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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 17

Infants [1] Child [3] Diagnoses include 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). physician’s orders, or as self-reported by applicant/participant/caregiver. Document on Health Information screen (health conditions slider) in Crossroads. 383 (CPA) Infants [1] Neonatal Abstinence Syndrome (NAS): 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. Infants < 6 months of Age The condition must be diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by the infant’s caregiver. Document on Care Plan Summary – Nutrition Assessment in Crossroads. Manually assign on Assigned Risk Factors screen. Rick Category: Dietary Code Category/[Priority] Risk Criteria/Definition Required Documentation 401 (SA/CPA) PG [1] BF [1] NBF [3-6] Child [3] Failure to Meet Dietary Guidelines for Americans: Women and Children (> 2 years) who meet the income, categorical, and residency eligibility requirements may be presumed to be a nutrition risk. Risk may only be used for Women and Children (>2 years) when a complete nutrition assessment has been completed and no other risk criteria have been identified. 411 (SA/CPA) Infants [1] Inappropriate Nutrition Practices for Infants: Routine use of feeding practices that may result in impaired nutrient status, disease, or health problems. Refer to Codes 411.1 through 411.11 for examples. Document the inappropriate nutrition practice on Dietary and Health Screen in Crossroads. Document details regarding specific risk(s) on Care Plan Summary – Nutrition Assessment in Crossroads. Pertains to 411.1 thru 411.11. 411.1

Routinely using a substitute(s) for human milk or for FDA approved iron-fortified formula as the primary nutrient source during the first year of life: Examples of substitutes: • Low iron formula without iron supplementation. • Cow’s milk, goat’s milk, or sheep’s milk (whole, reduced fat, low-fat, skim), canned evaporated or sweetened condensed milk. • Imitation or substitute milks (such as rice- or soy-based beverages, non-dairy creamer), or other “homemade concoctions”.

411.2

Routinely using nursing bottles or cups improperly: Such as • 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.