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WIC Nutrition Risk Criteria

System Assigned (SA); System or CPA Assigned (SA/CPA); CPA Assigned (CPA); Automatic High Risk* (HR) Code Category [Priority] Risk Criteria/Definition Required Documentation 4

•Obese [>30.0]: gain > 20 pounds weight gain determined by subtracting prepregnancy weight from weight at delivery. 134* (SA/CPA) (HR) Infants [1] Child [3] Failure to thrive (FTT): Presence of failure to thrive. FTT describes an inadequate growth pattern where growth is significantly lower than what is expected for age and sex. Typically, a sign of undernutrition, the cause of FTT is often complex and includes many factors. Growth should be assessed over time, rather than using a single measurement. 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. Document on Health Information Screen (health conditions slider) in Crossroads. 135 (SA) Infants [1] Slowed/Faltering Growth Pattern (Infants < 6 Months of Age): Infants birth to 2 weeks: Excessive weight loss after birth, defined as > 7% of birth weight. Infants 2 weeks to 6 months of age: Any weight loss. Use two separate weight measurements taken at least 8 weeks apart. All weights must be documented on Anthro/Lab Screen in Crossroads. 141 (SA) Infants [1] Child [3] Low Birth Weight and Very Low Birth Weight (Infants and Children <24 Months of Age): Low birth weight (LBW): < 5 lb 8 oz or < 2500 g. Very Low Birth Weight (VLBW): < 3 lb 5 oz or < 1500 g. Birth weight documented on Health Information Screen in Crossroads. 142 (SA)

Infants [1] Child [3] Preterm or Early Term Delivery (Infants and Children < 24 Months of Age): Preterm: Delivery of infant <36 weeks gestation Early Term: Delivery of an infant born >37 weeks and <38 weeks gestation Weeks gestation documented on Health Information Screen in Crossroads.

Mother/caregiver can self-report or referral information from the medical provider may be used. 153 (SA/CPA) Infants [1] Large for Gestational Age: Birth weight > 9 pounds or > 4000 g. Birth weight documented on Health Information Screen in Crossroads. Presence of condition diagnosed, documented, or reported by a physician or some working under a physician’s orders, or as self-reported by applicant/participant/caregiver. Risk Category: Biochemical Code Category/[Priority] Risk Criteria/Definition Required Documentation 201 (SA)

*(HR)

PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Low Hematocrit/Low Hemoglobin: Non-smoking Pregnant Woman Threshold values: First Trimester (0-13 weeks) Hgb <11.0 g/dl/HCT <33.0% Second Trimester (14-26 weeks) Hgb <10.5 g/dl/HCT <32.0% Third Trimester (27-40 weeks) Hgb <11.0 g/dl/HCT <33.0% HR* (High Risk) Values Hgb <9.9 g/dl/HCT <29.9% Must be done according to Anemia Screening Schedule and documented on Anthro/Lab Screen in Crossroads.

Must be done during current pregnancy or after delivery by WIC clinic or health care provider and documented on Anthro/Lab Screen in Crossroads. For the assessment