us-or/manual/oha/wic/675/document-1

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675.1 Policy 675 Risk Criteria Codes and Descriptions October 1, 2025 (Revised) POLICY The competent professional authority (CPA) shall use this list of risk criteria, codes and descriptions when assigning nutrition risks to program applicants. PURPOSE To specify and define allowable nutrition risks used in the Oregon WIC Program. To ensure consistent assessment of applicants for nutrition risk assignment throughout the state. RELEVANT REGULATIONS 7 CFR §246.7 ¶(e)—Nutritional Risk APPENDICES Page 675.31 Appendix A WIC Hematocrit and Hemoglobin Values Adjusted for Altitude and Smoking Page 675.40 Appendix B Altitudes of Oregon Cities DEFINITIONS

Gestational age adjust: For the preterm or early term infant, adjusting calculation of weight for age and/or length for age based on gestational rather than chronological age. Homeless person: A person who lacks a fixed and regular nighttime residence, or whose primary nighttime residence is one of the following: a. A temporary accommodation of not more than 365 days in the residence of another individual. b. A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation (for example cars, park benches, abandoned buildings, or campgrounds). c. A supervised publicly or privately operated shelter designed to provide temporary living accommodations (including a hotel, a family shelter or a shelter for victims of domestic violence). d. An institution that provides a temporary residence for individuals intended to be institutionalized. Migrant farm worker: A person whose principal employment is in seasonal agriculture, who has been so employed in the last 24 months and who establishes a temporary abode because of that employment.

Risk Criteria Codes and Descriptions, Continued 675.2 Migrant in stream: A migrant farm worker or family member who comes into a clinic service area with the harvest and leaves the clinic service area, often mid-certification, for employment in the harvest of crops in other areas or to return home. Nutrition risk: A health problem, medical condition, diet deficiency or other issue that can compromise the health of a participant. Identification through assessment of biochemical or anthropometric measurements, dietary intake, feeding behaviors, medical conditions and environmental factors is required for program eligibility.

PROCEDURE 1.0 CPAs will use the nutrition risk criteria that Oregon has adopted from national policy to assess and assign participant nutrition risk factors. The United States Department of Agriculture (USDA) risk criteria numbering system is used to document nutrition risks in the data system. (see next several pages for Nutrition Risk Criteria)

POLICY HISTORY Date * Major Revision, Minor revision 7/13/2018 Major revision 9/10/2019 Major revision (revised w/ 2019 USDA Nutrition Risks) 10/1/2021 Updated risk codes 10/1/2024 Updated risk codes 10/1/2025 Updated risk codes

The date located at the top of the policy is the implementation date unless an “effective date” is noted on the policy. Policies will become compliance findings 6 months from the implementation date. Release notes can be found in the corresponding document on the Policy and Procedure Manual page. *Major Revisions: Significant content changes made to policy. Minor Revisions: Minor edits, grammatical updates, clarifications, and/or formatting changes have occurred. Date of Origin: Date policy was initially released

If you need this in large print or an alternate format, please call 971-673-0040. This institution is an equal opportunity provider.

Risk Criteria Codes and Descriptions, Continued 675.3 Nutrition risk criteria allowed for WIC program certification

USDA Code Risk Criterion Definition and Cutoff * Participant Category & Priorities 100 Series ANTHROPOMETRIC - Weight for Height/Length 101 Underweight (Women) ♦ Pregnant participants— prepregnancy Body Mass Index (BMI) <18.5 ♦ Non-breastfeeding and breastfeeding participants who are < 6 months postpartum —prepregnancy or current BMI <18.5. ♦ Breastfeeding participants who are ≥ 6 months postpartum — current BMI <18.5. WP I WE, WB I WN, VI 103 Underweight (Infants and Children) ♦ Underweight: • Birth to < 24months: ≤2% weight for length • 2-5 years: ≤5% BMI for age ♦ At Risk of Underweight: • Birth to < 24months: >2% and ≤ 5% weight for length • 2-5 years: >5% and ≤ 10% BMI for age I I C III 111

Overweight (Women) ♦ Pregnant participants— prepregnancy BMI ≥ 25.0 ♦ Non-breastfeeding birth parent and breastfeeding participants who are< 6 months postpartum — prepregnancy BMI ≥ 25. ♦ Breastfeeding participantswho are ≥ 6 months postpartum — current BMI ≥ 25. WP I WE, WB I WN, VI 113 Overweight (Children 2–5 years of age)

≥ 24 months to 5 years: ≥ 95 % BMI for age. Recumbent length measurements may not be used to determine this risk. C III

LEGEND ≤ “less than or equal to” WP Woman, pregnant

≥ “greater than or equal to” WE Woman fully breastfeeding

I Infant (IE, IB, IN) WB Woman some or mostly

C Child WN Woman non-breastfeeding

Risk Criteria Codes and Descriptions, Continued 675.4 USDA Code Risk Criterion Definition and Cutoff * Participant Category & Priorities 114 At Risk of Overweight (Children 2 -5 years of age)

≥24 months to 5 years: ≥ 85% and < 95 % BMI for age. Recumbent length measurements may not be used to determine this risk. C III 115 High Weight for Length (Infants and Children < 24 months of age) Birth to < 24 months: ≥ 98% weight for length I I C III 120 Series ANTHROPOMETRIC - Short Stature 121 Short Stature (Infants and Children) Short Stature: • Birth to < 24 months: <2% length for age • 2-5 years: ≤5% height for age At Risk of Short Stature: • Birth to < 24 months: >2% and ≤ 5% length for age • 2-5 years: > 5% and ≤ 10 % height for age I I C III

Risk Criteria Codes and Descriptions, Continued 675.5 USDA Code Risk Criterion Definition and Cutoff * Participant Category & Priorities 130 Series ANTHROPOMETRIC - Inappropriate Growth/Weight Gain 131 Low prenatal weight gain In the 2nd and 3rd trimesters, weight gain for singleton pregnancies: ♦ underweight < 1 lbs (16 oz) /week ♦ normal < .8 lbs (12.8 oz) /week ♦ overweight < .5 lbs (8 oz) /week ♦ obese < .4 lbs ( (6.4 oz) /week

Weight loss or low weight gain at any point in pregnancy, such that a participant’s weight plots at any point beneath the bottom line of the appropriate weight gain range for her respective prepregnancy weight category (underweight, normal, overweight, obese), using IOM-based weight gain grid.

Prepregnancy Weight Group BMI Risk if gain is: Singleton Underweight < 18.5 <28 lbs Normal 18.5-24.9 <25 lbs Overweight 25.0-29.9 <15 lbs Obese ≥ 30.0 <11 lbs

Use the same assessment for both teens and adults

WP I

Risk Criteria Codes and Descriptions, Continued 675.6 USDA Code Risk Criterion Definition and Cutoff * Participant Category & Priorities Additional research is needed to establish specific weight gain ranges for multifetal pregnancies. 133 High maternal weight gain In the 2nd and 3rd trimesters, , weight gain for singleton pregnancies: ♦ underweight >1.3 lbs / week ♦ normal >1 lb /week ♦ overweight >.7 lb /week ♦ obese > .6 lbs /week

High weight gain at any point in pregnancy, such that a participant’s weight plots at any point above the top line of the appropriate weight gain range for her respective prepregnancy weight category (underweight, normal, overweight, obese), using IOM-based weight gain grid.

WP I WE, WB I WN VI

Risk Criteria Codes and Descriptions, Continued 675.7 USDA Code Risk Criterion Definition and Cutoff * Participant Category & Priorities

Breastfeeding or Non-breastfeeding postpartum participant, most recent pregnancy total weight gain exceeding:

Prepregnancy Weight Group BMI Risk if gain is: Singleton Underweight

< 18.5 >40 lbs Normal

18.5-24.9 >35 lbs Overweight

25.0-29.9 >25 lbs Obese

≥ 30.0 >20 lbs

Additional research is needed to establish specific weight gain ranges for multifetal pregnancies

134 Failure to thrive Presence of failure to thrive diagnosed by a physician as self-reported by applicant/participant/caregiver; or as reported or documented by a physician, or someone working under physician’s orders. Base diagnosis of failure to thrive for premature infants on gestational age adjustment. I I C III 135

Infant weight loss

A. INFANTS from Birth to 2 weeks of age: Excessive weight loss after birth defined as ≥ 7 % of birth weight.

B. INFANTS from 2 weeks to 6 months of age: Any weight loss. Use 2 separate weights taken at least 8 weeks apart. ,

USDA name: Slowed/Faltering Growth Pattern I (< 6 mo.) I

Risk Criteria Codes and Descriptions, Continued 675.8 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 140 Series ANTHROPOMETRIC - Low Birth Weight/Preterm Birth 141A

141 B Low Birth Weight

Low Birth Weight Birth weight ≤ 5 lbs 8 oz (≤ 2500 g). For infants 0-11 months of age.

I I C III (< 24 mo.) Birth weight ≤ 5 lbs 8 oz (≤ 2500 g). For infants 12 months of age and children <24 months of age.

142 Preterm or Early Term Delivery Preterm delivery: delivery on or before 36 weeks 6 days gestation. Early term delivery: delivery between 37 weeks 0 days and 38 weeks 6 days gestation.

For infants and children <24 months of age.

I I C III (< 24 mo.) 150 Series ANTHROPOMETRIC - Other 151 Small for Gestational Age (SGA) For infants and children < 24 months of age:

Presence as diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders

I I C III (< 24 mo.) 152 Low Head Circumference For infants and children < 24 months of age: ≤ 2.3rd percentile head circumference for age

Note: premature infants and children with a history of prematurity, base assignment on adjusted for gestational age.

I I C III (<24 mo.)

Risk Criteria Codes and Descriptions, Continued 675.9 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 153 Large for Gestational Age (LGA) Birth weight ≥ 9 lbs (≥ 4000g)

Presence as diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

I I

200 Series BIOCHEMICAL - Hematocrit or Hemoglobin 201A

201B Low Hemoglobin or Hematocrit

Low Hemoglobin or Hematocrit

201A: Hemoglobin or Hematocrit concentration that is below the 95% confidence interval (i.e., below the .025th percentile) for healthy, well- nourished individuals of the same age, gender, and stage of pregnancy.

201A: Pregnant Women – Nonsmokers Altitude 1st 2nd 3rd 0–2,999 ft. Trimester Trimester Trimester PP Hgb 11.0 10.5 11.0 12.0 Hct 33 32 33

32.7 Infants and Children Altitude Infants Children Children 0–2,999 ft. 6 – 12 mos. 1 – 2 yr. 2 – 5 yr. Hgb 11.0 11.0 11.1 Hct 33 33 33

WP I WE, WB I WN VI I I C III 201B: Hemoglobin or Hematocrit concentration that is more than 1 gram/dL (Hemoglobin) or more than 3% (Hematocrit) below the 95% confidence interval (i.e., below the .025th percentile) for healthy, well-

Risk Criteria Codes and Descriptions, Continued 675.10 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities nourished individuals of the same age, gender, and stage of pregnancy.

201B: Pregnant Women – Nonsmokers Altitude 1st 2nd 3rd 0–2,999 ft. Trimester Trimester Trimester PP Hgb 10 9.5 10 11.0 Hct 30 29 30 32.7 Infants and Children Altitude Infants Children Children 0–2,999 ft. 6 – 12 mos. 1 – 2 yr. 2 – 5 yr. Hgb 10.0 10.0 10.1 Hct 30 30 30

Cut-off values are included in Appendix A. It includes a table of rounded Hematocrit values adapted from Centers for Disease Control and Prevention (CDC) for those WIC agencies that obtain hematocrit only in whole-numeric values. See Appendix B for altitude of Oregon cities.

211 Lead poisoning Blood lead level of ≥ 5 μg/deciliter within the past 12 months. Cut off value is the current published guidance from CDC. WP I, WE, WB I WN VI I I

Blood lead level of ≥ 3.5 μg/deciliter within the past 12 months. Cut off value is the current published guidance from the CDC. C III 300 Series CLINICAL/HEALTH/MEDICAL - Prenatal Conditions

Risk Criteria Codes and Descriptions, Continued 675.11 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 301 Hyperemesis gravidarum Severe and persistent nausea and vomiting during pregnancy which may cause more than 5 % weight loss and fluid and electrolyte imbalances. This risk is based on a chronic condition, not single episodes. Presence of hyperemesis gravidarum diagnosed by physician as self-reported by applicant/participant/caregiver, or as reported or documented by a physician, or someone working under physician’s orders.

WP I 302 Gestational diabetes Presence of gestational diabetes diagnosed by a physician as self- reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

WP I 303 History of Gestational diabetes History of diagnosed gestational diabetes. May or may not have been insulin dependent. Any pregnancy (WP), most recent pregnancy only (WE, WB), (WN) WP I WE, WB I WN VI

304 History of Preeclampsia History of diagnosed preeclampsia in any past pregnancy for any Pregnant/Postpartum participant (WP, WE, WB, or WN). WP I WE, WB I WN VI

310 Series CLINICAL/HEALTH/MEDICAL – History of Low-Birth Weight/Preterm Infant 311 History of Preterm or Early Term delivery Birth of an infant at /or before 38 weeks 6 days gestation in any pregnancy for a pregnant participant (WP) or during the most recent pregnancy only for a postpartum participant (WE, WB), (WN) WP I WE, WB I WN VI 312 History of low birth weight Birth of an infant weighing ≤ 5 lb 8 oz (≤ 2500 g). Any pregnancy (WP), most recent pregnancy only (WE, WB), (WN) WP I WE, WB I WN VI

Risk Criteria Codes and Descriptions, Continued 675.12 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 320 Series CLINICAL/HEALTH/MEDICAL - History of Poor Pregnancy Outcome 321 History of fetal or neonatal loss A fetal death (death at ≥ 20 weeks gestation) or a neonatal death (0 – 28 days of life). Pregnant (WP): Any history of fetal or neonatal loss. Non-Breastfeeding (WN): most recent pregnancy. Breastfeeding (WE, WB): most recent pregnancy with one or more infants still living.

WP I WE, WB I WN VI 330 Series CLINICAL/HEALTH/MEDICAL - Other Prenatal Risks 331 Pregnancy at a young age Conception ≤ 20 years of age. Current pregnancy (WP), most recent pregnancy only (WE, WB), (WN) WP I WE, WB I WN VI 332 Closely spaced pregnancy Conception before 18 months postpartum. Current pregnancy (WP), most recent pregnancy only (WE, WB), (WN) WP I WE, WB I WN VI 334 Lack of or inadequate prenatal care Prenatal care beginning after the 1st trimester (after 13th week) or 1st prenatal visit in the third trimester (7–9 months) or: Weeks of Gestation Number of Prenatal Visits 14–21 0 or unknown 22–29 1 or less 30–31 2 or less 32–33 3 or less 34 or more

4 or less

WP I 335 Multiple fetus pregnancy > 1 fetus in a current pregnancy (WP) or the most recent pregnancy (WE, WB and WN) USDA name: Multi fetal Gestation.

WP I WE, WB I WN VI

Risk Criteria Codes and Descriptions, Continued 675.13 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 336

Fetal growth restriction (FGR) Fetal Growth Restriction (FGR) (replaces the term Intrauterine Growth Retardation, IUGR), may be diagnosed by a physician with serial measurement of fundal height, abdominal girth and can be confirmed with ultrasonography. FGR is usually defined as a fetal weight below (<) the 10th percentile for gestational age. Presence diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician or someone working under physician’s orders. WP I 337 History of a birth of a large for gestational age infant History of birth of an infant weighing ≥ 9 lbs (≥ 4000 g) Any pregnancy (WP), most recent pregnancy only (WE, WB and WN). WP I WE, WB I WN VI 338 Pregnant woman currently breastfeeding Breastfeeding participant now pregnant. WP I 339 History of birth with nutrition related congenital birth defect A participant who has given birth to an infant who has a congenital or birth defect linked to inappropriate nutritional intake, e.g., inadequate zinc, folic acid, or excess vitamin A. Any pregnancy (WP), most recent pregnancy only (WE, WB and WN) WP I WE, WB I WN VI 340, 350, 360 Series CLINICAL/HEALTH/MEDICAL - Nutrition Related Conditions 341 Nutrient deficiency or disease Any currently treated or untreated nutrient or disease Diseases include, but are not limited to: Protein Energy Malnutrition, Scurvy, Rickets, Beriberi, Hypocalcemia, Osteomalacia, Vitamin K Deficiency, Pellagra, Cheilosis, Menkes Disease, Xerophthalmia, etc. Presence diagnosed by a physician as self-reported by applicant/participant/care-giver; or as reported or documented by a physician, or someone working under physician’s orders. WP I WE, WB I WN VI I I C III

Risk Criteria Codes and Descriptions, Continued 675.14 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities

342 Gastrointestinal disorders Diseases or conditions that interfere with the intake or absorption of nutrients. The conditions include but are not limited to: WP I WE, WB I WN VI I I C III • stomach or intestinal ulcers, • small bowel enterocolitis or short bowel syndrome, • malabsorption syndromes, • inflammatory bowel disease, including: ulcerative colitis or Crohn’s disease, • liver disease, • pancreatitis, • biliary tract and gall bladder disease. • gastro esophageal reflux disease (GERD) • post bariatric surgery

Presence of gastro-intestinal disorders diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders

343 Diabetes mellitus Presence of diabetes mellitus diagnosed by a physician as self- reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders. WP I WE, WB I WN VI I I C III 344 Thyroid Disorders Presence of a thyroid disorder diagnosed, documented or reported by a physician or someone working under a physician’s orders or as self-reported by the applicant/participant/caregiver. Thyroid disorders include but are not limited to the following: WP I WE, WB I WN VI I I C III • Hyperthyroidism • Hypothyroidism • Congenital hyperthyroidism • Congenital hypothyroidism • Postpartum thyroiditis

Risk Criteria Codes and Descriptions, Continued 675.15 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities

345 Hypertension and Prehypertension Hypertension is defined as high blood pressure. Prehypertension is defined as being at high risk for developing hypertension based on blood pressure levels. The diagnosis may include the following conditions: ♦ chronic hypertension ♦ preeclampsia ♦ eclampsia ♦ gestational hypertension

Diagnosed by a physician as self-reported by applicant/participant/caregiver; or as reported or documented by a physician, or someone working under physician’s orders. WP I WE, WB I WN VI I I C III 346 Renal disease Any renal disease including pyelonephritis and persistent proteinuria but excluding urinary tract infections (UTI) involving the bladder. Presence of renal disease diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders. WP I WE, WB I WN VI I I C III 347

Cancer A chronic disease whereby populations of cells have acquired the ability to multiply and spread without the usual biologic restraints. The current condition, or the treatment for the condition, must be severe enough to affect nutritional status. Presence of cancer diagnosed by a physician as self-reported by applicant/ participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

WP I WE, WB I WN VI I I C III

Risk Criteria Codes and Descriptions, Continued 675.16 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 348 Central nervous system disorders Conditions that alter nutrition status metabolically and/or mechanically, which affect energy requirements and may affect the individual’s ability to feed him/herself. Includes, but is not limited to: WP I WE, WB I WN VI I I C III • epilepsy • cerebral palsy (CP) • neural tube defects (NTD), such as spina bifida or myelomeningocele. Presence of central nervous system disorders diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

349 Genetic and congenital disorders Hereditary condition at birth that causes physical or metabolic abnormality. The current condition must alter nutrition status metabolically, mechanically, or both. May include, but is not limited to: WP I WE, WB I WN VI I I C III • cleft lip or palate • Down’s syndrome

• Thalassemia • sickle cell anemia (not sickle cell trait Presence of genetic and congenital disorders diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

351 Inborn errors of metabolism Gene mutations or gene deletions that alter metabolism in the body, including, but not limited to: WP I WE, WB I

Risk Criteria Codes and Descriptions, Continued 675.17 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities • phenylketonuria (PKU) • maple syrup urine disease • galactosemia • hyperlipoproteinuria • homocystinuria • tyrosinemia • histidinemia • urea cycle disorders

• glutaric aciduria • methylmalonic acidemia • glycogen storage disease • galactokinase deficiency • fructoaldolase deficiency • propionic acidemia • hypermethioninemia.

WN VI I I C III

Presence of inborn error(s) of metabolism diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

352A

352B

Infectious diseases-Acute

Infectious diseases- Chronic An infectious disease characterized by a single or repeated episode of rapid onset and short duration caused by bacteria, viruses, parasites or fungi. Conditions includes but are not limited to: WP I WE, WB I WN VI I I C III • Hepatitis A • Pneumonia • Meningitis (bacterial/viral) • Parasitic infections

• Bronchitis (3 episodes in last 6 months) • Hepatitis E • Listeriosis

An infectious disease likely lasting a lifetime requiring long term management of symptoms caused by bacteria, viruses, parasites or fungi. Conditions include but are not limited to: • HIV (Human Immunodeficiency Virus infection) • AIDS (Acquired Immunodeficiency Syndrome)

Risk Criteria Codes and Descriptions, Continued 675.18 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities • Hepatitis B • Hepatitis C • Hepatitis D

The infectious disease must be present within the past six (6) months, and diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

353 Food allergies An adverse immune response to a food or a hypersensitivity that causes adverse immunologic reaction. Presence of food allergy diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders. WP I WE, WB I WN VI I I C III 354 Celiac disease Also known as: Celiac Sprue, Gluten Enteropathy, Non-tropical Sprue Inflammatory condition of the small intestine precipitated by the ingestion of wheat in individuals with certain genetic make-up. Presence of Celiac Disease diagnosed by a physician as self- reported by applicant/participant/care giver; or as reported or documented by a physician or someone working under physician’s orders.

WP I WE, WB I WN VI I I C III

Risk Criteria Codes and Descriptions, Continued 675.19 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 355 Lactose Intolerance Lactose intolerance occurs when there is 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 the following GI disturbances: nausea, diarrhea, bloating, cramps. Lactose intolerance varies among and within individuals and ranges from mild to severe.

Presence of lactose intolerance diagnosed by a physician as self- reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders. Documentation should indicate that the ingestion of dairy products causes the above symptoms and the avoidance of such dairy products eliminates them.

WP I WE, WB I WN VI I I C III 356 Hypoglycemia Presence of hypoglycemia diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders. WP I WE, WB I WN VI I I C III

357 Drug Nutrient Interactions Use of prescription or over the counter drugs or medications that are known to interfere with nutrient intake, absorption, distribution, metabolism or excretion to an extent that nutritional status is compromised.

WP I WE, WB I WN VI I I C III

Risk Criteria Codes and Descriptions, Continued 675.20 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 358 Eating Disorders Eating disorders are characterized by severe disturbances in a person’s eating behaviors and related thoughts and emotions. Eating disorders include, but are not limited to:

• Anorexia Nervosa (AN) • Bulimia Nervosa (BN) • Binge-Eating Disorder (BED)

Presence of eating disorder diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver WP I WE, WB I WN VI

359

Recent major surgery, physical trauma, burns Major surgery (includes C-sections), physical 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.

WP I WE, WB I WN VI I I C III

Risk Criteria Codes and Descriptions, Continued 675.21 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities 360 Other medical conditions Diseases or conditions with nutritional implications that are 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 is not limited to: WP I WE, WB I WN VI I I C III • juvenile rheumatoid arthritis (JRA) • lupus erythematosus • cardiorespiratory diseases

• heart disease • cystic fibrosis • persistent asthma (moderate or severe) requiring daily medication Presence of other medical condition(s) diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders.

361

Mental Illnesses As defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition, a mental disorder (or mental illness) is: “A syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.”

Mental illnesses where the current condition, or treatment for the condition may affect nutrition status include, but are not limited to: Depression, Anxiety Disorders, Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Personality WP, I WE, WB I WN IV C III

Risk Criteria Codes and Descriptions, Continued 675.22 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities Disorders, Bipolar Disorders, Schizophrenia and Attention- Deficit/Hyperactivity Disorder (ADHD)

The presence of a mental illness that is diagnosed, documented, or reported by a physician, or someone working under a physician’s orders, mental health provider or as self-reported by an applicant, participant, or caregiver. 362 Developmental delays, sensory or motor delays interfering with the ability to eat Developmental, sensory or motor disabilities that restrict the ability to chew or swallow food or require tube feeding to meet nutritional needs. Includes but not limited to, minimal brain function, feeding problems due to developmental disability such as pervasive development disorder (PDD), which includes autism, birth injury, head trauma, brain damage, and other disabilities.

WP I WE, WB I WN VI I I C III 363 Pre-Diabetes Presence of pre-diabetes diagnosed by a physician as self-reported by applicant/participant/care giver; or as reported or documented by a physician, or someone working under physician’s orders for a postpartum participant. (WE, WB, WN). WE, WB I WN VI

370 Series CLINICAL/HEALTH/MEDICAL - Substance Abuse 371 Nicotine and Tobacco Use Any use of products that contain nicotine and/or tobacco including 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).

WP I WE, WB I WN VI 372 Alcohol and Substance Use Pregnancy (WP): • Any alcohol use • Any illegal substance use • Any abuse of prescription medications WP I WE, WB I WN VI

Risk Criteria Codes and Descriptions, Continued 675.23 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities • Any marijuana use in any form

Breastfeeding (WE, WB) and Non-Breastfeeding Postpartum birth parent (WN): • High risk drinking: Routine consumption of 8 or more drinks per week or 4 or more drinks on any day (a standard sized drink or serving is 12-oz beer, 5-oz wine, 1.5 fluid oz 80 proof distilled spirits such as gin, rum, vodka, whiskey, cordials or liqueurs) • Binge drinking: Routine consumption of 4 or more drinks within 2 hours • Any illegal substance use • Any abuse of prescription medications

Breastfeeding (WE, WB)(not WN): • Any marijuana use in any form

380 Series CLINICAL/HEALTH/MEDICAL - Other 381 Oral Health Conditions Diagnosis of oral health conditions by a physician or a health care provider working under the orders of a physician or adequate documentation by the CPA. Includes, but is not limited to tooth decay, periodontal disease including gingivitis and periodontitis, tooth loss, oral infections and ineffectively replaced teeth. WP I WE, WB I WN VI I I C III 382 Fetal Alcohol Spectrum Disorders Fetal Alcohol Spectrum Disorders are a group of conditions that occur in a person whose mother consumed alcohol while pregnant. Diagnosis may include: ♦ Fetal alcohol syndrome I I C III

Risk Criteria Codes and Descriptions, Continued 675.24 USDA Code Risk Criterion Definition and Cutoff* Participant Category & Priorities ♦ Partial fetal alcohol syndrome ♦ Alcohol related birth defects ♦ Alcohol related neurodevelopmental disorders

Diagnosed by a physician as self-reported by applicant/participant/caregiver; or as reported or documented by a physician, or someone working under a physician’s orders.

383 Neonatal Abstinence Syndrome (NAS) Drug withdrawal symptoms that occur after delivery when an infant is exposed to drugs during pregnancy. Condition must be present within the first 6 months of birth.

Condition must be diagnosed by a physician or health care provider and can be self-reported by the infant’s caregiver or as reported by a physician or someone working under a physician’s orders.

I 1 400 Series DIET - Presumed Eligibility 401 Presumed dietary eligibility for women and children age 2 to 5 years Pregnant and postpartum participants and children age two to five years may be presumed to be at nutrition risk based on inability to meet Dietary Guidelines for Americans as defined by consuming fewer than the recommended number of servings from one or more of the basic food groups.

This risk may only be assigned after a complete nutrition assessment has been performed and no other risks have been identified. WP IV WE, WB IV WN VI C V

Risk Criteria Codes and Descriptions, Continued 675.25 411 Series DIET - Inappropriate Nutrition Practices for Infants 411.1 Use of substitutes for breast milk or formula Routinely using substitutes for breast milk or FDA approved iron-fortified formula as the primary nutrient source during the first year of life. Examples of substitutes include but are not limited to: Low iron formula without iron supplementation Cow’s milk, goat’s milk, sheep’s milk, canned evaporated or sweetened condensed milk Imitation or substitute milks such as rice or soy based beverages, non- dairy creamer or other “homemade concoctions”

I IV 411.2

Inappropriate use of bottles or cups Routinely using nursing bottles or cups improperly. Examples include but are not limited to: • Using a bottle to feed juice • Feeding any sugar-containing fluids such as soda, gelatin water, corn syrup solutions, sweetened tea • Allowing the infant to fall asleep or to be put to bed with a bottle at naps or bedtime • Allowing the infant to use a bottle without restriction such as walking around with a bottle or using a bottle as a pacifier • Propping the bottle while feeding • Allowing an infant to carry around and drink throughout the day from a covered training cup • Adding any food such as cereal or other solids to the infant’s bottle • I IV 411.3 Early introduction of solid foods Routinely offering complimentary foods (foods or beverages other than breast milk or formula) or other substances that are inappropriate in type or timing. Examples of inappropriate complementary foods include but are not limited to: • Introducing any food other than breast milk or iron fortified formula before 6 months of age • Adding sweet agents such as sugar, honey or syrup to any beverage (including water), or to prepared food, or on a pacifier I IV

Risk Criteria Codes and Descriptions, Continued 675.26

411.4 Inappropriate feeding practices Routinely using feeding practices that disregard the developmental needs or stage of the infant. Examples include but are not limited to: • Inability to recognize, insensitivity to or disregarding the infant’s cues for hunger or satiety • Feeding foods of inappropriate consistency, size or shape that put infants at risk for choking • Not supporting an infant’s need for growing independence with self-feeding such as solely spoon feeding an infant who is able and ready to finger feed and/or try self-feeding with the appropriate utensils • Feeding infant foods with inappropriate textures based on his/her developmental stage such as feeding primarily pureed foods when an infant is ready and capable of eating mashed, chopped or finger foods.

I IV 411.5 Feeding potentially harmful foods Feeding foods to an infant that could be contaminated with harmful microorganisms or toxins. Examples of potentially harmful foods include but are 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 or on a pacifier • Raw or undercooked meat, fish, poultry or eggs • Raw vegetable sprouts such as alfalfa, clover, bean, or radish I IV

Risk Criteria Codes and Descriptions, Continued 675.27 • Deli meats, hotdogs and processed meats unless heated steaming hot • Feeding donor human milk acquired directly from individuals or the internet (does not include sterilized donor milk from milk banks)

411.6 Incorrect dilution of formula Routinely feeding inappropriately diluted formula. • Failure to follow manufacturer’s dilution instructions including stretching formula for economic reasons • Failure to follow specific instructions accompanying a prescription

I IV 411.7 Infrequent breastfeeding Routinely limiting the frequency of nursing of the exclusively breastfed infant when breast milk is the sole source or nutrients. Examples of inappropriate frequency of nursing: • Scheduled feedings instead of demand feedings • Less than 8 feedings in 24 hours if less than 2 months of age

I IV 411.8 Feeding low calorie or low nutrient diets Routinely feeding a diet very low in calories and/or essential nutrients. Examples include but are not limited to: I IV • Vegan diet • Macrobiotic diet

• Other diets very low in calories and/or essential nutrients 411.9 Improper handling of expressed breast milk or formula Routinely using inappropriate sanitation in preparation, handling and storage of expressed breast milk or formulas. Examples of inappropriate sanitation include but are not limited to: • Limited or no access to a safe water supply, heat source for sterilization and/or refrigerator or freezer for storage • Failure to properly prepare, handle and store bottles or storage containers of expressed breast milk or formula

Breast Milk • Thawing in a microwave • Refreezing I IV

Risk Criteria Codes and Descriptions, Continued 675.28 • Adding freshly expressed unrefrigerated breast milk to frozen breast milk • Adding refrigerated breast milk to frozen milk in an amount that is greater than the amount of frozen milk • Feeding thawed breast milk more than 24 hours after thawing • Saving breast milk from a used bottle for another feeding • Failure to clean the 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 one hour • Failure to store prepared formula per manufacturer’s instructions • Using formula in a bottle one hour after the start of a feeding 411.10 Inappropriate use of dietary supplements Feeding dietary supplements with potentially harmful consequences. Examples of dietary supplements which, if fed in excess of recommended dosage, may be toxic or have harmful consequences include but may not be limited to:

I IV • Single or multi-vitamins • Mineral supplements

• Herbal or botanical supplements/remedies/teas 411.11 Inadequate fluoride and Vitamin D supplementation Routinely not providing dietary supplements recognized as essential by national public health policy when an infant’s diet alone cannot meet nutrient requirements.

Infants who are 6 months of age or older who are ingesting less than 0.25 mg of fluoride daily when the water supply contains less than 0.3ppm fluoride

Infants consuming less than one quart of vitamin D fortified formula and not receiving 400 IU Vitamin D supplement I IV

Risk Criteria Codes and Descriptions, Continued 675.29

425 Series DIET - Inappropriate Nutrition Practices for Children 425.1 Use of inappropriate beverages as milk source Routinely feeding inappropriate beverages as the primary milk source. Examples include but are not limited to:

• Non-fat or reduced-fat milks between 12 and 24 months of age (unless assigned by a CPA to a child for whom overweight or obesity is a concern) • Sweetened condensed milk • Imitation or substitute milks such as inadequately or unfortified rice or soy based beverages or other “homemade concoctions” • Non-dairy creamer • Unfortified goat’s or sheep’s milk

C V 425.2 Feeding sweetened beverages Routinely feeding a child sugar-containing fluid. Examples of sugar- containing beverages include but are not limited to:

C V • Soda • Gelatin water

• Corn syrup solutions • Sweetened tea

425.3 Inappropriate use of bottles or cups Routinely using nursing bottles, cups or pacifiers improperly. Examples include but are not limited to:

• Using the bottle for feeding or drinking beyond 14 months of age • Using a bottle to feed juice, diluted cereal or other solids • Allowing the child to fall asleep or to be put to bed with a bottle at naps or bedtime • Allowing the child to use a bottle without restriction such as walking around with a bottle or using a bottle as a pacifier • Allowing a child to carry around and drink throughout the day from a covered training cup

C V

Risk Criteria Codes and Descriptions, Continued 675.30 425.4

Inappropriate feeding practices Routinely using feeding practices that disregard the developmental needs or stage of the child. Examples include but are not limited to:

• Inability to recognize, insensitivity to or disregarding the child’s cues for hunger or satiety • Feeding foods of inappropriate consistency, size or shape that put children at risk for choking • Not supporting a child’s need for growing independence with self- feeding such as solely spoon feeding a child who is able and ready to finger feed and/or try self-feeding with the appropriate utensils • Feeding a child foods with inappropriate textures based on his/her developmental stage such as feeding primarily pureed or liquid foods when the child is ready and capable of eating mashed, chopped or appropriate finger foods

C V 425.5

Feeding potentially harmful foods Feeding foods to a child that could be contaminated with harmful microorganisms. Examples of potentially harmful foods for a child include but are 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 such as alfalfa, clover, bean, or radish • Deli meats, hotdogs & processed meats unless heated until steaming hot

C V 425.6 Feeding low calorie or low nutrient diets Routinely feeding a diet very low in calories and/or essential nutrients. Examples include but are not limited to: C V • Vegan diet • Macrobiotic diet • Other diets very low in calories and/or essential nutrients

Risk Criteria Codes and Descriptions, Continued 675.31 425.7 Inappropriate use of dietary supplements Feeding dietary supplements with potentially harmful consequences. Examples of dietary supplements which, if fed in excess of recommended dosage, may be toxic or have harmful consequences include but may not be limited to:

C V • Single or multi-vitamins • Mineral supplements • Herbal or botanical supplements/remedies/teas

425.8 Inadequate fluoride and Vitamin D supplementation Routinely not providing dietary supplements recognized as essential by national public health policy when a child’s diet alone cannot meet nutrient requirements.

Providing children under 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 to 60 months of age less than 0.50 mg of fluoride daily when the water supply contains less than 0.3 ppm fluoride

Providing children less than 400 IU Vitamin D supplement if drinking less than one quart Vitamin D fortified milk daily

C V 425.9 Pica Routine ingestion of non-food items. Examples of inappropriate nonfood items include but are not limited to: C V • Ashes • Carpet fibers • Cigarettes or cigarette butts • Chalk • Clay • Dust • Foam rubber • Paint chips • Soil • Starch (laundry or cornstarch)

427 Series DIET - Inappropriate Nutrition Practices for Women

Risk Criteria Codes and Descriptions, Continued 675.32 427.1 Inappropriate use of dietary supplements Consuming dietary supplements with potentially harmful consequences. Examples of dietary supplements which when ingested in excess of recommended dosages may be toxic or have harmful consequences:

WP IV WE, WB IV WN VI

• Single or multi-vitamins • Mineral supplements

• Herbal or botanical supplements/remedies/teas 427.2 Consuming very low calorie diets Consuming a diet very low in calories and/or essential nutrients. Examples include but are not limited to:

WP IV WE, WB IV WN VI

• Strict vegan diet • Low-carbohydrate, high protein diet • Macrobiotic diet • Any other diet restricting calories and/or essential nutrients

427.3 Pica Compulsive ingestion of non-food items. Examples of nonfood items include but are not limited to:

WP IV WE, WB IV WN VI

• Ashes • Baking soda • Burnt matches • Carpet fibers • Chalk • Cigarettes • Clay

• Dust • Large quantities of ice or freezer frost • Paint chips • Soil • Starch (laundry and cornstarch)

427.4 Inadequate iron, iodine or folic acid supplementation Inadequate vitamin-mineral supplementation recognized as essential by national public health policy.

• Consumption of less than 27 mg of iron as a supplement daily by pregnant women

WP IV WE, WB IV WN VI

Risk Criteria Codes and Descriptions, Continued 675.33 • 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 or supplements daily by non-pregnant women

427.5

Eating potentially harmful foods Pregnant participants ingesting foods that could be contaminated with pathogenic microorganisms. Examples of potentially harmful foods include but are not limited to: • Raw fish or shellfish • Refrigerated smoked seafood unless it is an ingredient in a cooked dish • Raw or undercooked meat or poultry • Hot dogs, luncheon meat, fermented or dry sausage and other deli style meat or poultry products unless reheated until steaming hot • Refrigerated pate or meat spreads • Unpasteurized milk of foods containing unpasteurized milk • Soft cheeses such as feta, brie, camembert, blue-veined 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 salad dressings, cookie and cake batters, sauces, and beverages such as unpasteurized eggnog • Raw sprouts including alfalfa, clover or bean • Unpasteurized fruit or vegetable juices

WP IV

428 Series

DIET - Presumed eligibility 428 Presumed dietary eligibility for infants and children age 4 to 23 months This risk may only be assigned to infants from 4 to 12 months of age and children 13 to 23 months of age after a complete nutrition assessment has been performed and no other risks have been identified. An infant or child who has begun to consume complementary foods and beverages, to eat independently, to be weaned from breast milk or formula and is I IV C V

Risk Criteria Codes and Descriptions, Continued 675.34 transitioning from a diet based on infant/toddler foods to one based on the Dietary Guidelines for Americans is at risk for inappropriate complementary feeding.

500 Series OTHER RISKS - Transfers 501 Possibility of Regression 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 competent professional authority determines there is a possibility of regression in nutritional status without the benefits that the WIC program provides. Not every nutrition risk criterion lends itself to the possibility of regression. Can only be used one time.

WE, WB IV WN VI I IV C V 502 Transfer of certification Person with current valid Verification of Certification (VOC) card 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 the receiving agency is at maximum caseload, the transferring participant 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 at the time of transfer or if the participant was initially certified based on a nutrition risk condition not in use by the receiving State agency.

N/A 600 Series OTHER RISKS - Breastfeeding Parent/Infant Dyad 601 Breastfeeding motherof infant at nutritional risk A breastfeeding parent whose breastfed infant has been determined to be at nutritional risk. WP, WE, WB I, II, IV Must be at same priority

Risk Criteria Codes and Descriptions, Continued 675.35 as at-risk infant 602 Breastfeeding complications or potential complications (women) A breastfeeding parent with any of the following complications or potential complications: • 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 • age ≥ 40 years • failure of milk to come in by 4 days postpartum • tandem nursing (breastfeeding two siblings who are not twins).

WP, WE, WB I 603 Breastfeeding complications or potential complications (infant) A breastfeeding infant with any of the following complications or potential complications: • jaundice • weak or ineffective 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.

I I 700 Series OTHER RISKS - Infant of a WIC-eligible Parent 701 Infant up to 6 months old of WIC mother or of a woman who would have been eligible during pregnancy An infant < 6 month of age whose parent was a WIC Program participant during pregnancy or whose parent’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. I II 702 Breastfeeding infant of Breastfeeding infant of participant at nutritional risk. I I, II, IV Must be at

Risk Criteria Codes and Descriptions, Continued 675.36 womanat nutritional risk the same priority as at- risk mother. 800 Series OTHER RISKS - Homeless/Migrant 801 Homelessness A personwho lacks a fixed and regular nighttime residence; or whose primary nighttime residence is: • a supervised publicly or privately operated shelter (including a hotel, a family shelter, or a shelter for victims of domestic violence) designed to provide temporary living accommodations • an institution that provides a 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

WP IV WE, WB IV WN VI I IV C V 802 Migrancy Categorically eligible participants 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.

WP IV WE, WB IV WN VI I IV C V 900 Series OTHER RISKS - Environmental 901 Recipient of abuse Recipient of abuse is defined as an individual who has experienced physical, sexual, emotional, economic, or psychological maltreatment that may frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure, and/or wound the individual.

The experience of abuse may be self-reported by the individual, an individual’s family member, or reported by a social worker, healthcare provider, or other appropriate personnel. Types of abuse relevant to the WP IV WE, WB IV WN VI I IV C V

Risk Criteria Codes and Descriptions, Continued 675.37 WIC population include, but are not limited to, the following: Domestic violence, Intimate partner violence (IPV) and Child abuse and/or neglect. 902 Woman or infant/ child of primary caregiver with limited ability to make feeding decisions and/or prepare food Parent, (pregnant, breastfeeding, or non-breastfeeding) or infant/child whose primary caregiver is assessed to have a limited ability to make appropriate feeding decisions and/or prepare food. Examples include: • 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 by a physician or psychologist as self-reported by a participant or caregiver • Intellectual disability diagnosed by a physician or psychologist as self-reported by the participant or caregiver • Physical disability to a degree which impairs ability to feed an infant/child or limits food preparation abilities • ≤ 17 years of age

WP IV WE, WB IV WN VI I IV C V 903 Foster Care Entering the foster care system during the previous six months or moving from one foster care home to another foster care home during the previous six months. Cannot be used two times in a row while the child remains in the same foster home. It should be used as the sole risk criterion only if careful assessment of the applicant’s status indicates that no other risks based on anthropometric, medical or nutritional risk criteria can be identified.

WP IV WE, WB IV WN VI I IV C V 904 Environmental Tobacco Smoke Exposure Environmental tobacco smoke (ETS) exposure is defined as exposure to smoke from tobacco products or aerosols from electronic nicotine delivery systems inside enclosed areas like home, place of child care, etc. ETS is also known as passive, secondhand or involuntary smoke. WP I WE, WB I WN VI I I C III REFERENCES WIC Policy Memorandum 98-9, Nutrition Risk Criteria, June 29, 1998

Risk Criteria Codes and Descriptions, Continued 675.38 Institute of Medicine: WIC Nutrition Risk Criteria: A Scientific Assessment; 1996 WIC Policy Memorandum 98-9, Revision 6: Nutrition Risk Criteria 2002 WIC Policy Memorandum 98-9, Revision 7: Nutrition Risk Criteria 2004 WIC Policy Memorandum 98-9, Revision 8: Nutrition Risk Criteria 2005 WIC Policy Memorandum 98-9, Revision 9: Nutrition Risk Criteria 2007 WIC Policy Memorandum 98-9, Revision 10: Nutrition Risk Criteria 2009 WIC Policy Memorandum 2011-5 WIC Nutrition Risk Criteria WIC Policy Memorandum, June 25, 2012, Nutrition Risk Criteria 2013 WIC Policy Memorandum, November 25, 2013, Nutrition Risk Criteria 2015 WIC Policy Memorandum, May 21, 2015, Revised, Not Allowed and Corrected Nutrition Risk Criteria 2016 WIC Policy Memorandum, June 29, 2016, Revised and Corrected Nutrition Risk Criteria 2017 WIC Policy Memorandum, May 22, 2017, Revised and Corrected Nutrition Risk Criteria 2018 WIC Policy Memorandum, June 13, 2018, Revised and Discontinued Nutrition Risk Criteria 2019 WIC Policy Memorandum, December 17, 2020, Revised Nutrition Risk Criteria WIC Policy Memorandum, November, 17, 2022, Revised Nutrition Risk Criteria

APPENDIX A WIC HEMATOCRIT VALUES - Adjusted for Altitude and Smoking (1998 CDC Guidelines)

CATEGORY 1st Trimester 2nd Trimester 3rd Trimester Nonpreg 12 – <15 yrs Nonpreg 15 – <18 yrs Nonpreg ≥18 yrs Infants 0 – <6 mo Infants 6 – 12 mo Children 1 – <2 yrs Children 2 – <5 yrs Hct < Hct < Hct < Hct < Hct < Hct < Hct < Hct < Hct < Hct < ALTITUDE SMOKING

No altitude adjustment Nonsmokers 33.0 32.0 33.0 35.7 35.9 35.7

32.9 32.9 33.0 Up to 34.0 33.0 34.0 36.7 36.9 36.7

Risk Criteria Codes and Descriptions, Continued 675.39 WIC HEMATOCRIT VALUES - Adjusted for Altitude and Smoking (1998 CDC Guidelines)

1–2 packs/day 34.5 33.5 34.5 37.2 37.4 37.2

>2 packs/day 35.0 34.0 35.0 37.7 37.9 37.7

3000–3999 ft Nonsmokers 33.5 32.5 33.5 36.2 36.4 36.2

33.4 33.4 33.5 Up to 34.5 33.5 34.5 37.2 37.4 37.2

1–2 packs/day 35.0 34.0 35.0 37.7 37.9 37.7

>2 packs/day 35.5 34.5 35.5 38.2 38.4 38.2

4000–4999 ft Nonsmokers 34.0 33.0 34.0 36.7 36.9 36.7

33.9 33.9 34.0 Up to 35.0 34.0 35.0 37.7 37.9 37.7

1–2 packs/day 35.5 34.5 35.5 38.2 38.4 38.2

>2 packs/day 36.0 35.0 36.0 38.7 38.9 38.7

5000–5999 ft Nonsmokers 34.5 33.5 34.5 37.2 37.4 37.2

34.4 34.4 34.5 Up to 35.5 34.5 35.5 38.2 38.4 38.2

1–2 packs/day 36.0 35.0 36.0 38.7 38.9 38.7

>2 packs/day 36.5 35.5 36.5 39.2 39.4 39.2

Risk Criteria Codes and Descriptions, Continued 675.40 WIC HEMATOCRIT VALUES - Adjusted for Altitude and Smoking (1998 CDC Guidelines)

6000–6999 ft Nonsmokers 35.0 34.0 35.0 37.7 37.9 37.7

34.9 34.9 35.0 Up to 36.0 35.0 36.0 38.7 38.9 38.7

1–2 packs/day 36.5 35.5 36.5 39.2 39.4 39.2

>2 packs/day 37.0 36.0 37.0 39.7 39.9 39.7

7000–7999 ft Nonsmokers 36.0 35.0 36.0 38.7 38.9 38.7

35.9 35.9 36.0 Up to 37.0 36.0 37.0 39.7 39.9 39.7

1–2 packs/day 37.5 36.5 37.5 40.2 40.4 40.2

>2 packs/day 38.0 37.0 38.0 40.7 40.9 0.7

8000–8999 ft Nonsmokers 37.0 36.0 37.0 39.7 39.9 39.7

36.9 36.9 37.0 Up to 38.0 37.0 38.0 40.7 40.9 40.7

1–2 packs/day 38.5 37.5 38.5 41.2 41.4 41.2

>2 packs/day 39.0 38.0 39.0 41.7 41.9 41.7

9000–9999 ft Nonsmokers 38.0 37.0 38.0 40.7 40.9 40.7

37.9 37.9 38.0 Up to 39.0 38.0 39.0 41.7 41.9 41.7

Risk Criteria Codes and Descriptions, Continued 675.41 WIC HEMATOCRIT VALUES - Adjusted for Altitude and Smoking (1998 CDC Guidelines)

1–2 packs/day 39.5 38.5 39.5 42.2 42.4 42.2

>2 packs/day 40.0 39.0 40.0 42.7 52.9 42.7

10,000 ft or more Nonsmokers 39.0 38.0 39.0 41.7 41.9 41.7

38.9 38.9 39.0 Up to 40.0 39.0 40.0 42.7 42.9 42.7

1–2 packs/day 40.5 39.5 40.5 43.2 43.4 43.2

>2 packs/day 41.0 40.0 41.0 43.7 43.9 43.7

Risk Criteria Codes and Descriptions, Continued 675.42 WIC HEMOGLOBIN Values - Adjusted for Altitude and Smoking (1998 CDC Guidelines)