Policy: Nutrition Assessment and Risk DeterminationNo: CT: 7

Effective: 3/01Revised: 06/12

PolicyTo be certified as eligible for the WIC program applicants who have met the program eligibility standards (refer to CT: 01) must be determined to be at nutritional risk. Only a Competent Professional Authority (CPA) through a medical and/or nutritional assessment may determine nutritional risk, certify for eligibility, and prescribe WIC food packages.

DefinitionCompetent Professional Authority (CPA) - an individual on the staff of the local agency authorized to determine nutritional risk and prescribe supplemental foods. The following persons are the only persons authorized to serve as a CPA: Physicians, Dietitians, Nutritionists (bachelor’s or master’s degree in Nutritional Sciences, Community Nutrition, Clinical Nutrition, Dietetics, Public Health Nutrition, or Home Economics with emphasis in Nutrition), Registered Nurses, Physician’s Assistants, or persons who have passed the Nevada State WIC Competent Professional Authority examination

ProcedureNutritional risk will be documented in the participant’s file and will be used to assess an applicant’s nutritional status and risk, tailor the food package to address nutritional needs, design appropriate nutrition education, and make referrals to health and social services for follow-up as necessary and appropriate.

Nutritional Assessment

A nutritional assessment is considered complete when the following indicators of nutritional status have been evaluated;

  1. Current weight and height/length (or data provided by a health care provider no more than 60 days prior to certification, excluding infants birth measurements)- All applicants
  2. Head Circumference (or data provided by a health care provider no more than 60 days prior to certification, excludes infants birth measurements)-Per RD discretion only

3.Hemoglobin or hematocrit- All applicants age 9 months of age or older (Refer

to Policy CT: 12).

  1. Medical/Nutritional Questionnaire-All applicants (Note: Code Sheet/Training Tool must be utilized to evaluate and score questionnaires.)

The full nutrition assessment must be completed before nutrition education is provided.

Nutrition Risk Conditions

Once a nutritional assessment has been completed, compile all data from the participant’s health history, diet screen, hemoglobin and anthropometric results.

Every condition of nutritional risk will be identified and marked on the participant’s questionnaire. In addition, all participants’ files will have supporting documentation for every risk code (e.g., growth charts, diet and health questionnaires).

High Risk Identification and Referral

The identification and referral of High-Risk codes to the Nutritionist or Dietitian are part of the CPAs duties. The WIC CPA is required to refer any participant assigned a High-Risk code to their Agency Registered Dietitian or Nutritionist within 60 days of identification. The nutritionist is then responsible for developing a Nutrition Care Plan within that time period.

State of Nevada Allowable Risk Criteria

The following is a list of the State of Nevada allowable nutrition risk criteria for each category. Refer to the “Nutrition Risk Criteria” handout for a listing of complete definitions and clarifications.

Prenatal Nutrition Risk Codes

PRIORITY 1:ANTHROPOMETRIC/BIOCHEMICAL

101H*Underweight Women201H*Anemia

111Overweight Women211HElevated Blood Lead Levels

131HLow Maternal Weight Gain

132H*Maternal Weight Loss During Pregnancy

133HHigh Maternal Weight Gain

PRIORITY 1:CLINICAL/HEALTH/MEDICAL

301HHyperemesis346HRenal (Kidney) Disease

302HGestational Diabetes347HCancer***

303H*History of Gestational Diabetes

304H*History of Preeclampsia348HCentral Nervous System Disorders

311H*History of Preterm Delivery349HGenetic and Congenital Disorders

312H*History of Low Birthweight351HInborn Errors of Metabolism

321H*History of Fetal or Neonatal Loss352HInfectious Diseases***

331H*Pregnancy at a Young Age353H*Food Allergies

332Closely Spaced Pregnancies354HCeliac Disease

333High Parity and Young Age355H*Lactose Intolerance

334Lack of or Inadequate Prenatal Care356HHypoglycemia

335H*Multifetal Gestation357Drug-Nutrient Interactions WIC Nutri. Only!

336HFetal Growth Restriction358HEating Disorders

337History of Birth of Large for Gestational359H*Recent Major Surgery, Trauma, Burns

Age Infant360HOther Medical Conditions

338Pregnant Woman Currently 361H*Depression

Breastfeeding362HDevelopmental Delays, Sensory or

339H History of Birth with Nutrition Related

Congenital or Birth Defect371Maternal Smoking

341HNutrient Deficiency Diseases372H*Alcohol and Illegal Drug Use***

342HGastro-Intestinal Disorders381H* Dental Problems

343H Diabetes Mellitus904Environmental Tobacco Smoke Exposure

344H Thyroid Disorders

345HHypertension and/or Prehypertension

PRIORITY 4:DIETARY

427H* Inappropriate Nutrition Practices for Women

  • Consuming dietary supplements with potential harmful consequences--H
  • Diet v low in calories or essential nutrients or impaired absorption or caloric intake after bariatric surgery--H
  • Pica--H
  • Inadequate vitamin/mineral supplementation
  • Potentially harmful foods ingested while pregnant

**401 Failure to Meet Dietary Guidelines for Americans

** Use 401 only after assessing for 427

PRIORITY 4:OTHER RISKS

502Transfer of Certification801Homelessness

503Presumptive Eligibility for Pregnant Women802Migrancy

901HRecipient of Abuse

902HWoman or Infant/Child of Primary Caregiver with Limited Ability to Make Feeding Decisions

and/or Prepare Food

H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in computer.

Breastfeeding Nutrition Risk Codes

PRIORITY 1:ANTHROPOMETRIC/BIOCHEMICAL

101HUnderweight Women201H*Anemia

111HOverweight Women211HElevated Blood Lead Levels

PRIORITY 1:CLINICAL/HEALTH/MEDICAL

303H*History of Gestational Diabetes346HRenal (Kidney ) Disease

304H*History of Preeclampsia347HCancer***

311History of Preterm Delivery348HCentral Nervous System Disorders

312History of Low Birthweight349HGenetic and Congenital Disorders 321 History of Fetal or Neonatal Loss 351H Inborn Errors of Metabolism

331H*Pregnancy at a Young Age352HInfectious Diseases***

332Closely Spaced Pregnancies353H*Food Allergies

333 High Parity and Young Age354HCeliac Disease

335H*Multifetal Gestation355H*Lactose Intolerance

337History of Birth of Large for Gestational356HHypoglycemia

Age Infant357Drug-Nutrient Interactions WIC Nutri. Only!

339HHistory of Birth with Nutrition Related358HEating Disorders

Congenital or Birth Defect359H* Recent Major Surgery, Trauma, Burns

341HNutrient Deficiency Diseases360HOther Medical Conditions

342HGastro-Intestinal Disorders361H*Depression

343H Diabetes Mellitus362HDevelopmental Delays, Sensory or Motor Delays

344H Thyroid DisordersInterfering With the Ability to Eat

345HHypertension and/or Prehypertension363HPre-Diabetes

371Maternal Smoking

372HAlcohol and Illegal Drug Use***

381H*Dental Problems

904Environmental Tobacco Smoke Exposure

PRIORITY 4:DIETARY

427H* Inappropriate Nutrition Practices for Women

  • Consuming dietary supplements with potential harmful consequences--H
  • Diet very low in calories or essential nutrients or impaired absorption/caloric intake after bariatric surgery-H
  • Pica--H
  • Inadequate vitamin/mineral supplementation H

**401 Failure to Meet Dietary Guidelines for Americans

** Use 401 only after assessing for 427

PRIORITY 4:OTHER RISKS

801 Homelessness (Priority 4)

802Migrancy (Priority 4)

901HRecipient of Abuse (Priority 4)

902HWoman or Infant/Child of Primary Caregiver with

Limited Ability to Make Feeding Decisions

and/or Prepare Food (Priority 4)

PRIORITY 1 OR 4: OTHER RISKS

501Possibility of Regression (Priority must be601Breastfeeding Mother of Infant at Nutritional

same as last certification)Risk (Priority must be same as at-risk infant)

502Transfer of Certification602Breastfeeding Complications or Potential

Complications (Priority 1)

H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority ___) = must be entered in computer.

Non-Breastfeeding Nutrition Risk Criteria

PRIORITY 6:ANTHROPOMETRIC/BIOCHEMICAL

101HUnderweight Women201H*Anemia

111HOverweight Women211HElevated Blood Lead Levels

PRIORITY 4:CLINICAL/HEALTH/MEDICAL

303H*History of Gestational Diabetes345HHypertension and/or Prehypertension

304H*History of Preeclampsia346HRenal (Kidney) Disease

331H*Pregnancy at a Young Age***347HCancer***

337History of Birth of Large for Gestational348HCentral Nervous System Disorders

Age Infant349HGenetic and Congenital Disorders

341HNutrient Deficiency Diseases351HInborn Errors of Metabolism

342HGastro-Intestinal Disorders352HInfectious Diseases***

343HDiabetes Mellitus354HCeliac Disease

344HThyroid Disorders356HHypoglycemia 357 Drug-Nutrient Interactions WIC Nutri. Only!

358HEating Disorders

359H*Recent Major Surgery, Trauma, Burns

360HOther Medical Conditions

362HDevelopmental Delays, Sensory or Motor

Delays Interfering With the Ability to Eat

363HPre-Diabetes

372HAlcohol and Illegal Drug Use***

381H*Dental Problems

PRIORITY 6:CLINICAL/HEALTH/MEDICAL

311History of Preterm Delivery (Priority 6)353H*Food Allergies

312History of Low Birth Weight (Priority 6)355H*Lactose Intolerance

321H*History of Fetal or Neonatal Loss (Priority 6)361H*Depression

332Closely Spaced Pregnancies (Priority 6)371Maternal Smoking

333High Parity and Young Age (Priority 4)904Environmental Tobacco Smoke Exposure

335H*Multifetal Gestation (Priority 6)

339HHistory of Birth with Nutrition Related Congenital

or Birth Defect (Priority 6)

PRIORITY 6: DIETARY

427H* Inappropriate Nutrition Practices for Women

  • Consuming dietary supplements with potential harmful consequences--H
  • Diet v low in calories or essential nutrients or impaired absorption or caloric intake after bariatric surgery--H
  • Pica--H
  • Inadequate vitamin/mineral supplementation--H

**401 Failure to Meet Dietary Guidelines for Americans

** Use 401 only after assessing for 427

PRIORITY 4 or 6: OTHER RISKS

501Possibility of Regression (Priority 4 or 6)801Homelessness (Priority 6)

must be same as last certification802Migrancy (Priority 6)

502Transfer of Certification 901HRecipient of Abuse (Priority 6)

902HWoman or Infant/Child of Primary Caregiver

with Limited Ability to Make Feeding

Decisions and/or Prepare Food (Priority 6)

H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in computer.

Child Nutrition Risk Codes

PRIORITY 3:ANTHROPOMETRIC/BIOCHEMICAL

103H*Underweight or At Risk of Underweight201H*Low Hematocrit/Low Hemoglobin

113H*Obese211HElevated Blood Lead Levels

114Overweight or At Risk of Overweight

121Short Stature or At Risk of Short Stature

134HFailure to Thrive

135HInadequate Growth

141H*Low Birth Weight and Very Low Birth Weight (< 2 yrs)

142 Prematurity (<2 yrs)

151HSmall for Gestational Age (< 2 yrs)

PRIORITY 3:CLINICAL/HEALTH/MEDICAL

341HNutrient Deficiency Diseases356HHypoglycemia

342HGastro-Intestinal Disorders357Drug-Nutrient Interactions WIC Nutritionist Only!

343HDiabetes Mellitus359H*Recent Major Surgery, Trauma, Burns

344HThyroid Disorders360HOther Medical Conditions

345HHypertension and/or Prehypertension361H*Depression

346HRenal (Kidney) Disease362HDevelopmental Delays, Sensory or Motor

347HCancer***Delays Interfering With the Ability to Eat

348HCentral Nervous System Disorders381H*Dental Problems

349HGenetic and Congenital Disorders382HFetal Alcohol Syndrome

351HInborn Errors of Metabolism904Environmental Tobacco Smoke Exposure

352HInfectious Diseases***

353H*Food Allergies

354HCeliac Disease

355H*Lactose Intolerance

PRIORITY 5:DIETARY

425H* Inappropriate Nutrition Practices for Children

  • Routine feeding of inappropriate beverages as primary milk source
  • Routine feeding of sugar-containing fluids (e.g. soda, sweetened tea, etc)
  • Routine use of nursing bottles, cups, or pacifiers improperly
  • Routine feeding practices that disregard developmental needs or stages of child
  • Feeding foods that could be contaminated with harmful microorganisms
  • Routine feeding diet very low in calories and/or essential nutrients (e.g. vegan diet, low carb diet)--H
  • Feeding dietary supplements with potentially harmful consequences (e.g. excess vitamins, minerals, herbs)--H
  • Routinely not providing dietary supplements recognized as essential by national public health policy when child’s diet alone cannot meet nutrient requirements
  • Pica--H

**401 Failure to Meet Dietary Guidelines for Americans ≥ 2yrs Only

**428 Dietary Risk Associated with Complementary Feeding Practices – 12 Months to 23 Months Only

** Use 401 and 428 only after assessing for 425

PRIORITY 5:OTHER RISKS

801Homelessness901HRecipient of Abuse

802Migrancy902HWoman or Infant/Child of Primary Caregiver With

Limited Ability to Make Feeding Decisions and/or

Prepare Food

903Foster Care

PRIORITY 3 or 5: OTHER RISKS

501Possibility of Regression (Priority must be502Transfer of Certification

same as last certification

H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in computer.

Infant Nutrition Risk Codes

PRIORITY 1:ANTHROPOMETRIC/BIOCHEMICAL

103H*Underweight or At Risk of Underweight151HSmall for Gestational Age

115High Weight-for Length152HLow Head Circumference

121Short Stature or At Risk of Short Stature153 Large for Gestational Age

134HFailure to Thrive201H*Anemia

135HInadequate Growth211HElevated Blood Lead Levels

141HLow Birth Weight and Very Low Birth Weight

142Prematurity

PRIORITY 1:CLINICAL/HEALTH/MEDICAL

341HNutrient Deficiency Diseases 353H*Food Allergies

342HGastro-Intestinal Disorders 354HCeliac Disease

343HDiabetes Mellitus 355H*Lactose Intolerance

344HThyroid Disorders356HHypoglycemia

345HHypertension and/or Prehypertension357Drug-Nutrient Interactions WIC Nutri. Only!

346HRenal (Kidney) Disease359H*Recent Major Surgery, Trauma, Burns

347HCancer*** 360HOther Medical Conditions

348HCentral Nervous System Disorders362HDevelopmental Delays, Sensory or Motor Delays

349HGenetic and Congenital DisordersInterfering With the Ability to Eat

381H*Dental Problems

351H Inborn Errors of Metabolism382HFetal Alcohol Syndrome

352HInfectious Diseases***904Environmental Tobacco Smoke Exposure

PRIORITY 4:DIETARY

411H* Inappropriate Nutrition Practices for Infants

  • Routinely using substitute for breastmilk or FDA approved iron-fortified formula as primary nutrient source
  • Routine use of nursing bottles or cups improperly
  • Routinely offering complementary foods or other substances inappropriate in type or timing
  • Routine feeding practices that disregard developmental needs or stage of infant
  • Feeding foods that could be contaminated with harmful microorganisms or toxins
  • Routinely feeding inappropriately diluted formula
  • Limiting frequency of nursing of exclusively breastfed infant when breastmilk is sole source of nutrients
  • Routine feeding of diet very low in calories and/or essential nutrients--H
  • Inappropriate sanitation in preparation, handling and storage of expressed breastmilk or formula
  • Feeding dietary supplements with potentially harmful consequences--H
  • Not providing dietary supplements recognized as essential by national public health policy when diet alone

Cannot meet nutrient requirements

**428 Dietary Risk Associated with Complementary Feeding Practices – 4 Months to 12 Months Only

** Use 428 only after assessing for 411

PRIORITY 1 or 2: OTHER RISKSPRIORITY 4:OTHER RISKS

501Possibility of Regression (Priority 1)

502Transfer of Certification 801Homelessness

603Breastfeeding Complications or Potential 802Migrancy

Complications (Priority 1)901HRecipient of Abuse

701Infant to 6 mos of WIC Mother (Priority 2)902HWoman or Infant/Child of Primary Caregiver

Or a Woman who would have been eligibleLimited Ability to Make Feeding Decisions and/or

702Breastfeeding Infant of a Woman at Nutrition Risk Prepare Food

(Priority must be same as at-risk mother)903Foster Care

703HInfant Born of Woman w/Mental Retardation or

Alcohol or Drug Abuse (Priority 1)

H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in computer.

Imputing Risk Codes and Assigning Priority

Enter nutrition risk codes from the applicant’s questionnaire into the participant’s record into the WIC computer program. Usually the priority will automatically appear in the computer, if not, enter the priority. Each risk code is listed under its priority category. If the participant has more than one risk, enter the highest priority that applies. General categories of nutritional risk codes are listed below with priority levels.

Priority

A priority of I-VI must be assigned to each applicant, based on the applicant’s

nutritional risk and category, as follows:

  • Priority I – Pregnant and breastfeeding women and infants with nutritionally-related medical risks. Breastfeeding women of Priority I infants and infants of Priority I breastfeeding women.
  • Priority II – Infants under 6 months of age who were born to women who were either on the WIC Program during pregnancy or who were not on the program but would have qualified as Priority I had they been on the program. Breastfeeding women of Priority II infants.
  • Priority III – Children with nutritionally-related medical risks.
  • Priority IV – Pregnant and breastfeeding women and infants with dietary risks. Breastfeeding women of Priority IV infants and infants of Priority IV breastfeeding women. Postpartum women with nutritionally-related medical risks.
  • Priority V – Children with dietary risks.
  • Priority VI – Postpartum women with dietary and medical/nutritional risks.

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