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Section 7.7: Food Package 1 (Food Package for Infants 0-5 Months) 04/2014 References: 7 CFR 246.10 Policy ▪ Food packages must be prescribed by CPAs, in consultation with the participant or parent/caregiver, and must be prescribed to minimize any adverse impact on breastfeeding. ▪ The food package must be appropriate to the category of eligibility and must be specifically tailored to address the nutritional needs, circumstances, and preferences of the participant. Purpose: To provide a food package that will best meet the participant’s needs and will be used by the participant. Procedures Issuance requirements Food Package 1 is issued to infants 0 through 5 months of age. There are 3 feeding options in this Food Package. The feeding options reflect the amount of breastfeeding, and determine the infant’s Food Package. The infant’s Food Package determines the mother’s Food Package. ▪ Fully Breastfed Infants receiving no formula from WIC --- This is the ideal. (Mother is eligible for Food Package 7) ▪ Mostly-Breastfed Infants receiving limited amount of formula. (Mother is eligible for Food Package 5, or Food Package 7 - if breastfeeding multiples) ▪ Some-Breastfed/Fully Formula Fed Infants (Mother is eligible for Food Package 6) Breastfeeding Breastfeeding is the normal method for feeding infants; therefore breastfeeding must be considered the first and preferred method to feed infants. Every mother must be encouraged to breastfeed. See Section 6.5: Breastfeeding Education for Pregnant Women. Breastfeeding is how infants were meant to be fed, with human milk the only complete, and most nutritious, infant food. CPAs must consider it first and encourage every mother to breastfeed, without supplementing with formula. ▪ CPAs may only prescribe formula after assessment and counseling.

S E C T I O N 7 . 7 : F O O D P A C K A G E 1 2 ▪ For breastfed infants receiving formula, CPAs must evaluate current feeding practices and prescribe only the minimum amount of formula that is necessary. ▪ CPAs must not automatically provide 1 can of powder formula to breastfeeding infants. ▪ CPAs are not required to issue the maximum amount of formula allowed in the food package. ▪ Breastfed infants receiving WIC formula should be provided powder formula, rather than concentrate or Ready-To-Use (unless the criteria for Ready-To-Use formula is met). With powder formula, smaller amounts can be prepared -- better supporting breastfeeding and reducing waste. ▪ Food packages for the breastfeeding mother and infant dyad are closely tied and must match (except for rare situations). ▪ If the mother is breastfeeding multiple infants with differing breastfeeding statuses, the mother’s food package corresponds to the food package of the infant with the most breastfeeding. Formula Feeding At 4-5 months of age, the maximum formula quantities allowed increase. CPAs must assess feeding and adjust the food package as needed. ▪ Issue the food package as indicated in the table below. ▪ Maximum formula quantities vary by breastfeeding status and by age. ▪ If formula is prescribed for a breastfed infant, provide the minimum amount of formula needed (as determined by assessment) to support mother’s milk supply and infant health. ▪ CPAs must change the food package accordingly. ▪ Ready-to-Use formula may be issued in only in specific situations. Refer to Section 7.5.2: Ready-to-Feed/Use Formula. ▪ Only contract formulas -- including both primary and alternate contract formulas -- are available in this Food Package. Standard non-contract formulas are not allowed. Refer to Section 7.5: WIC Formulas and Exhibit 7-B: WIC Formula Summary. Counseling ▪ CPAs must counsel on infant feeding practices. See Guidance below. ▪ If formula is provided, CPAs must instruct participants on safe and appropriate formula preparation and handling. For additional information, see WIC Infant Nutrition and Feeding Guide, Chapter 4.

S E C T I O N 7 . 7 : F O O D P A C K A G E 1 3 Tables for Food Package 1: Infants 0-5 months Available range of cans of formula or amount of food/month based on breastfeeding status Maximum number of ounces in ( ) Birth to 1 Month Food item Fully Breastfed Mostly-Breastfed Some-Breastfed/ Fully Formula Fed Powdered Formula/Month (a 12.5-oz can of Enfamil Infant yields approximately 90 fl. oz. reconstituted) None 1 can (104 fluid ounces reconstituted) 2-9 cans (870 fluid ounces reconstituted) Concentrate Formula/Month None None 1-31 cans (806 fluid ounces reconstituted) Ready-To Use Formula/Month (RTF) None None 11-26 quarts (832 fluid ounces) 1 to 3 Months Food item Fully Breastfed Mostly-Breastfed Some-Breastfed/ Fully Formula Fed Powdered Formula/Month None 1-4 cans (435 fluid ounces reconstituted) 5-9 cans (870 fluid ounces reconstituted) Concentrate Formula/Month None 1-14 cans (364 fluid ounces reconstituted) 15-31 cans (806 fluid ounces reconstituted) Ready-To Use Formula/Month (RTF) None 1-12 quarts (384 fluid ounces) 13-26 quarts (832 fluid ounces) 4 to 5 Months Food item Fully Breastfed Mostly-Breastfed Some-Breastfed/ Fully Formula Fed Powdered Formula/Month None 1-4 cans (435 fluid ounces reconstituted) 5-9 cans (870 fluid ounces reconstituted) Concentrate Formula/Month None 1-17 cans (442 fluid ounces reconstituted) 15-31 cans (806 fluid ounces reconstituted) Ready-To Use Formula/Month (RTF) None 1-12 quarts (448 fluid ounces) 13-26 quarts (832 fluid ounces) Mom’s Corresponding Food Package (Applies to all infant age categories) 7 5 7 (if multiples) 6 See Exhibit 7-J: Mom and Baby WIC Food Packages which displays mom and baby’s food packages together.

S E C T I O N 7 . 7 : F O O D P A C K A G E 1 4 Guidance The following items should be part of nutrition education and counseling: ▪ CPAs must counsel on infant feeding practices, including hunger cues, signs of fullness, and guidelines on feeding frequency. Information about normal infant gastrointestinal behaviors such as spitting up and stooling can be very helpful so that caregivers do not misinterpret normal patterns or overlook abnormal behaviors. Refer to Chapter 2 and Chapter 6 in the WIC Infant Nutrition and Feeding Guide for more information. ▪ If infant is breastfed, CPAs must counsel on breastfeeding basics, including milk supply, feeding positions, and frequency of feeding. See Section 7.4: Supporting Breastfeeding with the WIC Food Package. ▪ If formula is provided, CPAs must: ▪ Counsel on how formula intake affects breastmilk supply. ▪ Instruct on safe and appropriate formula preparation and handling. For additional information see Chapter 4 in WIC Infant Nutrition and Feeding Guide. ▪ Provide guidance on the mechanics of formula feeding, such as appropriate bottle or cup use (if these are used), positioning, etc. ▪ For more information on formula, refer to Section 7.5: WIC Formulas. ▪ CPAs must assess for Vitamin D adequacy and counsel as appropriate. ▪ All infants need a source of Vitamin D. Refer to the American Academy of Pediatrics clinical report on Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents and the Institute of Medicine Dietary Reference Intakes for Calcium and Vitamin D report. ▪ Mostly-Breastfeeding and Fully-Breastfeeding infants need a daily Vitamin D supplement of 400 IU to ensure adequacy. ▪ Infant formula is fortified with Vitamin D, but the infant’s Vitamin D adequacy depends on how much formula is consumed. AAP recommends Vitamin D supplementation for partially breastfed and non-breastfed infants ingesting less than 1 quart (or 1 liter) per day of Vitamin D-fortified formula. ▪ If there are questions, refer to the Health Care Provider. ▪ Before issuing formula to a breastfed infant, consider the following: ▪ If only a small amount of formula would be prescribed, encourage the family to purchase the formula. If the infant is not receiving formula from WIC, the mother remains eligible to receive more foods from WIC, as indicated in the table above. ▪ If formula is prescribed for a breastfed infant, issue the minimum amount needed. For example, a 2 month old receiving 6 ounces of formula a day (186 oz/month) does not need the maximum quantity of 435 ounces of reconstituted powder formula from the

S E C T I O N 7 . 7 : F O O D P A C K A G E 1 5 Mostly-Breastfed Infant Food Package. Tailor the Food Package to provide only the amount of formula needed. ▪ Infant foods are not provided until 6 months of age. See Section 7.8: Food Package 2 (Food Package for Infants 6-11 Months). ▪ Adding foods before 6 months displaces breastmilk, and may decrease mother’s milk supply. ▪ Most infants are developmentally ready for semisolid foods around 6 months of age. ▪ Goat milk is inappropriate for infants and is not available for issuance. See WIC Infant Nutrition and Feeding Guide for more information. ▪ Additional food package information is available on the WIC Local Agency website, including CPA tools and participant educational resources that may be downloaded. Reference – Complete Listing of Hyperlinks Section 7.13: Food Package 7 (Food Package for Fully Breastfeeding Women) (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch7/sct n7_13.pdf) Section 7.11: Food Package 5 (Food Package for Pregnant Woment and Mostly-Breastfeeding Women) (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch7/sct n7_11.pdf) Section 7.12: Food Package 6 (Food Package for Some-Breastfeeding and Non-Breastfeeding Postpartum Women) (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch7/sct n7_12.pdf) Section 6.5: Breastfeeding Education for Pregnant Women (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch6/sct n6_5.pdf) Section 7.5: WIC Formulas (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch7/sct n7_5.pdf) Exhibit 7-B: WIC Formula Summary (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/exhbts/ex7/7b. pdf) WIC Infant Nutrition and Feeding Guide (https://wicworks.fns.usda.gov/sites/default/files/media/document/Infant_Nutrition_and_Fee ding_Guide.pdf)

S E C T I O N 7 . 7 : F O O D P A C K A G E 1 6 Exhibit 7-J: Mom and Baby WIC Food Packages (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/exhbts/ex7/7j. pdf) Section 7.4: Supporting Breastfeeding with the WIC Food Package (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch7/sct n7_4.pdf) Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents (http://pediatrics.aappublications.org/content/122/5/1142.full) Institute of Medicine Dietary Reference Intakes for Calcium and Vitamin D (https://nap.nationalacademies.org/catalog/13050/dietary-reference-intakes-for-calcium-and- vitamin-d) Section 7.8: Food Package 2 (Food Package for Infants 6-11 Months) (https://www.health.state.mn.us/docs/people/wic/localagency/program/mom/chsctns/ch7/sct n7_8.pdf) WIC Local Agency (https://www.health.state.mn.us/people/wic/localagency/index.html) Minnesota Department of Health - WIC Program 625 Robert St N, PO BOX 64975, ST PAUL MN 55164-0975; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us. To obtain this information in a different format, call: 1-800-657-3942 This institution is an equal opportunity provider.