PENNSYLVANIA DEPARTMENT OF HEALTH

Policy Number: 5.03 WIC State Agency

USDA Approval Date: March 5, 2025

State Effective Date: May 5, 2025

POLICY MANUAL

5. NUTRITION AND BREASTFEEDING SERVICES.

5.03 Formula Issuance to Breastfed Infants.

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A. POLICY OVERVIEW:

PA WIC shall provide supplementation to breastfed infants when clinically indicated due to questionable or inadequate intake, a breastfeeding or medical problem, or an assessed need indicates supplemental formula is nutritionally necessary.

B. POLICY:

1. All formula issued to breastfeeding participants shall be handled by Competent Professional Authorities (CPAs) or Competent Paraprofessional Authorities (CPPAs) who have successfully completed appropriate breastfeeding training. Refer to Policy 3.03, Training of WIC Staff.

2. If a mother needs or wants to supplement breastfeeding, appropriate WIC staff (such as Designated Breastfeeding Experts (DBEs), CPAs, CPPAs, or Breastfeeding Peer Counselors) shall first provide education about the option of milk expression and encourage supplementation with expressed breast milk. As needed, appropriate WIC staff shall inform the participant of the impacts on health and milk supply that are associated with formula introduction.

a. If needed, LAs shall issue a WIC breast pump to enable milk expression for supplementation purposes. Refer to Policy 5.02, Breastfeeding Promotion and Support. b. LAs shall provide information about the enhanced food package for fully breastfeeding women and infants.

3. Prior to issuing supplemental formula, WIC staff must identify the reason for formula introduction and determine if a Detailed Breastfeeding Assessment and/or additional breastfeeding support is needed. Detailed Breastfeeding Assessments shall be conducted as outlined in Policy 5.02, Breastfeeding Promotion and Support.

4. If the infant feeding screening and assessment, conducted by a CPA or CPPA, deems it nutritionally necessary to supplement with formula, no more than 104 reconstituted fluid ounces may be issued to breastfed infants who are less than one month old at the time of benefit issuance.

a. LAs shall provide breastfeeding parents who request formula prior to the infant’s first month with in-depth breastfeeding support according to the protocols in SA guidance. b. Additionally, as appropriate, LAs shall refer such breastfeeding parents to a peer counselor, WIC Designated Breastfeeding Expert, lactation consultant, breastfeeding coordinator and/or another lactation specialist available at the local agency or in the community.

5. For infants one month or older, the amount of formula issued shall be based on assessed need. The mother’s food package will be based on the amount of formula prescribed in the infant’s food package. Refer to Policy 5.06, Issuance of Food Packages.

a. If the mother requests more formula than the infant feeding screening and

PENNSYLVANIA DEPARTMENT OF HEALTH

Policy Number: 5.03 WIC State Agency

USDA Approval Date: March 5, 2025

State Effective Date: May 5, 2025

POLICY MANUAL

5. NUTRITION AND BREASTFEEDING SERVICES.

5.03 Formula Issuance to Breastfed Infants.

Page 2 of 2

assessment indicates, CPAs or CPPAs shall inform the mother of the amount of formula WIC will provide. CPAs and CPPAs shall also inform the mother that feeding formula above the nutritional needs of the infant can result in overfeeding, vomiting, stomach and bowel discomfort, infant/child obesity and may decrease breast milk supply.

6. If supplemental formula is being offered to the infant:

a. CPAs, CPPAs, or DBEs must inform the participant of the percent of daily nutritional needs being met by formula. The percent of daily nutritional needs and the reason for supplementing with formula shall also be documented in the MIS. b. CPAs and CPPAs must inform the participant of safe formula preparation, handling and storage per manufacturer instructions. This education must be documented in the MIS per SA guidance.

7. Supplemental formula shall be issued in powder or concentrate forms. Ready-to-feed (RTF) formula may only be issued to supplement breastfeeding when the criteria outlined in Policy 5.08, Infant Formula, have been met. Staff must obtain the appropriate medical documentation and document in the MIS the details outlined in Policy 5.08, Infant Formula.

__________________________ Reference(s): 1. WIC Regulations: 7 CFR 246.10(e)(1)(ii) 2. WIC Regulations: 7 CFR 246.10(e)(2) 3. WIC Breastfeeding Policy and Guidance, FNS, USDA (July 2016).

Policy Status: 1. This Policy supersedes Policy Number 7.06 dated June 29, 2015.