microorganisms or toxins

  • CATEGORY:  IBE, IBP, IFF
  • ASSIGNMENT: Auto-assigned based on report of potentially harmful foods
  • CRITERIA:
    • Examples of potentially harmful foods (including, but not limited to):
      • Unpasteurized fruit or vegetable juice;
      • Unpasteurized dairy products or soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese;
      • Honey (added to liquids or solid foods, used in cooking, as part of processed foods, on a pacifier, etc.);
      • Raw or undercooked meat, fish, poultry, or eggs;
      • Refrigerated pate/meat spreads/smoked seafood (not cooked)
      • Raw vegetable sprouts (alfalfa, clover, bean, and radish);
      • Hot dogs, lunch meats and processed meats (avoid unless heated until steaming hot);
      • Donor human milk acquired directly from individuals or the internet.

RISK: 41106  Routinely feeding inappropriately diluted formula

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT: Auto-assigned based on reported formula preparation
  • CRITERIA:           
    • Including, but not limited to:
      • Failure to follow manufacturer’s dilution instructions (to include stretching formula for household economic reasons)
      • Failure to follow specific instructions accompanying a prescription

RISK: 41107  Routinely limiting the frequency of nursing of the exclusively breastfed infant when breast milk is the sole source of nutrients

  • CATEGORY:IBE, IBP, IFF
  • ASSIGNMENT:   
    • Auto-assigned based on inappropriate feeding frequency of nursing.
  • CRITERIA:           
    • Examples of inappropriate feeding frequency of nursing:
      • Less than 8 feedings in 24 hours if < 2 months of age; and
      • Scheduled feedings instead of on demand feedings

RISK: 41108  Routinely feeding a diet very low in calories and/or essential nutrients
HIGH RISK

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT:  
    • Auto-assigned based on report of routinely feeding diet very low in calories and/or essential nutrients.
    • o Manually assigned based on determination of any other very low calorie diet.
  • CRITERIA:           
    • Including, but not limited to:
      • Vegan Diet;
      • Macrobiotic Diet; and
      • Other diets very low in calories and/or essential nutrients

RISK: 41109 Routinely using inappropriate sanitation in the feeding, preparation, handling and,or storage of expressed human milk or formula

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT: 
    • Auto-assigned based on determination of inappropriate sanitation practices listed under criteria including providing donor human milk and extra precautions (as needed) to protect against cronobacter.
  • CRITERIA:           
    • Examples of inappropriate sanitation:
      • Limited or no access to a:
        • Safe water supply (documented by appropriate officials e.g. municipal or health department authorities)
        • Heat source for sterilization, and/or
        • Refrigerator or freezer for storage
    • Failure to prepare, handle and store bottles, storage containers, or breast pumps properly; examples include:
      • HumanMilk
        • Thawing/heating in microwave
        • Refreezing
        • Adding freshly expressed unrefrigerated human milk to frozen human milk
        • Adding freshly pumped chilled human milk to frozen human milk in an amount that is greater than the amount of frozen human milk
        • Feeding thawed refrigerated human milk more than 24 hours after it was thawed
        • Saving human milk from a used bottle for another feeding
        • Failure to clean breast pump per manufacturer’s instruction
        • Feeding donor human milk acquired directly from individuals or the internet.
      • Formula
        • Storing at room temperature for more than 1 hour
        • Failure to prepared formula per manufacturer’s or physician instructions
        • Using formula in a bottle one hour after the start of a feeding
        • Saving formula from a used bottle for another feeding
        • Failure to clean baby bottle properly
    • If infant is less than 3 mo of age and younger, premature, or less able to fight germs and sickness due to illness or medical treatment, parent may want to take extra precautions in preparing infant’s formula to protect against Cronobacter.
      • Boil water and let it cool to no less than 158°F/70°C before pouring it into a clean and sterilized feeding cup with a lid, or bottle. Water should cool to this temperature within 30 minutes after boiling.
      • Add the exact amount of formula listed on the container and carefully shake the bottle rather than stirring the mixture.
      • Immediately cool the formula to body temperature to ensure it is not too hot before feeding your baby. Run the prepared, capped bottle under cool water or place it into an ice bath. Do not let the cooling water get into the bottle or on the nipple.
      • Before feeding the baby, test the formula’s temperature by shaking a few drops on your wrist to see if it’s too hot.
      • Use formula within 2 hours of preparing it. If your baby does not finish the entire bottle of formula, throw away leftover formula. If you do not plan to use the prepared formula right away, refrigerate it immediately. Use refrigerated formula within 24 hours.

RISK: 41110  Feeding dietary supplements with potentially harmful consequences

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT: Auto-assigned based on report of potentially harmful dietary supplements as listed in criteria.
  • CRITERIA:           
    • Examples of dietary supplements, which when fed in excess of recommended dosage, may be toxic or have harmful consequences:
      • Herbal or botanical supplements/remedies/teas;
      • Mineral supplements; and
      • Multi or single vitamins

RISK: 41111  Routinely not providing dietary supplements recognized as essential by national public health policy when an infant’s diet alone cannot meet nutrient requirements

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT:
    • Auto-assigned based on report of no supplements for exclusively breastfed clients
    • Manually-assigned based on determination of inadequate vitamin D or fluoride.
  • CRITERIA:           
    • Examples:
      • Infants and children age 6 months of age or older who are ingesting less than 0.25 mg of fluoride daily when the water supply contains less than 0.3 ppm fluoride.
      • Infants who are exclusively breastfed, or who are ingesting less than 1 quart (1 Liter/ 32 ounces) per day of Vitamin D-fortified formula and are not taking a supplement of 400 IU of Vitamin D.

RISK: 425 – Inappropriate Nutrition Practices (Child)

  • CATEGORY: C1-C4
  • ASSIGNMENT: This is an overall category title and not a code that is assigned.
  • CRITERIA:  
    • Routine use of feeding practices that may result in impaired nutrient status, disease or health problems.

RISK: 42501  Routinely feeding inappropriate beverages as the primary milk source

  • CATEGORY: C1-C4
  • ASSIGNMENT: Auto-assigned based on report of what child drinks
  • CRITERIA:           
    • Examples of inappropriate beverages (including but not limited to):
      • Non-fat or reduced fat milk (between 12 and 24 months only) or sweetened condensed milk; and
      • Imitation or substitute milks (such as inadequately or unfortified rice- or soy-beverages, non-dairy creamer), or other “homemade concoctions.”
    • Exception:
      • Children 12-24 months may receive reduced fat milk when risk code 11501 High Weight for Length is assigned.

RISK: 42502  Routinely feeding a child any sugar-containing fluids

  • CATEGORY: C1-C4
  • ASSIGNMENT: Auto-assigned based on report of what the child is provided.
  • CRITERIA:           
    • Examples of sugar-containing fluids:
      • Soda/Soft drinks;
      • Gelatin water;
      • Corn syrup solutions; and
      • Sweetened tea

RISK: 42503  Routinely using nursing bottles, cups, or pacifiers improperly

  • CATEGORY: C1-C4
  • ASSIGNMENT:  Auto-assigned based on report of how the child is provided bottles, cups, or pacifiers.
  • CRITERIA:           
    • Including, but not limited to:
      • Using a bottle to feed
        • Fruit juice
        • Diluted cereal or other solid foods
      • Allowing the child to use the bottle without restriction (e.g., walking around with a bottle) or as a pacifier
      • Using the bottle for feeding or drinking beyond 14 months of age
      • Allowing the child to fall asleep or be put to bed with the bottle at naps or bedtime
      • Using a pacifier dipped in sweet agents such as sugar, honey or syrups
      • Allowing a child to carry around and drink throughout the day from a covered or training cup

RISK: 42504  Routinely using feeding practices that disregard the developmental needs or stages of the child

  • CATEGORY:  C1-C4
  • ASSIGNMENT: Auto-assigned based on report of child being fed only baby food, being forced to eat, choking often, and/or does not feed self.
  • CRITERIA:           
    • Including, but not limited to:
      • Inability to recognize, insensitivity to, or disregarding the child’s cues for hunger and satiety (e.g., forcing a child to eat a certain type and/or amount of food or beverage or ignoring a child’s request for appropriate foods).
      • Not supporting a child’s need for growing independence with self-feeding (e.g., solely spoon-feeding a child who is able and ready to finger-feed and/or try self-feeding with appropriate utensils).
      • Feeding a child food with an inappropriate texture based on his/her developmental stage (e.g., feeding primarily pureed or liquid foods when the child is ready and capable of eating mashed, chopped or appropriate finger foods).
      • Feeding foods of inappropriate consistency, size, or shape that put the child at risk of choking
    • Exception: if developmentally child is not ready for self-feeding or advanced textures code should be removed and documentation provided with reason for removal.

RISK: 42505  Feeding foods to an infant that could be contaminated with harmful microorganisms or toxins

  • CATEGORY: C1-C4
  • ASSIGNMENT: Auto-assigned based on report of eating potentially harmful foods
  • CRITERIA:           
    • Examples of potentially harmful foods (including, but not limited to):
      • Unpasteurized fruit or vegetable juice;
      • Unpasteurized dairy products or soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese;
      • Raw or undercooked meat, fish, poultry, or eggs;
      • Raw vegetable sprouts (alfalfa, clover, bean, and radish);
      • Deli meats, hot dogs, and processed meats (avoid unless heated until steaming hot).
      • Donor breast milk

RISK: 42506  Routinely feeding a diet very low in calories and/or essential nutrients
HIGH RISK

  • CATEGORY: C1-C4
  • ASSIGNMENT: 
    • Auto-assigned based on report of diet very low in calories and/or essential nutrients
    • Manually-assigned based on determination of other special diet that meets criteria
  • CRITERIA:           
    • Including, but not limited to:
      • Vegan Diet;
      • Macrobiotic Diet; and
      • Other diets very low in calories and/or essential nutrients

RISK: 42507  Feeding dietary supplements with potentially harmful consequences

  • CATEGORY:  C1-C4
  • ASSIGNMENT: Auto-assigned based on report of supplements with potentially harmful consequences
  • CRITERIA:
    • Examples of dietary supplements, which when fed in excess of recommended dosage, may be toxic or have harmful consequences:
      • Herbal or botanical supplements/remedies/teas;
      • Mineral supplements; and
      • Multi or single vitamins

RISK: 42508 Routinely not providing dietary supplements recognized as essential by national public health policy when a child’s diet alone cannot meet nutrient requirements

  • CATEGORY: C1-C4
  • ASSIGNMENT: Manually-assigned based on determination of meeting criteria
  • CRITERIA:           
    • Examples:
      • Providing children less than 36 months of age less than 0.25 mg of fluoride daily when the water supply contains less than 0.3 ppm fluoride.
      • Providing children 36-60 months of age less than 0.50 mg of fluoride daily when the water supply contains less than 0.3 ppm fluoride.
      • Not providing 400 IU of vitamin D if a child consumes less than 1 Liter (or 1 quart) of vitamin D fortified milk or formula

RISK: 42509  Routine ingestion of nonfood items (pica)
HIGH RISK

  • CATEGORY: C1-C4
  • ASSIGNMENT: Auto-assigned based on reported pica
  • CRITERIA:           
    • Examples of inappropriate food items:
      • Ashes
      • Carpet fibers;
      • Cigarettes or cigarette butts;
      • Clay;
      • Dust;
      • Foam Rubber;
      • Paint chips;
      • Soil; and
      • Starch (laundry, cornstarch)

RISK: 427– Inappropriate Nutrition Practices (Women)

  • CATEGORY:  PG, BE, BP, NPP
  • ASSIGNMENT: This is an overall category title and not a code that is assigned.
  • CRITERIA: 
    • Routine nutrition practices that may result in impaired nutrient status, disease, or health problems

RISK: 42701 Consuming dietary supplements with potentially harmful consequences

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on report of supplements with potentially harmful consequences
  • CRITERIA:           
    • Examples of dietary supplements, which when fed in excess of recommended dosage, may be toxic or have harmful consequences:
      • Herbal or botanical supplements/remedies/teas
      • Mineral supplements
      • Multi or single vitamins

RISK: 42702 Consuming a diet very low in calories and/or essential nutrients; or impaired caloric intake or absorption of essential nutrients following bariatric surgery
HIGH RISK

  • CATEGORY:  PG, BE, BP, NPP
  • ASSIGNMENT: 
    • Auto-assigned based on reported diet very low in calories and/or essential nutrients or report of bariatric surgery..
    • Manually assigned based on determination of other special diet meeting criteria
  • CRITERIA:                          
    • Examples:
      • Strict Vegan Diet
      • Low-carbohydrate, high-protein diet
      • Macrobiotic Diet
      • Any other diet restricting calories and/or essential nutrients

RISK: 42703 Compulsively ingesting nonfood items (pica)
HIGH RISK

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT: Auto-assigned based on reported pica
  • CRITERIA:           
    • Examples of inappropriate food items:
      • Non-food items
      • Ashes
      • Carpet fibers
      • Baking Soda
      • Burnt Matches
      • Chalk
      • Cigarettes
      • Clay
      • Dust
      • Large quantities of ice and/or freezer frost
      • Paint chips
      • Soil
      • Starch (laundry, cornstarch)

RISK: 42704 Inadequate vitamin/mineral supplementation recognized as essential by national public health policy

  • CATEGORY: PG, BE, BP, NPP
  • ASSIGNMENT:
    • Auto-assigned based on report of no vitamins, minerals, or supplements, or taking prenatal without iodine for BE or BP categories and for no vitamins, minerals, or supplements, or taking gummy vitamin (without iron) or prenatal without iodine for PG category.
    • Manually assigned for determination of inadequate folic acid for postpartum women and for any other situation meeting criteria.
  • CRITERIA:           
    • Examples include but are not limited to:
      • Consumption of age less than 27 mg of iron as a supplement daily by pregnant women
      • Consumption of less than 150 mcg of supplemental iodine per day by pregnant and breastfeeding women
      • Consumption of less than 400 mcg of folic acid from fortified foods and/or supplements daily by non-pregnant women

RISK: 42705 Pregnant woman ingesting foods that could be contaminated with pathogenic microorganisms

  • CATEGORY: PG
  • ASSIGNMENT: Auto-assigned based on reported potentially harmful foods
  • CRITERIA:           
    • Potentially harmful foods:
      • Raw fish or shellfish, including oysters, clams, mussels, and scallops
      • Refrigerated smoked seafood, unless it is an ingredient in a cooked dish, such as a casserole
      • Raw or undercooked meat or poultry
      • Hot dogs, luncheon meats (cold cuts), fermented and dry sausage and other deli-style meat or poultry products unless reheated until steaming hot
      • Refrigerated pâté or meat spreads
      • Unpasteurized milk or foods containing unpasteurized milk
      • Soft cheeses such as feta, Brie, Camembert, blue-veined cheeses and Mexican style cheese such as queso blanco, queso fresco, or Panela unless labeled as made with pasteurized milk
      • Raw or undercooked eggs or foods containing raw or lightly cooked eggs including certain salad dressings, cookie and cake batters, sauces, and beverages such as unpasteurized eggnog
      • Raw sprouts (alfalfa, clover, and radish)
      • Unpasteurized fruit or vegetable juices

RISK: 42801 – Dietary Risk Associated with Complementary Feeding Practices

  • CATEGORY:  IBE, IBP, IFF, C1
  • ASSIGNMENT: Auto-assigned based on age (4-24 months) and no other risk determined by system
  • CRITERIA: 
    • An infant or child who has begun to or is expected to begin to 1) consume complementary foods and beverages, 2) eat independently, 3) be weaned from breast milk or infant formula, or 4) transition from a diet based on infant/toddler foods to one based on the Dietary Guidelines for Americans, is at risk of  inappropriate complementary feeding.
    • A complete nutrition assessment, including for risk #411 or #425, must be completed prior to assigning this risk.

500 Risk Series – Fear of Regression/Transfer

RISK: 50101 – Possibility of Regression

  • CATEGORY: BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Manually-assigned based on determination of situation meeting criteria
  • CRITERIA: 
    • A participant who has previously been certified eligible for the Program may be considered to be at nutritional risk in the next certification period if the CPA determines there is a possibility of regression in nutritional status without the benefits that the WIC Program Provides.
    • The following circumstances apply (based on South Dakota limitations):
    • Fear of regression in nutritional status without WIC Program benefits after a risk code from the 100, 200, 300, 400, 800 or 900 Risk Series when no other risk code is identified. Risk #501 cannot follow a certification with only risk from the 500, 600, or 700 Risk Series.
      • EXCEPTION: Risk code 501 does not apply to previous risk(s) with respect to a pregnancy only condition. These risk conditions are directly associated with the pregnancy. For example, gestational diabetes is not a condition to which a new mother could regress.
    • A WIC re-certification assessment shall be completed to rule out the existence of another risk factor before assigning risk code 501.
    • The client’s record, e.g. medical and nutrition history assessment shall contain a written statement identifying the risk factor to which the client may regress.
    • Note: The code cannot be used under the following conditions:
      • Initial certification of participant
      • Infant certified as Infant Up to 6 Months of Mother Who Would be Eligible (701)
      • Participant certified for Regression Possibility (501) during preceding period. Risk code cannot be assigned for 2 subsequent certification periods

RISK: 502 – Transfer of Out-of-State Certification

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on transferring from out-of-state
  • CRITERIA:           
    • Person with current valid Verification of Certification (VOC) document from another State or local agency.  The VOC is valid through the end of the current certification period, even if the participant does not meet the receiving agency’s nutritional risk, priority or income criteria, or the certification period extends beyond the receiving agency’s certification period for that category, and shall be accepted as proof of eligibility for Program benefits.  If receiving local agency is at maximum caseload, the transferring individual must be placed at the top of any waiting list and enrolled as soon as possible.
    • This criterion would be used primarily when the VOC card/document does not reflect another (more specific) nutrition risk condition or if the participant was certified based on a nutrition risk condition not in use by the receiving State agency.

600 Risk Series – Breastfeeding Woman/Infant Dyad

RISK: 60101 – Breastfeeding Mother of Infant at Nutritional Risk (100-300 Risk Series)

  • CATEGORY: PG, BE, BP
  • ASSIGNMENT: Auto-assigned based on infant’s assigned risks
  • CRITERIA: 
    • A breastfeeding woman whose breastfed infant has been determined to be at anthropometric, biochemical, or clinical/health/medical risk.

RISK: 60201 – Breastfeeding Complications or Potential Complications (Women)

  • CATEGORY: PG, BE, BP
  • ASSIGNMENT:
    • Auto-assigned for BE or BP and manually assigned for PG women who are currently breastfeeding based on determination of meeting criteria.
  • CRITERIA: 
    • A breastfeeding woman with any of the following complications or potential complications for breastfeeding:
      • Severe breast engorgement
      • Recurrent plugged ducts
      • Mastitis (fever or flu-like symptoms with localized breast tenderness)
      • Flat or inverted nipples
      • Cracked, bleeding or severely sore nipples
      • At or older than 40 years of age
      • Failure of milk to come in by 4 days postpartum
      • Tandem nursing (breastfeeding 2 siblings who are not twins)

RISK: 60301 – Breastfeeding Complications or Potential Complications (Infants)

  • CATEGORY: IBE, IBP
  • ASSIGNMENT:
    • Auto-assigned based on report of jaundice, weak suck, difficulty latching, or inadequate wet diapers.
    • Manually assigned for determination of other situation meeting criteria, such as poor weight gain or inadequate bowel movements.
  • CRITERIA: 
    • A breastfed infant with any of the following complications or potential complications for breastfeeding:
      • Jaundice
      • Weak or ineffectual suck
      • Difficulty latching onto mother’s breast
      • Inadequate stooling (for age, as determined by a physician or other health care professional), and/or less than 6 wet diapers per day

RISK: 60401 – Breastfeeding Mother of Infant at Nutritional Risk (400 Risk Series)

  • CATEGORY: BE, BP
  • ASSIGNMENT: Auto-assigned based on infant’s assigned risks
  • CRITERIA: 
    • A lactating woman whose breastfed infant is eligible for WIC with a dietary risk only

700 Risk Series – Infant Enrolled Due to Maternal Risk

RISK: 70101 – Infant Up to 6 Months Old of WIC Mother or of a Woman Who Would Have Been Eligible During Pregnancy

  • CATEGORY: IBE, IBP, IFF
  • ASSIGNMENT:  Auto-assigned based on age, category, and mother’s assigned risks
  • CRITERIA:
    • An infant < 6 months of age whose mother was a WIC Program participant during pregnancy or whose mother’s medical records document that the woman was at nutritional risk during pregnancy because of detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric measurements or other documented nutritionally related medical conditions.

RISK: 70201 – Breastfeeding Infant of Woman at Nutritional Risk 100-300 Series

  • CATEGORY: IBE, IBP
  • ASSIGNMENT: Auto-assigned based on age, category, and mother’s assigned risks
  • CRITERIA: 
    • Breastfeeding infant of woman with an anthropometric, biochemical, or clinical/health/medical risk

RISK: 70401 – Breastfeeding Infant of Woman at Nutritional Risk 400 Series

  • CATEGORY: IBE, IBP
  • ASSIGNMENT: Auto-assigned based on age, category, and mother’s assigned risks
  • CRITERIA:
    • Breastfeeding infant of woman with a dietary risk

800 Risk Series – Homelessness/Migrancy

RISK: 80101 – Homelessness

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on mandatory family information
  • CRITERIA:
    • A woman, infant, or child who lacks a fixed and regular nighttime residence; or whose primary residence is:                             
      • A supervised publicly or privately operated shelter (including a welfare hotel, a congregate shelter, or a shelter for victims of domestic violence) designed to provide temporary living accommodations;
      • An institution that provides temporary residence for individuals intended to be institutionalized;
      • A temporary accommodation of not more than 365 days in the residence of another individual; or
      • A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings

RISK: 80201 – Migrancy

  • CATEGORY:  PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on mandatory family information
  • CRITERIA: 
    • Categorically eligible women, infants and children who are members of families which contain at least one individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode

900 Risk Series – Other Nutritional Risks

RISK: 90101 – Recipient of Abuse

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:  Manually-assigned based on determination of meeting criteria
  • CRITERIA: 
    • Battering or child abuse within past 6 months as self- reported, or as documented by a social worker, health care provider or on other appropriate documents, or as reported through consultation with a social worker, health care provider, or other appropriate personnel.         
    • “Battering” generally refers to violent physical assaults on women.
    • Child abuse/neglect:  “Any recent act or failure to act resulting in imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation of an infant or child by a parent or caretaker.”
    • Note: As mandatory reporters according to state law, a WIC staff member is required to report any instance where he or she has reasonable cause to suspect that a child under the age of 18 has been abused or neglected. Mandatory reporters must report the instance to the state’s attorney of the county in which the child resides or is present, the Department of Social Services, or law enforcement officers. 

RISK: 90201 – Woman or Infant/Child of Primary Caregiver with Limited Ability to Make Feeding Decisions and/or Prepare Food

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:   
    • Auto-assigned for infants and children based on mandatory question regarding primary caregiver’s limited ability to make appropriate feeding decisions and/or prepare food. Manually assigned for women based on CPA assessment of meeting criteria.
  • CRITERIA: 
    • A woman or an infant/child whose primary caregiver is assessed to have a limited ability to make appropriate feeding decisions and/or prepare food.
    • Examples include, but are not limited to a woman or an infant/child of caregiver with the following:
      • Documentation or self-report of misuse of alcohol, use of illegal substances, use of marijuana, or misuse of prescription medications.
      • Mental illness, including clinical depression diagnosed, documented, or reported by physician or psychologist or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver.
      • Intellectual disability diagnosed, documented, or reported by a physician or psychologist or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver.
      • Physical disability to a degree which impairs ability to feed infant/child or limits food preparation abilities.
      • < 17 years of age
    • See Definitions for more information about self-reporting a diagnosis.

RISK:  90301 – Foster Care

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT:   
    • Auto-assigned based on mandatory foster care question for infants and children
    • Manually-assigned based on determination of any PG, BE, BP, or NPP meeting criteria
  • CRITERIA:           
    • Entering the foster care system during the previous 6 months or moving from one foster care home to  another foster care home during the previous 6 months.

RISK:  90401 – Environmental Tobacco Smoke Exposure

  • CATEGORY: PG, BE, BP, NPP, IBE, IBP, IFF, C1-C4
  • ASSIGNMENT: Auto-assigned based on report of exposure to environmental tobacco smoke.
  • CRITERIA:           
    • Environmental tobacco smoke (ETS) exposure is defined (for WIC eligibility purposes) as exposure to smoke from tobacco products inside enclosed areas, like the home, places of childcare, workplaces, vehicles, etc. ETS is also known as passive, second-hand or involuntary smoke. The ETS definition also includes the exposure to the aerosol from electronic nicotine delivery systems.

Reference:
Federal Regulations 246.7

This post was last updated on April 12th, 2022 at 1:24 PM

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