Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 1 of 11 Risk Code Category and Priority

Risk Definition P B N I C

1000

Anthropometric Women USDA Code VA Code Priority Nutrition Risk 101 1100* 1 1 5

Underweight 111 1200 1 1 5

Overweight 111 1210* 1 1 5

Very overweight 131 1300* 1

Low Maternal Weight Gain 132 1310* 1

Maternal Weight Loss during Pregnancy 133 1400 1 1 5

High Maternal Weight Gain Infants and Children 151 1610*

1 3 Small for gestational age (SGA) 141 1630*

1 3 Low Birth Weight (< 5lbs 8oz or 2500 gm) For infants and children < 24 months of age 141 1629

1 3 Very Low Birth Weight ( < 3lbs 5oz or 1500 gm) For infants and children < 24 months of age 153 1631

1

Large for gestational age (BW > 9 lbs.) 103 1640

1 3 At Risk of Becoming Underweight (weight/length or BMI/age 6 -10%ile) 103 1641*

1 3 Underweight (weight/length or BMI/age < 5%ile) 121 1660

1 3 At Risk of Short Stature (Length/age or Stature/age 6- 10%ile) 121 1661

1 3 Short Stature (Length/age or Stature/age < 5%ile) 113 1711*

3 Overweight (WT for HT or BMI > 95th percentile) for children 2 to 5 years of age 134

1 3 Failure to Thrive (Diagnosed by a physician) 142

1 3 Prematurity (Infant born at < 37 weeks gestation) For infants and children < 24 months old 152

1

Low Head Circumference ( <5% head circumference based on NCHS growth charts) Infants and children up to 24 months of age and reported by referral sources

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 2 of 11

Risk Code Category and Priority

Risk Definition P B N I C

2000

Biochemical USDA Code VA Code Priority Nutrition Risk 201 2100 1 1 5 1 3 Low Hgb/Hct/Diagnosis of Iron Deficiency Anemia

"P" Wks Gestation Hgb (gms) Hct (%) 0-13 wks 10 to 10.9 29 to 32.9 14-26 wks 10 to 10.4 29 to 31.9 27-42 wks

10 to 10.9 29 to 32.9

Breastfeeding/Postpartum 12-14.9 yrs 11 to 11.7 33 to 35.6 15-17.9 yrs 11 to 11.9 33 to 35.8 18+ yrs 11 to 11.9 33 to 35.6

Infants/Children 6 mo to 2 yrs 10 to 10.9 29 to 32.8 2-5 yrs 10 to 11 29 to 32.9

201 2110*

1 1 5 1 3 Very Low Hgb or Hct or diagnosis of Iron Deficiency Anemia

Hgb (gms) Hct (%)

Pregnant/Infants/Children < 10 < 29%

Breastfeeding/Postpartum < 11 < 33% Other Biochemical Test Results which indicate Nutritional Abnormality 211 2300* 1 1 5 1 3 High lead - lead poisoning (> 10 ug/dL)

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 3 of 11

Risk Code Category and Priority

Risk Definition P B N I C

3000

Pregnancy-related conditions (Current or Most Recent) Pregnancy History (Women's Condition) USDA Code VA Code Priority Nutrition Risk 332 3010 1 1 5

Closely spaced pregnancies (< 16 months) 334 3020R 1

Lack of prenatal care 303 3030* 1 1 5

Gestational diabetes 336 3040* 1

Fetal Growth Retardation (FGR) 335 3050* 1 1 5

Multifetal gestation 331 3060 1 1 5

Pregnancy at a young age (< 18 years) 311 3070 1 1 5

Preterm delivery of most recent infant 345 3080* 1

Pregnancy Induced Hypertension Pregnancy History (Infant's Condition) 312 3113 1 1 5

Infant with low birth weight(< or =2500 gms) 321 3115 1 1 5

Fetal or neonatal loss 339 3117 1 1 5

Infant with Spina bifida 339 3118 1 1 5

Infant with Cleft lip 339 3119 1 1 5

Infant with Cleft lip and palate 339 3120 1 1 5

Infant with Cleft palate 337 3130 1 1 5

Infant with high birth weight (> or = to 9 lbs.)

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 4 of 11

Risk Code Category and Priority

Risk Definition P B N I C

USDA Code VA Code Priority Nutrition Risk 341 4100* 1 1 5 1 3 Kwashiorkor 341 4110* 1 1 5 1 3 Nutritional marasmus - severe calorie deficiency 341 4120* 1 1 5 1 3 Other severe, protein-calorie malnutrition Other and Unspecified Protein-Calorie Malnutrition 341 4210* 1 1 5 1 3 Malnutrition of moderate degree 341 4220* 1 1 5 1 3 Malnutrition of a mild degree 341 4230* 1 1 5 1 3 Arrested development following protein- caloriemalnutrition 341 4240* 1 1 5 1 3 Other protein-calorie malnutrition 341 4250* 1 1 5 1 3 Unspecified protein-calorie malnutrition Thiamine and Niacin Deficiency States 341 4410* 1 1 5 1 3 Beriberi 341 4420* 1 1 5 1 3 Other and unspecified manifestations of thiamine deficiency 341 4430* 1 1 5 1 3 Pellagra Deficiency of B-complex Components 341 4510* 1 1 5 1 3 Ariboflavinosis 341 4520* 1 1 5 1 3 Vitamin B6 deficiency 341 4530* 1 1 5 1 3 Other B-complex deficiencies 341 4540* 1 1 5 1 3 Unspecified vitamin B deficiency Vitamin D Deficiency 341 4710* 1 1 5 1 3 Rickets, active 341 4720* 1 1 5 1 3 Rickets, late effect 341 4730* 1 1 5 1 3 Osteomalacia, unspecified 341 4740* 1 1 5 1 3 Unspecified vitamin D deficiency Other Nutritional Deficiencies 341 4801* 1 1 5 1 3 Ascorbic Acid Deficiency 341 4802* 1 1 5 1 3 Vitamin A Deficiency

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 5 of 11 Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) USDA Code VA Code Priority Nutrition Risk 341 4810* 1 1 5 1 3 Deficiency of vitamin K 341 4820* 1 1 5 1 3 Deficiency of other vitamins 341 4830* 1 1 5 1 3 Unspecified vitamin deficiency 341 4840* 1 1 5 1 3 Mineral deficiency 341 4850* 1 1 5 1 3 Other nutritional deficiency 341 4860* 1 1 5 1 3 Unspecified nutritional deficiency 341 4900*

1

Infant malnutrition 347 5010* 1 1 5 1 3 Cancer Cardiovascular 360 5021* 1 1 5 1 3 Cardiac defects 360 5022* 1 1 5 1 3 Congenital heart disease 360 5023* 1 1 5 1 3 Congestive heart failure 345 5024* 1 1 5 1 3 Hypertension Central & Peripheral Nervous System 348 5031* 1 1 5 1 3 Cerebral Palsy 348 5032* 1 1 5 1 3 Epilepsy 348 5033* 1 1 5 1 3 Muscular Dystrophy 348 5034* 1 1 5 1 3 Multiple Sclerosis 348 5035* 1 1 5 1 3 Neural tube defects – Spina bifida or Myelomeningocele Chronic or Recurrent Infections 352 5041* 1 1 5 1 3 AIDS or HIV positive 352 5042* 1 1 5 1 3 Hepatitis- chronic or cirrhosis 352 5043* 1 1 5 1 3 Intestinal parasites (Giardiasis) 352 5044* 1 1 5 1 3 Meningitis 352 5045* 1 1 5 1 3 Pneumonia or influenza

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 6 of 11

Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) USDA Code VA Code Priority Nutrition Risk 352 5046* 1 1 5 1 3 Tuberculosis (active) 352 5047* 1 1 5 1 3 Viral Hepatitis Congenital/Genetic Disorders Anemias 349 5052* 1 1 5 1 3 Sickle cell anemia 349 5053* 1 1 5 1 3 Thalassemia (major, minor, intermedia) 349 5054* 1 1 5 1 3 Cleft lip 349 5055* 1 1 5 1 3 Cleft palate 349 5056* 1 1 5 1 3 Cleft palate with cleft lip 349 5058* 1 1 5 1 3 Down’s Syndrome 349 5059* 1 1 5 1 3 Lowes Syndrome 349 5061* 1 1 5 1 3 Prader Willi Syndrome 349 5062* 1 1 5 1 3 Rhetts Syndrome 349 5063* 1 1 5 1 3 Williams Syndrome 350 5080*

1

Pyloric stenosis Endocrine 343 5091* 1 1 5 1 3 Diabetes 344 5092* 1 1 5 1 3 Hyperthyroidism 344 5093* 1 1 5 1 3 Hypothyroidism 356 5094* 1 1 5 1 3 Hypoglycemia Food Intolerance 355 5201 1 1 5 1 3 Lactose intolerance Gastrointestinal 354 5301* 1 1 5 1 3 Celiac disease 342 5302* 1 1 5 1 3 Cholecystitis/cholelithiasis 342 5303* 1 1 5 1 3 Crohn’s disease

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 7 of 11 Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) USDA Code VA Code Priority Nutrition Risk 342 5304* 1 1 5 1 3 Dumping Syndrome 342 5305* 1 1 5 1 3 Hiatal hernia 301 5306* 1

Hyperemesis gravidarum - Excessive nausea and vomiting 342 5307* 1 1 5 1 3 Irritable bowel syndrome/colitis 342 5308* 1 1 5 1 3 Malabsorption syndrome 342 5309* 1 1 5 1 3 Pancreatitis 342 5310* 1 1 5 1 3 Regional enteritis/ileitis 342 5311* 1 1 5 1 3 Ulcerative colitis 342 5312* 1 1 5 1 3 Short bowel syndrome Inborn Errors of Metabolism 351 5401* 1 1 5 1 3 Acidemia 351 5402* 1 1 5 1 3 Cystic Fibrosis 351 5403* 1 1 5 1 3 Disorders of lipid metabolism, pure Hypercholesterolemia, pure Hyperglyceridemia, Mixed Hyperlipidemia, hyperchylomicronemia 351 5404* 1 1 5 1 3 Disturbances of sulphur-bearing amino-acid

metabolism - Homocystinemia, Hypermethioninemia, Methioninemia 351 5405* 1 1 5 1 3 Galactosemia 351 5406* 1 1 5 1 3 Glucose-6-phosphate dehydrogenase (G6PD) 351 5407* 1 1 5 1 3 Histidinemia 351 5408* 1 1 5 1 3 Maple syrup urine disease (MSUD) 351 5409* 1 1 5 1 3 Phenylketonuria (PKU) 351 5410* 1 1 5 1 3 Tyrosinuria Pulmonary 360 5501* 1 1 5 1 3 Asthma (Severe)

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 8 of 11 Risk Code Category and Priority

Risk Definition P B N I C

5000

Medical Conditions (Cont.) Other Medical Conditions USDA Code VA Code Priority Nutrition Risk 360 5502* 1 1 5 1 3 Broncho-pulmonary dysplasia (BPD) Other Medical Conditions 358 5601* 1 1 5

Anorexia or Bulimia 358 5602* 1 1 5

Eating Disorders 134 5603*

1 3 Failure to Thrive 382 5604*

1 3 Fetal alcohol syndrome 360 5605* 1 1 5 1 3 Hemophilia 360 5606* 1 1 5 1 3 Juvenile Rheumatoid Arthritis 360 5607* 1 1 5 1 3 Liver disease 360 5608* 1 1 5

Lupus erythematosus 346 5609* 1 1 5 1 3 Renal disease 360 2210* 1 1 5 1 3 Pernicious anemia 360 2220* 1 1 5 1 3 Vitamin B12 deficiency 360 2230* 1 1 5 1 3 Folate-deficiency anemia 360 2240* 1 1 5 1 3 Protein-deficiency anemia 360 2250*

1

Anemia of prematurity 360 5700* 1 1 5 1 3 Other 6000

Other Health Risks 603 6010

1

Infant breastfeeding complications or potential complications 602 6011*

1

Breastfeeding complications or potential complications 381 6020R 1 1 5 1 3 Dental/oral - cavities that interfere with eating/gum disease 361 6021* 1 1 5

3 Depression 353 6030* 1 1 5 1 3 Food allergies

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 9 of 11

Risk Code Category and Priority

Risk Definition P B N I C

7000

Other Risks USDA Code VA Code Priority Nutrition Risk 423 6041 4 4 6 4 5 Inappropriate or excessive intakes of dietary supplements including vitamins, minerals and herbal remedies 421 6050 4 4 6

5 Pica 338 6051 1

Pregnant woman currently breastfeeding 142 6060

1

Prematurity 359 6070* 1 1 5 1 3 Recent major surgery, trauma, burns, severe acute infections 801 7010 4 4 6 4 5 Homeless 802 7020 4 4 6 4 5 Migrant 502 7030 9 9 9 9 9 Transfer of certification (VOC) 601 7040

1

Breastfeeding an infant who is a WIC participant 701 7050

2

Infant born to a WIC participant 702 7051

1

Breastfed infant’s mother is a WIC participant 701 7052

2

Infant born to a non-WIC participant 903 7060 4 4 6 4 5 Foster Care – entering or changing homes within the last 6 months 8000

Substance abuse 372 8010R 1 1 5

Alcohol Use 372 8020R 1 1 5

Illegal Drug Use 371 8030R 1 1

Smoking 9000

Dietary Diet Low In Two Dietary Guidelines, missing one food group, or high intake in fat or sugar (Participants 2 years and older) 401 9110 4 4 6

5 Diet low in Fruits and Vegetables 401 9111 4 4 6

5 Diet low in Vitamin A foods 401 9112 4 4 6

5 Diet low in Vitamin C foods 401 9120 4 4 6

5 Diet low in Milk or Calcium rich foods

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 10 of 11 Risk Code Category and Priority

Risk Definition P B N I C

9000

Dietary (Cont.) Inappropriate Feeding Practices for Infants USDA Code VA Code Priority Nutrition Risk 401 9130 4 4 6

5 Diet low in Bread, Cereal and Grain foods 401 9140 4 4 6

5 Diet low in Meats and other protein foods 401 9150 4 4 6

5 Diet high in dietary fat 401 9160 4 4 6

5 Diet high in dietary sugar 420 9170

4

Excessive caffeine intake (Breastfeeding Woman) Restrictive Diets 403 9310 4 4 6 4 5 Highly restrictive diet 402 9320 4 4 6 4 5 Vegan diet 411 9501

4

Inappropriate infant feeding practices 412 9510

4

Early introduction of solid foods 415 9520

4

Improper dilution of formula 419 9530

4 5 Inappropriate use of nursing bottle 417 9540

4

Lack of sanitation in preparation of nursing bottles 418 9550

4

Infrequent breastfeeding as sole source of nutrients 413 9560

4

Feeding cow’s milk during 1st 12 months

416 9570

4

Feeding other foods low in essential nutrients 414 9580

4

No dependable source of iron after 4-6 months Inappropriate Feeding Practices for Children 425 9610

5 Excessive juice intake (>or = 12 oz a day) 425 9620

5 Non-fat/reduced fat milk as primary milk source (1-2 years) 425 9630

5 Foods low in essential nutrients/high in calories (1-2 years) 425 9640

5 Foods that put children at risk of choking (< 4 years) 425 9650

5 Forcing a child to eat a certain type/amount of food 425 9660

5 Ignoring child's requests for appropriate foods when hungry 425 9670

5 Restricting appropriate consumption of nutritional meals 425 9680

5 Not supporting a child's need for self-feeding

Division of Community Nutrition

Subject: WIC Program Nutrition Risks Policy: CRT 06.5 Reference: CRT 06.4 Effective: August 12, 2013 Supersedes: November 1, 2005

Page 11 of 11 425 9690

5 Inappropriate feeding/offering primarily pureed/liquid food