ND WIC Program Nutrition Risk Code Manual February 2020 · User Nutrition Interview (Question 1a, 1e, or 1 g) 302 HR P-1 Gestational Diabetes Presence of gestational diabetes defined

ND WIC Program

Nutrition Risk Code Manual

February 2020

Nutrition Risk Codes 1

Definitions 28

LegeNDS Nutrition Interview Medical Conditions List 29

Quick Guide to High Risk Codes 30

357 – Drug Nutrient Interactions Guidance 31

1

Nutrition Risk Codes 2019

Code

Number

Part.

Type

Priority

Risk Code Name/Description of Risk Code

User or

System

Assigned

Information Used to Determine Risk

Anthropometric Risks

101 P-1

BF-1

NB-3

Underweight/Women

• Pregnant: pre-pregnancy BMI < 18.5

• Breastfeeding/Not Breastfeeding < 6 months postpartum: pre-

pregnancy BMI < 18.5

• Breastfeeding 6 months postpartum: current BMI < 18.5

System Pregnancy Panel (Pre-Pregnancy BMI) or

Anthropometrics Panel (Current BMI)

103A I-1

C-3

At Risk for Underweight (Infants and Children)

• Birth to < 24 months: > 2.3rd and < 5th percentile weight-for-length

• 2-5 years: > 5th and < 10th percentile BMI-for-age

System Anthropometrics Panel (Growth Charts – Weight For

Length or BMI For Age)

103B I-1

C-3

Underweight (Infants and Children)

• Birth to < 24 months: < 2.3rd percentile weight-for-length

• 2-5 years: < 5th percentile BMI-for-age

System Anthropometrics Panel (Growth Charts – Weight For

Length or BMI For Age)

111 P-1

BF-1

NB-3

Overweight/Women

• Pregnant: pre-pregnancy BMI 25

• Breastfeeding/Not Breastfeeding < 6 months postpartum: pre-

pregnancy BMI 25

• Breastfeeding 6 months postpartum: current BMI 25

System Pregnancy Panel (Pre-Pregnancy BMI) or

Anthropometrics Panel (Current BMI)

113 C-3 Obese (Children 2-5 Years)

> 95th percentile BMI-for-age

System Anthropometrics Panel (BMI For Age Growth Chart)

114 C-3 Overweight or At Risk of Overweight Children

> 85th and < 95th percentile BMI-for-age

System Anthropometrics Panel (BMI For Age Growth Chart)

This risk code will also assign for the child if the child’s

mother is currently on WIC as pregnant and has a pre-

pregnancy BMI > 30 or recently delivered a baby (in the past

6 months) and was on WIC with a pre-pregnancy BMI > 30.

115 I-1

C-3

High Weight-for-Length (< 24 months of age)

> 97.7th percentile weight-for-length

System Anthropometrics Panel (Weight For Length Growth

Chart)

121A I–1

C-3

At Risk of Short Stature (Infants and Children)

• Birth to < 24 months: > 2.3rd and < 5th percentile length-for-age

• 2-5 years: > 5th and < 10th percentile stature-for-age

For premature ( 37 weeks) infants and children (with a history of

prematurity) up to 2 years of age, assignment of this risk is based on

adjusted gestational age. For adjusted gestation age, use Diagnosed

Weeks Gestation, if available. If not, use Calculated Weeks Gestation.

System Anthropometrics Panel (Growth Charts – Length or

Stature For Age)

2

121B I–1

C-3

Short Stature (Infants and Children)

• Birth to < 24 months: < 2.3rd percentile length-for-age

• 2-5 years: < 5th percentile stature-for-age

For premature ( 37 weeks) infants and children (with a history of

prematurity) up to 2 years of age, assignment of this risk is based on



System Anthropometrics Panel (Growth Charts – Length or

Stature For Age Growth Chart)

131 P-1 Low Maternal Weight Gain

Low weight gain at any point in pregnancy, such that using a National

Academies of Sciences, Medicine, and Engineering-based weight gain

grid, a pregnant woman’s weight plots at any point beneath the bottom

line of the appropriate weight gain range for her respective pre-

pregnancy weight category as follows:

Pre-Pregnancy Weight Classification

• Underweight (BMI < 18.5) total weight gain range 28-40 pounds

• Normal Weight (BMI 18.5 to 24.9) total weight gain range 25-35

pounds

• Overweight (BMI 25 to 29.9) total weight gain range 15-25 pounds

• Obese (BMI > 30) total weight gain range 11-20 pounds

*Multi-fetal Pregnancies: The definition/cut-off values listed in this risk

code can also be used to assign this risk to pregnant women with multi-

fetal pregnancies. The rationale being that if a woman with a multi-fetal

pregnancy is not gaining weight as recommended for a singleton

pregnancy (the tables in the risk definition are for singleton

pregnancies), she is most definitely not gaining enough weight for a

multifetal pregnancy.

User Anthropometrics Panel (Risk Code Check Box)

This risk code should only be assigned an initial

certification. In subsequent visits, nutrition

counseling/education must be documented. Weight status

also needs to be monitored throughout the pregnancy.

*Multi-fetal Pregnancies: For twin gestations, the NASEM

recommendations provide provisional guidelines as follows:

normal weight women should gain 37‐54 pounds;

overweight women, 31‐50 pounds; and obese women, 25‐42

pounds. There was insufficient information for the NASEM

committee to develop even provisional guidelines for

underweight women with multiple fetuses. However, a

consistent rate of weight gain is advisable. A gain of 1.5

pounds per week during the second and third trimesters has

been associated with a reduced risk of preterm and low‐birth

weight delivery in twin pregnancy. In triplet pregnancies,

the overall gain should be around 50 pounds with a steady

rate of gain of approximately 1.5 pounds per week

throughout the pregnancy. Nutrition education and

counseling should address a steady rate of weight gain that is

higher than for singleton pregnancies.

3

133 P-1

BF-1

NB-3

High Maternal Weight Gain

Pregnant: A high rate of weight gain, such that in the 2nd and 3rd

trimesters, for singleton pregnancies:

• Underweight women gain more than 1.3 pounds/week

• Normal weight women gain more than 1 pound/week

• Overweight women gain more than .7 pounds/week

• Obese women gain more than .6 pounds/week

OR high weight gain at any point in pregnancy, a pregnant woman’s

weight plots at any point above the top line of the appropriate weight

gain range for her respective pre-pregnancy weight category (see below)

Pre-Pregnancy Weight Categories

• Underweight – BMI < 18.5

• Normal Weight – BMI 18.5 – 24.9

• Overweight – BMI 25 – 29.9

• Obese – BMI > 30

Breastfeeding/Not Breastfeeding: in most recent pregnancy, a total

pregnancy weight gain exceeding the upper limit of the IOM’s

recommended range based on BMI for singleton pregnancies:

Pre-Pregnancy Weight Weight Gained This Pregnancy

Underweight (BMI < 18.5) > 40 pounds

Normal Weight (BMI 18.5 – 24.9) > 35 pounds

Overweight (BMI 25 – 29.9) > 25 pounds

Obese (BMI > 30) > 20 pounds

User

System

Anthropometrics Panel (Risk Code Check Box)

This risk code should only be assigned an initial

certification. In subsequent visits, nutrition

counseling/education must be documented. Weight status

also needs to be monitored throughout the pregnancy.

Pregnancy Panel (Pre-Pregnancy BMI and Weight

Gained This Pregnancy)

134

HR

I-1

C-3

Failure to Thrive

Presence of failure to thrive, medical diagnosis needed

User Infant: Nutrition Interview (Question 3b)

Child: Nutrition Interview (Question 1b)

135

I-1 Slowed/Faltering Growth Pattern

• Birth to 2 weeks: Excessive weight loss after birth, defined as > 7%

birth weight

• 2 weeks to 6 months of age: Any weight loss (two separate

measurements taken at least eight weeks apart)

System Anthropometrics Panel (Weight Measurements)

User can also assign by marking the risk code check box on

the Anthropometrics Panel.

141A I-1

C-3

Low Birth Weight

Birth weight of 5 pounds 8 ounces (< 2500 grams) for infants and

children < 24 months of age

System Anthropometrics Panel (Birth Measurements – Weight)

141B I-1

C-3

Very Low Birth Weight

Birth weight of 3 pounds 5 ounces (< 1500 grams) for infants and


System Anthropometrics Panel (Birth Measurements – Weight)

4

142A I-1

C-3

Preterm Delivery

Delivery of an infant born 36 6/7 weeks gestation for infants and


System Family Panel (Enrollment Link – Expected DOB)

Anthropometrics Panel (Calculated Weeks Gestation or

Diagnosed Weeks Gestation)

142B I-1

C-3

Early Term Delivery

Delivery of an infant born > 37 0/7 weeks and 38 6/7 gestation for

infants and children < 24 months of age

System Family Panel (Enrollment Link – Expected DOB)

Anthropometrics Panel (Calculated Weeks Gestation or

Diagnosed Weeks Gestation)

152 I-1

Low Head Circumference

< 2.3rd percentile head circumference-for-age

For premature ( 37 weeks) infants, assignment of this risk is based on



System

Anthropometrics Panel (Head Circ For Age Growth

Chart)

153 I-1

Large for Gestational Age

• Birth weight > 9 pounds (> 4000 grams), or

• Diagnosed by a physician; medical diagnosis needed

System Anthropometrics Panel (Birth Measurement – Weight,

LGA Indicator Yes)

The CPA can check the Diagnosed LGA check box on the

Anthropometrics Panel to assign this risk if a physician

diagnoses an infant as large for gestational age.

Biochemical Risks 201 P-1

BF-1

NB-3

I-1

C-3

Low Hemoglobin/Hematocrit

Low Hemoglobin or hematocrit concentration based on CDC Guidelines

System

Blood Panel

For women participants that smoke, the Smoking group box

on the Blood panel must be completed.

211

HR

P-1

BF-1

NB-3

I-1

C-3

Elevated Blood Lead Levels

Blood lead level of 5 µg/deciliter within last 12 months

System Blood Panel

Clinical/Health/Medical Risks

301

HR

P-1 Hyperemesis Gravidarum

Severe and persistent nausea and vomiting during pregnancy which may

cause more than 5% weight loss and fluid and electrolyte imbalances;

based on a chronic condition, not single episodes; clinical diagnosis,

made after other causes of nausea and vomiting have been excluded,

medical diagnosis needed

User Nutrition Interview (Question 1a, 1e, or 1 g)

302

HR

P-1 Gestational Diabetes

Presence of gestational diabetes defined as any degree of

glucose/carbohydrate intolerance with onset or first recognition during

pregnancy, medical diagnosis needed

User Nutrition Interview (Question 1e or 1 g)

5

303 P-1

BF-1

NB-3

History of Gestational Diabetes

History of diagnosed gestational diabetes, medical diagnosis needed

User Pregnant: Nutrition Interview (Question 1d or 1 g)

Breastfeeding/Not Breastfeeding: Nutrition Interview

(Question 2f)

304

P-1

BF-1 NB-3

History of Preeclampsia

History of diagnosed preeclampsia, medical diagnosis needed

User Pregnant: Nutrition Interview (Question 1d)


(Question 2f)

311A P-1

BF-1

NB-3

History of Preterm Delivery

Delivery of an infant born 36 6/7 weeks gestation

• Pregnant: any history of

• Breastfeeding/Not Breastfeeding: most recent pregnancy

User Pregnant: Nutrition Interview (Question 1d or 1g)


(Question 2f)

311B P-1

BF-1

NB-3

History of Early Term Delivery

Delivery of an infant born > 37 0/7 and 38 6/7 weeks gestation





(Question 2f)

312 P-1

BF-1

NB-3

History of Low Birth Weight

Birth of an infant weighing 5 pounds 8 ounces (< 2500 grams)



User

System

Pregnant: Nutrition Interview (Question 1d or 1g)

Breastfeeding/Not Breastfeeding: Pregnancy Panel

(Infant(s) Born From This Pregnancy) and

Anthropometrics Panel (Birth Measurements – Weight)

321A P-1

History of Fetal or Neonatal Death or 2 or more Spontaneous

Abortions

Any history of fetal or neonatal death or 2 or more spontaneous

abortions (including terminology used by the mother such as

miscarriage, pre-term birth, or still-birth as long as the definition is the

same), medical diagnosis needed

• spontaneous abortions: the spontaneous termination of a gestation

< 20 weeks gestation or < 500 grams

• fetal death: the spontaneous termination of a gestation at > 20

weeks gestation

• neonatal death: the death of an infant within 0-28 days of life

User

Nutrition Interview (Question 1d or 1g)

321B BF-1 Fetal/Neonatal Death in Multifetal Pregnancy – 1 or more living

infants

Most recent pregnancy, in which there was a multi-fetal pregnancy with

one or more fetal or neonatal death(s) and one or more living infant(s),



weeks gestation


User

Nutrition Interview (Question 2f)

6

321C NB-3 Spontaneous Abortion, Fetal, or Neonatal Loss

Most recent pregnancy, medical diagnosis needed

• spontaneous abortions: the spontaneous termination of a gestation

< 20 weeks gestation or < 500 grams


weeks gestation


User

Pregnancy Panel (Risk Code Check Box)

331A P-1

BF-1 NB-3

Pregnancy at a Young Age – LMP before age 16

• Pregnant: current pregnancy


System Pregnancy Panel (Last Menstrual Period) and Family

Panel (Date of Birth)

331B P-1

BF-1

NB-3

Pregnancy at a Young Age – LMP at age 16 or 17



System Pregnancy Panel (Last Menstrual Period) and Family

Panel (Date of Birth)

332 P-1

BF-1

NB-3

Short Interpregnancy Interval

Interpregancy interval of < 18 months from the date of live birth to the

conception of the subsequent pregnancy



System Pregnant (First Pregnancy on WIC): Pregnancy Panel

(Last Menstrual Period) and Nutrition Interview

(Question 1b)

Pregnant (Subsequent Pregnancy on WIC) and

Breastfeeding/Not Breastfeeding: Pregnancy Panel

(current pregnancy Last Menstrual Period and previous

pregnancy Actual Delivery Date)

Breastfeeding/Not Breastfeeding Women (Only One

WIC Pregnancy Record): CPA Manually Assigned (Risk

Panel, Risk Tree) (i.e., Breastfeeding/Not Breastfeeding

women not on WIC with previous pregnancy)

334 P-1 Lack of Adequate Prenatal Care

Prenatal care beginning after the 1st trimester (after the 13th week) or

having an inadequate number of prenatal visits as follows:

Weeks 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

System Nutrition Interview (Question 1f)

335

HR

(P only)

P-1

BF-1

NB-3

Multifetal Gestation

More than one fetus in a current pregnancy

• Pregnant: Current pregnancy

• Breastfeeding/Not Breastfeeding: Most recent pregnancy

User Pregnancy Panel (Risk Code Check Box)

7

336 P-1 Fetal Growth Restriction

Fetal weight 10th percentile for gestational age, medical diagnosis

needed

User Nutrition Interview (Question 1g)

337 P-1

BF-1

NB-3

History Large for Gestational Age Birth

Birth of an infant weighing >9 pounds, medical diagnosis needed

• Pregnant: any history


User

System

Pregnant: Nutrition Interview (Question 1d or 1g)

Breastfeeding/Not Breastfeeding: Infant (from most

recent pregnancy) Anthropometrics Panel (Birth

Measurement – Weight, LGA Indicator Yes)

338 P-1 Pregnant Woman Currently Breastfeeding

Breastfeeding woman now pregnant

User Nutrition Interview (BF Preparation, Question 4b and 4c

and Risk Code Check Box)

339 P-1

BF-1

NB-3

History of Birth with Nutrition Related Congenital/Birth Defect

A woman 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, excess vitamin A, medical diagnosis needed

• Pregnant: any history



Breastfeeding/Not Breastfeeding: CPA Manually

Assigned Only (Risk Panel, Risk Tree)

341

HR

P-1

BF-1

NB-3

I-1

C-3

Nutrient Deficiency or Disease

Any currently treated or untreated deficiency or disease, medical

diagnosis needed

Diseases include, but are not limited to:

• Beri Beri

• Cheilosis

• Hypocalcemia

• Menkes Disease

• Osteomalacia

• Pellagra

• Protein Energy Malnutrition

• Rickets

• Scurvy

• Vitamin K Deficiency

• Xeropthalmia

• Iron Deficiency

User Pregnant: Nutrition Interview (Question 1g)


(Question 2c)

Infant: Nutrition Interview (Question 3b)


8

342

HR

P-1

BF-1

NB-3

I-1

C-3

Gastrointestinal Disorder

Disease(s) or condition(s) that interferes with the intake or absorption of

nutrients, medical diagnosis needed

The conditions include, but are not limited to:

• Gastroesophageal reflux disease (GERD)

• Peptic ulcer

• Post-bariatric surgery

• Short bowel syndrome

• Inflammatory bowel disease, including ulcerative colitis or Crohn's

disease

• Liver disease

• Pancreatitis

• Biliary tract disease



(Question 2c)



343

HR

P-1

BF-1

NB-3

I-1

C-3

Diabetes Mellitus

Presence of diabetes mellitus which consists of a group of metabolic

diseases characterized by inappropriate hyperglycemia resulting from

defects in insulin secretion, insulin action, or both (includes type 1, type

2, and maturity onset diabetes of the young), medical diagnosis needed



(Question 2c)



344

HR

P-1

BF-1

NB-3

I-1

C-3

Thyroid Disorders

Thyroid dysfunctions caused by abnormal secretion of thyroid

hormones including hyperthyroidism, hypothyroidism, congenital

hyperthyroidism, congenital hypothyroidism, and postpartum

thyroiditis, medical diagnosis needed



(Question 2c)



345

HR

P-1

BF-1

NB-3

I-1

C-3

Hypertension/Prehypertension

Presence of hypertension or prehypertension, medical diagnosis needed



(Question 2c)



346

HR

P-1

BF-1

NB-3

I-1

C-3

Renal Disease

Any renal disease, including persistent proteinuria and pyelonephritis,

but excluding urinary tract infections (UTI) involving the bladder,




(Question 2c)



347

HR

P-1

BF-1

NB-3

I-1

C-3

Cancer

A chronic disease whereby populations of cells have acquired the ability

to multiply and spread without the usual biologic restraints, medical

diagnosis needed. The current condition, or the treatment for the

condition, must be severe enough to affect nutritional status.



(Question 2c)



9

348

HR

P-1

BF-1

NB-3

I-1

C-3

Central Nervous System Disorders

Conditions which affect energy requirements, ability to feed self, or

alter nutritional status metabolically, mechanically, or both, medical

diagnosis needed

Includes, but is not limited to:

• Cerebral palsy (CP)

• Epilepsy

• Multiple Sclerosis (MS)

• Myelomeningocele

• Neural tube defects (NTD)

• Parkinson’s Disease

• Spina Bifida



(Question 2c)



349

HR

P-1

BF-1

NB-3

I-1

C-3

Genetic and Congenital Disorders

Hereditary or congenital condition at birth that causes physical or

metabolic abnormality, medical diagnosis needed. The current

condition must alter nutritional status metabolically, mechanically, or

both. Includes, but is not limited to:

• Cleft lip or palate

• Down syndrome

• Muscular dystrophy

• Sickle cell anemia (not sickle cell trait)

• Thalassemia major



(Question 2c)



10

351

HR

P-1

BF-1

NB-3

I-1

C-3

Inborn Errors of Metabolism

Inherited metabolic disorders caused by a defect in the enzymes or their

co-factors that metabolize protein, carbohydrate, or fat, medical

diagnosis needed. Inborn errors of metabolism (IEM) generally refer to

gene mutations or gene deletions that alter metabolism in the body,

including but not limited to:

• Frutoaldolase deficiency

• Galactosemia

• Galactokinase deficiency

• Glutaric aciduria

• Glycogen storage disease

• Histidinemia

• Homocystinuria

• Hyperlipoproteinemia

• Hypermethioninemia

• Maple syrup urine disease

• Medium-chain acyl-CoA dehydrogenase (MCAD)

• Methylmalonic academia

• Phenylketonuria (PKU)

• Propionic academia

• Tyrosinemia

• Urea cycle disorders



(Question 2c)



352A

P-1

BF-1

NB-3

I-1

C-3

Infectious Diseases – Acute

A disease which is characterized by a single or repeated episode of

relatively rapid onset and short duration. Infectious diseases come from

bacteria, viruses, parasites, or fungi and spread directly or indirectly

from person to person. Infectious diseases may also be zoonotic, which

are transmitted from animals to humans, or vector-borne, which are

transmitted from mosquitoes, ticks, and flees to humans. The infectious

disease must be present within the past 6 months, and medical diagnosis

is needed. These diseases and/or conditions include, but are not limited

to (an extensive listing of infectious diseases can be found at

www.nlm.nih.gov/medlineplus/infections.html):

• Bronchitis (3 episodes in last 6 months)

• Hepatitis A or E

• Listeriosis

• Meningitis (Bacterial/Viral)

• Pneumonia

• Parasitic infections



(Question 2c)



http://www.nlm.nih.gov/medlineplus/infections.html

11

352B

HR

P-1

BF-1

NB-3

I-1

C-3

Infectious Diseases – Chronic

Conditions likely lasting a lifetime and require long-term management

of symptoms. Infectious diseases come from bacteria, viruses,

parasites, or fungi and spread directly or indirectly, from person to

person. Infectious diseases may also be zoonotic, which are transmitted

from animals to humans, or vector-borne, which are transmitted from

mosquitoes, ticks, and fleas to humans. Medical diagnosis needed.

These diseases and/or conditions include, but are not limited to (an

extensive listing of infectious diseases can be found at

www.nlm.nih.gov/medlineplus/infections.html):

• AIDS (Acquired Immunodeficiency Syndrome)+

• Hepatitis B, C, or D

• HIV (Human Immunodeficiency Virus)+

(+ Breastfeeding is contraindicated for women with these conditions.)



(Question 2c)



353

HR

P-1

BF-1

NB-3

I-1

C-3

Food Allergies

Adverse health effects arising from a specific immune response that

occurs reproducibly on exposure to a given food, medical diagnosis

needed

User Pregnant: Nutrition Interview (Question 1g or Nutrition

Practices Risk Code Check Box)


(Question 2c or Nutrition Practices Risk Code Check

Box)

Infant: Nutrition Interview (Question 3b or Nutrition

Practices, Risk Code Check Box)

Child: Nutrition Interview (Question 1b or Nutrition

Practices, Risk Code Check Box)

354

HR

P-1

BF-1

NB-3

I-1

C-3

Celiac Disease

Autoimmune disease precipitated by the ingestion of gluten (a protein in

wheat, rye, and barley) that result in damage to the small intestine and

malabsorption of the nutrients from food, medical diagnosis needed



(Question 2c)



355

P-1

BF-1

NB-3

I-1

C-3

Lactose Intolerance

Syndrome of one or more of the following: diarrhea, abdominal pain,

flatulence, and/or bloating, that occurs after lactose ingestion, medical

diagnosis needed



(Question 2c)



356

P-1

BF-1

NB-3

I-1

C-3

Hypoglycemia

Presence of hypoglycemia, medical diagnosis needed



(Question 2c)



http://www.nlm.nih.gov/medlineplus/infections.html

12

357

P-1

BF-1

NB-3

I-1

C-3

Drug Nutrient Interactions

Use of prescription or over-the-counter drugs or medications that have

been shown to interfere with nutrient intake or utilization, to an extent

that nutritional status is compromised.

User Pregnant: Nutrition Interview (Question 1h)


Question 2d)

Infant: Nutrition Interview (Question 3c)

Child: Nutrition Interview (Question 1c)

See page 28 of this manual for additional guidance on

assigning this risk.

358

HR

P-1

BF-1

NB-3

Eating Disorders

Eating disorders (anorexia nervosa and bulimia) are characterized by a

disturbed sense of body image and morbid fear of becoming fat.

Medical diagnosis needed. Symptoms are manifested by abnormal

eating patterns including, but not limited to:

• Alternating periods of starvation

• Drug usage (i.e. appetite suppressants, diuretics)

• Purgative abuse

• Self-induced marked weight loss

• Self-induced vomiting



(Question 2c)

The CPA can assign this code even if they know the

participant has an eating disorder and didn’t report it.

359 P-1

BF-1

NB-3

I-1

C-3

Recent Major Surgery, Physical Trauma, or Burns

Major surgery (including cesarean sections), physical trauma, or burns

severe enough to compromise nutritional status

• Any occurrence within the past two (< 2) months may be self-

reported

OR

• If occurred 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



(Question 2c)



360

HR

P-1

BF-1

NB-3

I-1

C-3

Other Medical Conditions

Diseases or conditions with nutritional implications and are not included

in any of the other medical conditions, medical diagnosis needed. The

current condition, or treatment for the condition, must be severe enough

to affect nutritional status. This includes, but is not limited to:

• Asthma requiring daily medication

• Cardiorespiratory diseases

• Cystic fibrosis

• Heart disease

• Juvenile rheumatoid arthritis

• Lupus erythematosus

• Other, as defined in the care plan



(Question 2c)



13

361 P-1

BF-1

NB-3

Depression

Presence of clinical depression, including postpartum depression,




(Question 1/2a or 2c)

362

HR

P-1

BF-1

NB-3

I-1

C-3

Developmental/Sensory/Other Disabilities Interfering with Eating

Restrict the ability to intake, chew or swallow food or require tube

feeding to meet nutritional needs. Includes, but is 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

• Other disabilities



(Question 2c)



363

HR

BF-1

NB-3

Pre-diabetes

Impaired fasting glucose and/or impaired glucose tolerance are referred

as to pre-diabetes. These conditions are characterized by hyperglycemia

that does not meet the diagnostic criteria for diabetes mellitus. Medical

diagnosis needed.

• Impaired fasting glucose is defined as a fasting plasma glucose

level between 100-125 mg/dl.

• Impaired glucose tolerance is defined as a plasma glucose level of

140-199 mg/dl after a 2-hour oral glucose tolerance test.

User Nutrition Interview (Question 2c)

371 P-1

BF-1

NB-3

Maternal Smoking

Any smoking of tobacco products, i.e., cigarettes, pipes or cigars

(does not include chewing tobacco)

System Pregnant: Nutrition Interview (Question 3b)


(Question 4c)

372A P-1

BF-1

NB-3

Alcohol Use

• Pregnant: any alcohol use

• Breastfeeding/Not Breastfeeding:

• High Risk Drinking: Routine consumption of 8 drinks per

week or > 4 drinks on any day

OR

• Binge Drinking: Routine consumption of > 4 drinks within 2

hours

o Note: A serving or standard sized drink is: 12 ounces

beer, 5 ounces wine, or 1½ fluid ounces 80 proof

distilled spirits (e.g., gin, rum, vodka, whiskey,

cordials or liqueurs).

System Pregnant: Nutrition Interview (Question 3f)


(Question 4g)

14

372B P-1

BF-1

NB-3

Substance Use

• Pregnant and Breastfeeding: any illegal substance use and/or abuse

of prescription medication and any marijuana use in any form

• Not Breastfeeding: any illegal substance use and/or abuse of

prescription medications

System Pregnant: Nutrition Interview (Question 3g)


(Question 4h)

381 P-1

BF-1

NB-3

I-1

C-3

Oral Health Conditions

• Dental caries, often referred to as “cavities” or “tooth decay”

• Peridontal diseases such as gingivitis and periodontitis

• Tooth loss, ineffectively replaced teeth or oral infections which

impair the ability to ingest food in adequate quantity or quality

Presence of oral health conditions as diagnosed, documented, or

reported by a physician, dentist, or someone working under a

physician’s orders, or as self-reported by applicant/participant/caregiver.

User Pregnant: Nutrition Interview (Question 1g or 1i)


(Question 2c or 2g)

Infant: Nutrition Interview (Question 3b or 5a)

Child: Nutrition Interview (Question 1b or 5a)

382

HR

I-1

C-3

Fetal Alcohol Syndrome

Based on the presence of retarded growth, a pattern of facial

abnormalities, and abnormalities of the central nervous system,

including mental retardation, medical diagnosis needed



383

I-1

Neonatal Abstinence Syndrome

Drug withdrawal syndrome (physiologic and neurologic symptoms) that

occurs among drug-exposed (primarily opioid-exposed) infants as a

result of the mother’s use of drugs during pregnancy, must be present

within the first 6 months of birth, medical diagnosis needed


Dietary

401 P-4

BF-4

NB-6

C-5

Failure to Meet Dietary Guidelines for Americans

Women and children 2 years of age and older who meet the income,

categorical, and residency eligibility requirements may be presumed to

be at nutrition risk based on failure to meet Dietary Guidelines for

Americans. Based on an individual’s estimated energy needs, the

failure to meet Dietary Guidelines risk is defined as consuming fewer

than the recommended number of servings from one or more of the

basic food groups (grains, fruits, vegetables, milk products, and meat or

beans).

User Nutrition Interview (Nutrition Practices, Risk Code

Check Box)

This risk can only be assigned to children > 2 years of age

and all women when no other risk is found. LegeNDS will

not let you assign it with any other risk codes as it is only

supposed to be assigned after a complete nutrition

assessment was done and no other risk codes were

identified.

15

411A

I-4 Inappropriate Primary Feeding

Routinely using a substitute(s) for human milk or FDA approved iron-

fortified formula as the primary nutrient source during the first year of

life

Examples of substitutes:

• Low iron formula without iron supplementation

• Cow’s milk, goat’s milk, or sheep’s milk (whole, reduced fat, low-

fat, skim), canned evaporated or sweetened condensed milk

• Imitation or substitute milks (such as rice or soy-based beverages,

non-dairy creamer) or other “homemade concoctions”


Check Box)

The CPA can use information gathered from completing the

Nutrition Practices section of the Nutrition Interview to help

determine if this risk should be assigned.

411B

I-4 Routinely Using Bottles or Cups Improperly

• Using a bottle to feed fruit juice

• Feeding any sugar-containing fluids, such as soda/soft drinks,

gelatin water, corn syrup solutions, or sweetened tea

• Allowing the infant to fall asleep or be put to bed with a bottle at

naps or bedtime

• Allowing the infant to use the bottle without restriction (e.g.,

walking around with a bottle) or as a pacifier

• Propping the bottle when feeding

• Allowing an infant to carry around and drink throughout the day

from a covered or training cup

• Adding any food (cereal or other solid foods) to the infant’s bottle.


Check Box)




411C

I-4 Inappropriate Complementary Foods

Routinely offering complementary foods or other substances that are

inappropriate in type or timing (Complementary foods are any foods or

beverages other than human milk or infant formula.) Examples:

• Adding sweet agents such as sugar, honey, or syrups to any

beverage (including water) or prepared food, or used on a pacifier

• Introducing any food other than human milk or iron-fortified infant

formula before 6 months of age


Check Box)




16

411D

I-4 Feeding Practices Disregard Developmental Needs

Routinely using feeding practices that disregard the developmental

needs or stages of the infant such as:

• Inability to recognize, insensitivity to, or disregarding the infant’s

cues for hunger and satiety (e.g., forcing an infant to eat a certain

type and/or amount of food or beverage or ignoring a hungry

infant’s requests for appropriate foods).

• Feeding foods of inappropriate consistency, size, or shape that put

infants at risk of choking.

• Not supporting an infant’s need for growing independence with

self-feeding (e.g., solely spoon-feeding an infant who is able and

ready to finger-feed and/or try self-feeding with appropriate

utensils).

• Feeding an infant food with an inappropriate texture based on

his/her developmental stage (e.g., feeding primarily pureed or

liquid food when the infant is ready and capable of eating mashed

or chopped foods or appropriate finger foods).

User

Nutrition Interview (Nutrition Practices, Risk Code

Check Box)




411E

I-4 Potentially Contaminated Foods

Feeding foods to an infant that could be contaminated with harmful

microorganisms or toxins such as:

• 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, on a pacifier, etc.)

• Raw or undercooked meat, fish, poultry, or eggs

• Raw vegetable sprouts (alfalfa, clover, bean, and radish)

• Deli meats, hot dogs, and processed meats (avoid unless further

cooked to steaming hot)

• Donor human milk acquired directly from individuals or the

internet


Check Box)




411F

I-4 Inappropriately Diluted Formula

• Failure to follow manufacturer’s dilution instructions (to include

stretching formula for household economic reasons)

• Failure to follow specific instructions accompanying a prescription


Check Box)




17

411G

I-4 Inappropriate Frequency of Breastfeeding

Routinely limiting the frequency of nursing of the exclusively breastfed

infant when human milk is the sole source of nutrients

Examples:

• Scheduled feedings instead of demand feedings

• < 8 feedings in 24 hours if < 2 months of age


Check Box)




411H

HR

I-4 Diet Very Low in Calories or Essential Nutrients

Examples include:

• Vegan diet

• Macrobiotic diet

• Other diets very low in calories and/or essential nutrients


Check Box)




18

411I

I-4 Inadequate Sanitation Resources or Practices

Routinely using inappropriate sanitation in preparation, handling, and

storage of expressed human milk or formula

• Limited or no access to a:

o Safe water supply (documented by appropriate officials)

o Heat source for sterilization; and/or

o Refrigerator or freezer for storage

• Failure to prepare, handle, and store bottles, storage containers or

breast pumps properly; examples include:

o Human Milk

▪ Thawing/heating in a microwave

▪ Refreezing

▪ Adding freshly expressed unrefrigerated human milk to frozen

human milk

▪ Adding freshly pumped chilled human milk to frozen human

milk in an amount greater than the amount of frozen human

milk

▪ Feeding thawed refrigerated human milk more than 24 hours

after it was thawed

▪ Saving human milk from a used bottle for another feeding

▪ Failure to clean a breast pump per manufacturer’s instruction

▪ Feeding donor human milk acquired directly from individuals

or the internet

o Formula

▪ Failure to prepare and/or store formula per manufacturer’s or

physician instructions

▪ Storing at room temperature for more than one hour

▪ Using formula in a bottle one hour after the start of a feeding

▪ Saving formula from a used bottle for another feeding

▪ Failure to clean baby bottles properly


Check Box)




Mead Johnson’s refrigeration storage recommendations for

the five standard formulas allowed on ND WIC (Enfamil

Infant, ProSobee, Gentlease, AR, and Reguline) are listed

below.

• Prepared from Powder: No longer than 24 hours.

• Prepared from Concentrate or Ready-to-Feed: No

longer than 48 hours.

The CPA will have to find out the specific storage

recommendations for special infant formulas when needed

from the manufacturer directly (website, label, or product

guide).

411J

I-4 Potentially Harmful Dietary Supplements

Examples of dietary supplements which when fed in excess of

recommended dosage may be toxic or have harmful consequences:

• Single or multivitamins

• Mineral supplements

• Herbal or botanical supplements/remedies/teas


Check Box)




19

411K

I-4 Inadequate Fluoride or Vitamin D Intake

Routinely not providing a dietary supplement 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

0.3 ppm fluoride

• Infants who are exclusively breastfed or who are ingesting less than

1 liter (1 quart or 32 ounces) per day of vitamin D-fortified formula

and are not taking a supplement of 400 IU of vitamin D


Check Box)




425A

C-5 Inappropriate Beverages as Primary Milk Source

Examples include:

• Non-fat or reduced-fat milks between 12 and 24 months of age

(unless child has the high weight-for-length risk code meaning

overweight or obesity is a concern) or sweetened condensed milk

• Imitation or substitute milks (such as inadequately or unfortified

rice or soy-based beverages, non-dairy creamer) or “homemade

concoctions”


Check Box)




425B C-5 Routine Use of Sugar-containing Beverages

Routinely feeding a child any sugar-containing fluids such as:

• Soda/soft drinks

• Gelatin water

• Corn syrup solutions

• Sweetened tea


Check Box)




425C

C-5 Improper Use of Bottles, Cups, or Pacifiers

Routinely using a bottle, cup, or pacifier improperly such as:

• Using a bottle to feed fruit juice, diluted cereal, or other solid foods

• Allowing the child to fall asleep or be put to bed with a bottle at

naps or bedtime

• Allowing the child to use the bottle without restriction (e.g.,

walking around with a bottle) or as a pacifier

• Using a bottle for feeding or drinking beyond 14 months of age

• Using a pacifier dipped in sweet agents such as sugar, honey, or

syrups

• Allowing a child to carry around and drink throughout the day from

a covered or training cup


Check Box)




20

425D

C-5 Feeding Practices Disregard Developmental Needs

Routinely using feeding practices that disregard the developmental

needs or stages of the child such as:

• Inability to recognize, insensitivity to, or disregarding the child’s

cues for hunger and satiety (e.g., forcing a child to eat a certain type

and/or amount of food or beverage or ignoring a hungry child’s

requests for appropriate foods)

• Feeding foods of inappropriate consistency, size, or shape that put

children at risk of choking

• Not supporting a child’s need for growing independence with self-

feeding (e.g., solely spoon-feeding a child who is able and ready to

finger-feed and/or try self-feeding with appropriate utensils)

• Feeding a child food with an inappropriate texture based on his/her

developmental stage (e.g., feeding primarily pureed or liquid food

when the child is ready and capable of eating mashed or chopped

foods or appropriate finger foods)


Check Box)




425E

C-5 Potentially Contaminated Foods

Feeding foods to a child that could be contaminated with harmful

microorganisms such as:

• Unpasteurized fruit or vegetable juice

• Unpasteurized dairy products or soft cheeses such as feta, Brie,

Camembert, blue-veined, or Mexican-style cheese

• Raw or undercooked meat, fish, poultry, or eggs

• Raw vegetable sprouts (alfalfa, clover, bean, and radish)

• Deli meats, hot dogs, and processed meats (avoid unless further

cooked to steaming hot)


Check Box)




425F

HR

C-5 Diet Very Low in Calories or Essential Nutrients

Examples include:

• Vegan diet


• Other diets very low in calories and/or essential nutrients


Check Box)




A vegetarian diet can be just fine, but not a vegan or

macrobiotic diet. It can also be assigned to a child who is

only eating a handful of foods and/or is missing two of the

five major food groups.

21

425G

C-5 Potentially Harmful Dietary Supplements

Examples of dietary supplements which when fed in excess of

recommended dosage may be toxic or have harmful consequences:

• Single or multi-vitamins




Check Box)




425H

C-5 Inadequate Fluoride or Vitamin D Intake


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 36-60 months of age less than 0.50 mg of

fluoride daily when the water supply contains less than 0.3 ppm

fluoride

• Not providing 400 IU of vitamin D if a child consumes less than 1

quart (32 ounces) of vitamin D fortified milk or formula


Check Box)



determine if this risk should be assigned. Since 1 quart of

milk is in excess of the recommended 2 cups of milk per day

for preschool children, most children will need a vitamin D

supplement. The vitamin D content in vitamin/mineral

supplements can vary greatly. Most children’s chewable

vitamin/mineral supplements contain 400 IU of vitamin D

for the > 4-year-old dose. The recommended dose for 2-3-

year-old children is usually ½ a tablet (200 IU of vitamin D).

Generally, the recommended serving for gummy vitamins is

two gummies a day. So, if a child is eating one gummy

vitamin a day, they would only receive 200 IU of vitamin D.

Parents/caregivers should be advised to review the vitamin D

content of their child’s vitamin/mineral supplement and

discuss any concerns with their health care provider.

425I C-5 Pica

Routine ingestion of non-food items; examples include:

• Ashes, cigarettes, or cigarette butts

• Carpet fibers

• Clay, dust, or soil

• Foam rubber

• Paint chips

• Starch (laundry and cornstarch)


Check Box)



determine if this risk should be assigned. The CPA should

be looking for a child who is eating a non-food item four or

more days a week and the parent/guardian is not limiting

access to the item.

427A

P-4

BF-4

NB-6

Potentially Harmful Dietary Supplements

Consuming dietary supplements with potentially harmful consequences

Example of dietary supplements which when ingested in excess of

recommended dosages, may be toxic or have harmful consequences:

• Single or multiple vitamins




Check Box)




22

427B

HR

P-4

BF-4

NB-6

Diet Very Low in Calories or Essential Nutrients

Consuming a diet very low in calories and/or essential nutrients or

impaired caloric intake or absorption of essential nutrients following

bariatric surgery

• Strict vegan diet

• Low carbohydrate, high protein diet


• Any other diet restricting calories and/or essential nutrients


Check Box)



determine if this risk should be assigned. A vegetarian diet

can be just fine, but not a vegan or macrobiotic diet. It can

also be assigned to a woman who is following a low

carbohydrate or high protein diet or is missing two of the

five major food groups.

427C

P-4

BF-4

NB-6

Pica

Compulsively ingesting non-food items; examples include:

• Ashes, burnt matches, or cigarettes

• Baking soda or starch (laundry and/or cornstarch)

• Carpet fibers

• Chalk

• Clay, dust, or soil

• Large quantities of ice and/or freezer frost

• Paint chips


Check Box)



determine if this risk should be assigned. The CPA should be

looking for a pregnant woman who is eating a non-food item

four or more days a week.

427D

P-4

BF-4

NB-6

Inadequate Vitamin/Mineral Supplementation


national public health policy

• Pregnant Women: Consumption of less than 27 mg of

supplemental iron per day

• Pregnant and Breastfeeding Women: Consumption of less than 150

µg of supplemental iodine per day

• Breastfeeding and Not Breastfeeding Women: Consumption of less

than 400 mcg of folic acid from fortified foods and/or supplements

daily


Check Box)




The iron content in vitamin/mineral supplements can vary

greatly. Most prenatal supplements contain 27 milligrams of

iron. Pregnant women should be advised to review the iron

content of their prenatal supplements and discuss any

concerns with their health care provider.

The iodine content of prenatal vitamins is not mandated;

therefore, not all prenatal vitamins contain iodine. Pregnant

and breastfeeding women should be advised to review the

iodine content of their vitamins and discuss the adequacy of

the iodine with their health care provider.

If the woman is taking a multivitamin or prenatal vitamin, it

probably has the right amount of folic acid. She is also fine

if she is eating cold cereal with 100% folic acid every day.

23

427E P-4

Potentially Contaminated Foods

Eating foods that could be contaminated with pathogenic

microorganisms such as:

• Unpasteurized fruit or vegetable juices

• Unpasteurized milk or foods containing unpasteurized milk

• Soft cheeses such as feta, Brie, Camembert, blue-veined cheeses

and Mexican style cheese such as queso blanco, queso fresco, or

Panela unless labeled as made with pasteurized milk

• Raw or undercooked meat or poultry

• Raw or undercooked eggs or food containing raw or lightly cooked

eggs including certain salad dressings, cookie and cake batters,

sauces, and beverages such as unpasteurized eggnog

• Raw sprouts (alfalfa, clover, and radish)

• Hot dogs, luncheon meats (cold cuts), fermented and dry sausage

and other deli-style meat or poultry products unless reheated until

steaming hot

• Raw fish or shellfish, including oysters, clams, mussels, and

scallops and refrigerated, smoked seafood (unless it is an ingredient

in a cooked dish such as a casserole)

• Refrigerated pâté or meat spreads


Check Box)




428 I-4

C-5

Risk Associated with Complementary Feeding Practices

An infant or child from 4 but 23 months of age who has begun to or

is expected to begin to 1) consume complementary foods and beverages,

2) eat independently, 3) be weaned from breast milk or infant formula,

or 4) transition from a diet based on infant/toddler foods to one based on

the Dietary Guidelines for Americans, is at risk of inappropriate

complementary feeding.


Check Box)

LegeNDS will not let you assign this risk code with any

other risk codes as it is only supposed to be assigned after a

complete nutrition assessment was done and no other risk

codes were identified.

Other Risks 501 C-7 Possibility of Regression

A child, who has previously been certified eligible for the Program may

be considered to be at nutritional risk in the next certification period if

the CPA determines there is a possibility of regression in nutritional

status without the benefits that the WIC Program provides.

User CPA Manually Assigned Only (Risk Panel, Risk Tree)

This risk code may be used only once following a

certification period. It cannot be used for consecutive

certification periods or if other risk codes are assigned.

Also, when this risk is assigned, identify the nutrition risk

code to which the participant may regress to on the Care

Plan panel in LegeNDS.

24

502 P-1

BF-1

NB-3

I-1

C-3

Transfer of Certification

Person with a current valid Verification of Certification (VOC)

document 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 a

maximum caseload, the transferring participant must be placed at the

top of any waiting list and enrolled as soon as possible.

System Application Panel (Out-of-State VOC Information)

Since LegeNDS automatically assigns this risk code when a

VOC is entered, manually assign nutrition risk codes

documented on the VOC on the participant’s Risk panel.

Any additional information from the VOC that may be

useful for nutrition education/counseling should be

documented on the Care Plan panel.

601A

601B

601D

P or BF-1

P or BF-2

P or BF-4

BF Mother of Priority 1 Infant



A breastfeeding woman whose breastfed infant has been determined to

be at nutritional risk. Priority for woman and infant has to be the same.

System

Pregnant: Nutrition Interview (Question 4h)

For pregnant women currently breastfeeding, you may need

to create another risk record for their infant and assign 702A,

B, or D if their priorities aren’t the same.

Breastfeeding: Breastfeeding mother and infant must be

connected.

Risk codes 601/702 are automatically assigned to both

participants in a breastfeeding pair regardless of the

participants’ priority level.

602 P-1

BF-1

BF Complications/Mother

A breastfeeding woman with any of the following complications or

potential complications for breastfeeding:

• 602A – severe breast engorgement

• 602B – recurrent plugged ducts

• 602C – mastitis

• 602D – flat or inverted nipples

• 602E – cracked, bleeding, or severely sore nipples

• 602F – age 40 years old

• 602G – failure of milk to come in 4 days postpartum

• 602H – tandem nursing 2 siblings who are not twins

User

System

(602F)

User

System

(602F)

Pregnant: Nutrition Interview (Question 4h and 602 risk

code check boxes)

Pregnant: Risk code 602F will be automatically assigned

if a pregnant woman is > 40 years old (Date of Birth on

Family panel) and question 4h is marked on the

Nutrition Interview.

Breastfeeding: Nutrition Interview (Question 1b)

Breastfeeding: Risk code 602F will be automatically

assigned if a breastfeeding woman is > 40 years old (Date

of Birth on Family panel).

25

603 I-1 BF Complications/Infant

A breastfed infant with any of the following complications or potential

complications for breastfeeding:

• 603A – jaundice

• 603B – weak or ineffective suck

• 603C – difficulty latching onto mother's breast

• 603D – inadequate stooling (for age, as determined by a physician

or other health care professional) or < 6 wet diapers a day

User Nutrition Interview (Question 1b)

701 I-2 Mother on WIC or Mother Would Have Been Eligible

An infant < 6 months of age whose mother was a WIC Program

participant during her pregnancy or whose mother’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.

System Nutrition Interview (Question 7a or 7b)

If mom wasn't on WIC during her pregnancy, the CPA will

need to find out if she had any nutrition risks such as

tobacco, drug, or alcohol use, anemia, medical conditions,

lack of prenatal care, weight concerns, or pregnancy

complications and enter the issue(s) as part of question 7b.

702A

702B

702D

I-1

I-2

I-4

BF Infant of Priority 1 Mother



A breastfeeding infant of a woman at nutritional risk. Priority for

woman and infant has to be the same.

System Breastfeeding mother and infant must be connected.

Risk codes 601/702 are automatically assigned to both

participants in a breastfeeding pair regardless of the

participants’ priority level.

For infants whose mother is a pregnant woman currently

breastfeeding, you may need to create another risk record

and assign 702A, B, or D if their priorities aren’t the same.

801 P-4

BF-4

NB-6

I-4

C-5

Homelessness

A woman, infant, or child who lacks a fixed and regular nighttime

residence or whose primary nighttime residence is any of the following:

• A supervised publicly or privately-operated shelter (including a

welfare hotel, a congregate 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

• A public or private place not designed for, or ordinarily used as, a

regular sleeping accommodation for human beings

User Contact/Address Panel, Homeless Check Box

26

802 P-4

BF-4

NB-6

I-4

C-5

Migrancy

Categorically eligible women, infants, and children who are members of

a family 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.

User Contact/Address Link, Migrant Check Box

901 P-4

BF-4

NB-6

I-4

C-5

Recipient of Abuse/Neglect

Battering or child abuse/neglect within the past 6 months as self-

reported, documented by a social worker, health care provider or on

other appropriate documents, or as reported through consultation with a

social worker, health care provider, or other appropriate personnel.

“Battering” generally refers to violent physical assaults on women.

Child abuse/neglect: “Any recent act or failure to act resulting in

imminent risk of serious harm, death, serious physical or emotional

harm, sexual abuse, or exploitation of an infant or child by a parent or

caretaker.”

User Pregnant: Nutrition Interview (Questions 1g or 5a)


(Questions 2c or 5a)


Child: Nutrition Interview (Questions 1b or 6a)

902 P-4

BF-4

NB-6

I-4

C-5

Limited Ability to Make Feeding Decisions/Prepare Food (Women

or Infant/Child of Primary Caregiver)

Woman or infant/child whose primary caregiver is assessed to have a

limited ability to make appropriate feeding decisions and/or prepare

food. Examples include, but are not limited to, a woman or an

infant/child of caregiver with the following:

• 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, medical

diagnosis needed.

• Intellectual disability, medical diagnosis needed.

• Physical disability to a degree which impairs ability to feed

infant/child or limits food preparation abilities.

• < 17 years of age.

User Pregnant: Nutrition Interview (Question 5a)

Breastfeeding: Nutrition Interview (Question 1a or 5a)

Not Breastfeeding: Nutrition Interview (Question 2a or

5a)

All Women: Family Panel (Date of Birth)

Infant: Nutrition Interview (Question 6c)

Child: Nutrition Interview (Question 6a)

The CPA can use information gathered from the mother’s

pregnant Nutrition Interview question 3e or 3f (alcohol use)

and question 3g (illegal drug use) or from the mother’s

breastfeeding/not breastfeeding Nutrition Interview question

4f (alcohol use) and 4h (illegal drug use) to help determine if

this risk should be assigned.

Medical conditions described in this risk code definition

such as 361 Depression, 362 Developmental/Sensory/Other

Disabilities Interfering with Eating, etc. and documented on

the Nutrition Interview can also be used to help determine if

this risk code should be assigned.

27

903 P-4

BF-4

NB-6

I-4

C-5

Foster Care

Entering the foster care system during the previous 6 months or moving

from one foster care home to another foster care home during the

previous 6 months.

System Family Panel, Enrollment (Foster Care Group Box)

904 P-1

BF-1

NB-3

I-1

C-3

Environmental Tobacco Smoke Exposure

Exposure to smoke from tobacco products inside the home (also known

as passive, secondhand or involuntary smoke)

System Pregnant: Nutrition Interview (Question 3c)


(Question 4d)


Child: Nutrition Interview (Question 4c)

28

Definitions

High Risk (HR): Those codes marked HR indicate the need for a high risk contact by a staff person with a master’s degree in nutrition or public health

or by a registered dietitian licensed in ND (RD, LRD credential). Documentation of the contact must be part of the care plan.

Trimesters: The Centers for Disease Control and Prevention (CDC) defines a trimester as a term of three months in the prenatal gestation period with

the specific trimesters defined as follows in weeks:

• First Trimester: 0-13 weeks

• Second Trimester: 14-26 weeks

• Third Trimester: 27-40 weeks

CDC begins the calculation of weeks starting with the first day of the last menstrual period (LMP. If that date is not available, CDC estimates that date

from the estimated date of confinement (EDC).

Medical Diagnosis: Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as

self-reported by applicant/participant/caregiver.

Self-reporting of a diagnosis by a health care provider should not be confused with self-diagnosis, where a person simply claims to have or to have had

a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis (“My doctor says that I have/my son or daughter

has…”) should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis (documenting

information obtained when appropriate in the Nutrition Interview or on the Care Plan panel in LegeNDS).

Affecting, Altering, or Compromising Nutritional Status: Assign nutrition risk code if the medical condition, disease, or condition is the cause of

any of the following nutritional concerns:

• Has there been a weight gain or loss?

• Is there an increased or decreased need for a specific nutrient (fat, carbohydrate, protein, vitamins, minerals, or water)? (Example: a person

with a heart condition may be asked to decrease the fat in their diet)

• Is the participant replenishing or rebuilding tissue, bones, or fluids? (Example: a person who had surgery and the incision is healing)

• Is there an increased or decreased need in calories because of change in activity levels, contractures, or spasticity? (Example: a person with a

back injury who is confined to bed for an extended period of time)

• Does the participant have nausea, vomiting, or diarrhea?

• Is the participant unable to eat a specific food group?

• Does the participant have a problem with chewing, swallowing, sucking, or a limited ability to eat? (Example: a person who recently had

extensive mouth surgery)

Routine(ly): Four or more days a week.

29

LegeNDS Nutrition Interview Medical Conditions List All Participant Types

• 347 – Cancer

• 354 – Celiac Disease

• 348 – Central Nervous System Disorders

o Cerebral palsy (CP), Epilespy, Multiple Sclerosis (MS), Myelomeningocele, Neural tube defects (NTD), Parkinson’s disease, Spina Bifida

• 381 – Oral Health Conditions

• 362 – Developmental/Sensory/Other Disabilities Interfering with Eating

• 343 – Diabetes Mellitus

• 353 – Food Allergies (must enter type)

• 342 – Gastrointestinal Disorder

o Gastroesophageal reflux disease (GERD), Peptic ulcer, Post-bariatric surgery, Short bowel syndrome, Inflammatory bowel disease (UC and Crohn’s), Liver disease, Pancreatitis, Biliary tract disease

• 349 – Genetic and Congenital Disorders

o Cleft lip or palate, Down Syndrome, Muscular dystrophy, Sickle cell anemia (not sickle cell trait), Thalassemia major

• 345 – Hypertension/Prehypertension

• 356 – Hypoglycemia

• 351 – Inborn Errors of Metabolism

o Frutoaldolase deficiency, Galactosemia, Galactokinase deficiency, Glutaric aciduria, Glycogen storage disease, Histidinemia, Homocystinuria, Hyperlipoproteinemia, Hypermethioninemia, Maple syrup

urine disease, Medium-chain acyl-CoA dehydrogenase (MCAD), Methylmalonic academia, Phenylketonuria (PKU), Propionic academia, Tyrosinemia, Urea cycle disorders

• 352a – Infectious Diseases – Acute

o Bronchiolitis (3 episodes in last 6 months), Hepatitis A, Hepatitis E, Listerosis, Meningitis (Bacterial/Viral), Pneumonia, Parasitic Infections

• 352b – Infectious Diseases – Chronic

o AIDS (Acquired Immunodeficiency Syndrome), Hepatitis B, Hepatitis C, Hepatitis D, HIV (Human Immunodeficiency Virus)

• 355 – Lactose Intolerance

• 341 – Nutrient Deficiency or Disease

o Beri Beri, Cheilosis, Hypocalcemia, Menkes Disease, Osteomalacia, Pellagra, Protein Energy Malnutrition, Rickets, Scurvy, Vitamin K Deficiency, Xeropthalmia

• 359 – Recent Major Surgery, Physical Trauma, or Burns (must provide additional information)

• 901 – Recipient of Abuse/Neglect

• 346 – Renal Disease

o Persistent proteinuria, Pyelonephritis

• 344 – Thyroid Disorders

• 360 – Other Medical Conditions

o Asthma requiring daily medication, Cardiorespiratory diseases, Cystic fibrosis, Heart disease, Juvenile rheumatoid arthritis, Lupus erythematosus, Other, as defined in the care plan

Pregnant Women Only Breastfeeding/Not Breastfeeding Only

• 336 – Fetal Growth Restriction 363 – Pre-diabetes

• 302 – Gestational Diabetes

• 301 – Hyperemesis Gravidarum Infants Only

• 303 – History of Gestational Diabetes 383 – Neonatal Abstinence Syndrome

• 311a – History of Preterm Delivery

• 311b – History of Early Term Delivery Infants/Children Only

• 312 – History of Low Birth Weight 134 – Failure to Thrive

• 321a – History of Fetal or Neonatal Death or 2 or more Spontaneous Abortions 382 – Fetal Alcohol Syndrome

• 337 – History of Large for Gestational Age Birth

• 339 – History of Birth with Nutrition Related Congenital/Birth Defect

All Women Only

• 361 – Depression

• 358 – Eating Disorders

o Alternating periods of starvation, Drug usage (i.e. appetite suppressants, diuretics), Purgative abuse, Self-induced marked weight loss, Self-induced vomiting

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Quick Guide to High Risk Codes

The table below lists the risk codes that are identified as high risk in LegeNDS. Participants identified as high risk require high risk nutrition education

per policy 04-04-03. CPAs can also manually assign high risk status for participants with any other risk.

Risk Code Number Risk Code Name Participant Type User or System Assigned

134 Failure to Thrive I, C User

211 Elevated Blood Lead Levels P, BF, NB, I, C System

301 Hyperemesis Gravidarum P User

302 Gestational Diabetes P User

335 Multifetal Gestation P User

341 Nutrient Deficiency or Disease P, BF, NB, I, C User

342 Gastrointestinal Disorder P, BF, NB, I, C User

343 Diabetes Mellitus P, BF, NB, I, C User

344 Thyroid Disorders P, BF, NB, I, C User

345 Hypertension/Prehypertension P, BF, NB, I, C User

346 Renal Disease P, BF, NB, I, C User

347 Cancer P, BF, NB, I, C User

348 Central Nervous System Disorders P, BF, NB, I, C User

349 Genetic and Congenital Disorders P, BF, NB, I, C User

351 Inborn Errors of Metabolism P, BF, NB, I, C User

352B Infectious Diseases – Chronic P, BF, NB, I, C User

353 Food Allergies P, BF, NB, I, C User

354 Celiac Disease P, BF, NB, I, C User

358 Eating Disorders P, BF, NB User

360 Other Medical Conditions P, BF, NB, I, C User

362 Developmental/Sensory/Other Disabilities Interfering with Eating P, BF, NB, I, C User

363 Pre-diabetes BF, NB User

382 Fetal Alcohol Syndrome I, C User

411H Diet Very Low in Calories or Essential Nutrients I User

425F Diet Very Low in Calories or Essential Nutrients C User

427B Diet Very Low in Calories or Essential Nutrients P, BF, NB User

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357 – Drug Nutrient Interactions Nutrition Risk Code Definition:

Use of prescription or over-the-counter drugs or medications that have been shown to interfere with nutrient intake or utilization, to an extent that nutritional status is

compromised.

Guidance:

1. Staff can assign this risk in LegeNDS when a participant is taking a drug or medication that compromises nutritional status.

• Ask the question on the Nutrition Interview to see if the participant is currently taking any medications.

• If yes, assess if the medication compromises nutritional status.

o The Table of Common Drugs and Medications lists common medications and their possible effect on nutrition.

o Check the nutrition risk code check box for 357 – Drug Nutrient Interactions if the participant is on one of these medications. The table isn’t all-

inclusive meaning there could be other drugs or medications the participant is taking that have an effect on nutrition.

o You can use other resources like the websites listed below.

▪ Physician’s Desk Reference: www.pdrhealth.com

▪ WebMD – www.webmd.com/drugs

▪ RxList – www.Rxlist.com

▪ LactMed – https://www.ncbi.nlm.nih.gov/books/NBK501922/

▪ MotherToBaby – https://mothertobaby.org

▪ Medications and Mothers’ Milk online subscription* - https://www.halesmeds.com/login

• The following agencies have access to the online subscription: Fargo, Bismarck/Mandan, Grand Forks, Rolette County/Turtle Mountain,

FDHU, SWDHU, UMDHU, Walsh County, Richland County, and LRHU. o Document the drug(s) or medication(s) and other important information used to assign this nutrition risk code in the text box below the nutrition

risk code check box.

2. Gather information from the participant or caregiver to assess future steps.

• Ask if the participant has any side effects.

Questions to ask:

o Are you experiencing any side effects from this drug or medication? (If yes, tell me more.) Assess if participant’s nutrition status is affected.

o What concerns does your doctor have about your nutrition status because of this drug or medication?

3. Offer nutrition education and referrals based on the information gathered from talking with the participant or caregiver.

http://www.pdrhealth.com/

http://www.webmd.com/drugs

http://www.rxlist.com/

https://www.ncbi.nlm.nih.gov/books/NBK501922/

https://mothertobaby.org/

https://www.halesmeds.com/login

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Table of Common Drugs and Medications

This table lists common drugs and medications that can affect nutritional status.

Drugs/Medications Possible Side Effects Antiarthritic:

Naproxen thirst, inflammation of the mouth, dry mouth, difficulty swallowing, nausea and vomiting, difficulty with digestion, GI pain, constipation,

inflammation of the colon, diarrhea, gas

Anti-ADHD medication:

Concerta Loss of appetite or not able to eat, ↓ weight, ↓ growth with long term use, dry throat, nausea and vomiting, abdominal pain, diarrhea

Methylphenidate Loss of appetite or not able to eat, ↓ weight, ↓ growth with long term use, dry throat, nausea and vomiting, abdominal pain, diarrhea

Ritalin Loss of appetite or not able to eat, ↓ weight, ↓ growth with long term use, dry throat, nausea and vomiting, abdominal pain, diarrhea

Antiasthma:

Advair Dental pain, ↓ salivation, yeast infection, inflammation of the pharynx, throat irritation, nausea and vomiting, stomach ache, diarrhea

Albuterol appetite, loss of appetite or not able to eat, sore/dry throat, nausea and vomiting, difficulty with digestion, diarrhea

Flovent ↓sense of taste, sore throat, nausea and vomiting

Pulmicort Appetite, nausea, inflammation of the tongue, tooth disorder, tongue swelling, difficulty with digestion, nausea, inflammation of the intestines,

hemorrhoids

Salmeterol Dental pain, ↓ salivation, yeast infection, inflammation of the pharynx, throat irritation, nausea and vomiting, stomach ache, diarrhea

Amphetamine:

Adderall Loss of appetite or not able to eat, ↓ weight, ↓ growth in children, dry mouth, metallic taste, stomach pain/cramps, nausea, diarrhea, constipation

Antibiotic:

Amoxicillin Prebiotics may ↓ GI side effects, nausea and vomiting, diarrhea

Bactrim Loss of appetite or not able to eat, interferes with folic acid metabolism, inflammation of the mouth and tongue, , nausea and vomiting, diarrhea,

Cefdinir Fe, Mg or Aluminum ↓ absorption of drug, nausea and vomiting, abdominal pain, diarrhea,

Cephalexin Oral yeast infection & sore mouth/tongue with long term use, difficulty with digestion, inflammation of the stomach, diarrhea

Clindamycin (Cleocin) Loss of appetite or not able to eat, ↓ weight, thirst, metallic taste (with IV), inflammation of the esophagus, nausea and vomiting, cramps,

severe, gas, bloating, diarrhea

Antidepressants:

citalopram (Celexa) weight, appetite, loss of appetite or not able to eat, ↓ weight, dry mouth, taste changes, salivation, difficulty with digestion, nausea,

vomiting, abdominal pain, diarrhea, gas

duloxetine (Cymbalta) ↓ appetite, ↓ weight, loss of appetite or not able to eat, dry mouth, nausea and vomiting, difficulty with digestion, inflammation of the stomach,

constipation, diarrhea

Paxil appetite, weight or ↓appetite, ↓ weight, dry mouth, taste changes, nausea, difficulty with digestion, constipation, diarrhea, gas.

Wellbutrin loss of appetite or not able to eat, ↓ weight, appetite, weight, ↓ chocolate craving reported , dry mouth, inflammation of the mouth, taste

changes, difficulty in swallowing, inflammation of the pharynx, nausea and vomiting, abdominal pain, constipation, diarrhea

Zoloft Loss of appetite or not able to eat, ↓ weight, dry mouth, nausea and vomiting, difficulty with digestion, diarrhea, constipation, rare-GI bleeding

Anti epileptic:

Carbamazephine Loss of appetite or not able to eat, ↓ biotin, folic acid, Vit D, Ca, dry mouth, inflammation of the mouth, inflammation of the tongue, nausea and

vomiting, abdominal pain, constipation, diarrhea

Keppra Loss of appetite or not able to eat

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Drugs/Medications Possible Side Effects Klonopin Loss of appetite or not able to eat, ↓ weight, appetite, weight with alprazolam or chlordiazepoxide, thirst, dry mouth, salivation, nausea

and vomiting, constipation, diarrhea

Lamictal Loss of appetite or not able to eat, ↓ weight, dry mouth, tooth disorder, nausea and vomiting, difficulty with digestion, abdominal pain, diarrhea,

constipation

Lamotrigine Loss of appetite or not able to eat, ↓ weight, dry mouth, tooth disorder, nausea and vomiting, difficulty with digestion, abdominal pain, diarrhea,

constipation

levetiracetam Loss of appetite or not able to eat

Neurontin weight, appetite, loss of appetite or not able to eat, dental abnormalities, inflammation of the gums, dry mouth or throat, difficulty with

digestion, nausea and vomiting, gas, diarrhea, constipation

Phenobarbital rate of metabolism of Vit D & Vit K, possibly Folic Acid, avoid St. John’s Wort

Tegretol Loss of appetite or not able to eat, ↓ biotin, folic acid, Vit D, Ca, dry mouth, inflammation of the mouth, inflammation of the tongue, nausea and

vomiting, abdominal pain, constipation, diarrhea

Antihyperglycemic agent:

metformin Loss of appetite or not able to eat, stable weight or ↓ weight, ↓ Folic Acid and B12 absorption, metallic taste, difficulty with digestion, nausea and

vomiting, bloating, diarrhea, gas, constipation with extended release form of medication

Anticoagulant:

Coumadin Taste changes, nausea and vomiting, cramps, diarrhea

Heparin Nausea and vomiting, abdominal pain, GI bleeding, constipation, black tarry stools

warfarin Taste changes, nausea and vomiting, cramps, diarrhea

Antihistamine:

Benadryl Loss of appetite or not able to eat, dry mouth/throat, nausea and vomiting, abdominal pain, constipation, diarrhea

Claritin appetite, weight, thirst, loss of appetite or not able to eat, dry mouth, changes in taste, tooth disorder, inflammation of the mouth and tongue,

abdominal pain, diarrhea

loratadine appetite, weight, thirst, loss of appetite or not able to eat, dry mouth, changes in taste, tooth disorder, inflammation of the mouth and tongue,

abdominal pain, diarrhea

promethazine need for Riboflavin, dry mouth, nausea and vomiting, constipation

Anti-hypertensive:

Captopri Loss of appetite or not able to eat, ↓ weight , rare –altered sense of taste, metallic or salty taste, dry mouth, nausea and vomiting, abdominal pain,

constipation, diarrhea

clonidine weight due to swelling, loss of appetite or not able to eat, dry mouth, nausea and vomiting, constipation

labetalol Taste changes, nausea and vomiting, difficulty with digestion

Lasix Loss of appetite or not able to eat, thirst, oral irritation, cramps, nausea and vomiting, diarrhea, constipation

Lisinopril Loss of appetite or not able to eat, ↓ weight , rare –altered sense of taste, dry mouth, nausea and vomiting, abdominal pain, constipation, diarrhea

Tenex Dry mouth, taste changes, difficulty in swallowing, nausea, constipation

Anti-inflammatory:

corticosteroids

(prednisone) appetite, weight, negative Nitrogen balance due to protein breakdown, Ca wasting with long term use., Chromium deficiency may risk for

steroid induced diabetes, inflammation of the esophagus, nausea and vomiting, difficulty with digestion, peptic ulcer, bloating, GI

bleeding/rupture

Antipsychotic:

Seroquel appetite, weight, obesity, loss of appetite or not able to eat, dry mouth, difficulty with digestion, abdominal pain, constipation

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Drugs/Medications Possible Side Effects Antiulcer:

Nexium ↓ gastric acid secretion, gastric pH, nausea, abdominal pain, diarrhea

Omeprazole ↓ gastric acid secretion, gastric pH, nausea, abdominal pain, diarrhea

Prevacid ↓ gastric acid secretion, gastric pH, nausea, abdominal pain, diarrhea

Prilosec ↓ gastric acid secretion, gastric pH, nausea, abdominal pain, diarrhea

Rantidine (Zantac) ↓ Fe & Vit B12 absorption, ↓gastric acid secretions, ↓ gastric pH, nausea and vomiting, diarrhea, constipation

Others:

Digoxin Loss of appetite or not able to eat, ↓ weight, Ca & Vit D induced excess Calcium, maydrug effects, nausea and vomiting, diarrhea

Levothyroxin Appetite changes, ↓ weight

Flexeril Dry mouth, unpleasant taste, difficulty with digestion, nausea, constipation

Glyburide or ↓ appetite, weight, difficulty with digestion, nausea, diarrhea, constipation

Cannabis (marijuana) Dry mouth, nausea, vomiting, heart and blood pressure problems, ↓ immune system

PG - slow fetal growth, associated with childhood leukemia

Codeine - Hydrocodone Loss of appetite or not able to eat, delays digestion, dry mouth, nausea and vomiting, constipation

Corticosteroids Inflammation of the esophagus, nausea and vomiting, difficulty with digestion, peptic ulcer, bloating, GI bleeding/rupture. appetite, weight,

except loss of appetite or not able to eat with triamcinolone, negative Nitrogen balance due to pro breakdown. Ca wasting with long-term use.

Chromium def may risk for steroid induced diabetes.

Insulin weight, no weight in Type 1 diabetes with insulin.

Methadone Loss of appetite or not able to eat, dry mouth, nausea and vomiting, cramps, constipation

Nystatin GI pain, nausea and vomiting, stomach pain, diarrhea, No GI absorption

Oxycodone: Vicoden Loss of appetite or not able to eat, dry mouth, difficulty with digestion, inflammation of the stomach, nausea and vomiting, diarrhea, constipation

Percocet Loss of appetite or not able to eat, dry mouth, difficulty with digestion, inflammation of the stomach, nausea and vomiting, diarrhea, constipation

Propranolol Dry mouth, nausea and vomiting, abdominal pain, diarrhea, constipation, gas

Singulair Difficulty with digestion, diarrhea

Synthroid Appetite changes, ↓ weight, Rare- nausea, diarrhea

Tramadol Loss of appetite or not able to eat, dry mouth, difficulty with digestion, nausea and vomiting, abdominal pain, constipation, diarrhea, gas

Adapted from the Washington WIC Nutrition Program (10/2013)

Documents

ND WIC Program Nutrition Risk Code Manual February 2020 · User Nutrition Interview (Question 1a, 1e, or 1 g) 302 HR P-1 Gestational Diabetes Presence of gestational diabetes defined