What is Considered Nutritional Risk for WIC?

According to the USDA, WIC serves millions of low-income pregnant, postpartum, and breastfeeding women, and infants and children up to age five who are found to be at nutritional risk. To be eligible for WIC, a participant must meet certain income requirements and be determined to have at least one of these nutritional risk conditions.

Quick Summary

WIC defines nutritional risk using both medically-based and dietary-based criteria to determine eligibility. These risks include conditions like anemia, inappropriate weight gain or loss, and dietary deficiencies, assessed by a health professional.

Key Points

• Two Primary Risk Categories: WIC determines eligibility based on medically-based risks and dietary-based risks, which are distinct types of nutritional concerns.

• Professional Assessment is Required: Eligibility is not automatic and requires a nutritional assessment conducted by a qualified health professional like a Registered Dietitian or nurse.

• Risks Vary by Life Stage: Specific risk factors are evaluated depending on whether the participant is a pregnant woman, infant, or child, with criteria tailored to their unique needs.

• Anemia is a Common Factor: For many WIC participants, a hemoglobin or hematocrit blood test is performed to check for iron-deficiency anemia, a prevalent nutritional risk.

• Dietary Risk Includes Specific Practices: Beyond just general 'poor diet,' WIC evaluates specific inappropriate feeding practices for infants and children, such as early introduction of solids or inappropriate bottle use.

• Anthropometric Risks are Key: Measuring height and weight is a fundamental part of the assessment to identify anthropometric risks like being underweight, overweight, or having inappropriate growth patterns.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food assistance, nutrition education, and healthcare referrals to millions of Americans. A cornerstone of the program’s eligibility process is determining whether an individual is at “nutritional risk”. This is not simply a matter of being low-income, but rather a specific health or diet-related concern identified by a qualified health professional.

The Two Main Types of Nutritional Risk for WIC

WIC recognizes two primary categories of nutritional risk: medically-based and dietary-based. Both are evaluated during the certification process by a Competent Professional Authority (CPA), which may include a Registered Dietitian, nutritionist, nurse, or other designated health professional.

Medically-Based Nutritional Risk

This category includes health conditions or factors that have a direct impact on a person's nutritional status. These are often considered high-priority risks. The assessment typically involves gathering anthropometric data (height, weight) and biochemical data (blood tests).

Examples of medically-based risks include:

• Anthropometric risks: Concerns related to growth or body measurements.
  • Low/High Maternal Weight Gain: Inappropriate weight gain during pregnancy.
  • Underweight/Overweight/Obesity: Body Mass Index (BMI) outside of a healthy range for women or age-specific ranges for children.
  • Low Birth Weight/Prematurity: Birth weight under 5 lbs 8 oz (2500g) or preterm/early delivery.
  • Failure to Thrive: Slowed or faltering growth patterns in infants and children.
• Biochemical risks: Conditions revealed through blood work.
  • Anemia (Low Hemoglobin/Hematocrit): Iron deficiency is a common concern for WIC populations.
  • Elevated Blood Lead Levels: Indicates exposure to lead, which affects nutrition and development.
• Other medical risks: A broad range of diagnosed conditions.
  • Pregnancy Complications: Includes conditions like gestational diabetes or hyperemesis gravidarum.
  • Gastrointestinal Disorders: Conditions that affect nutrient intake, digestion, or absorption.
  • Genetic and Congenital Disorders: Conditions impacting nutritional needs.
  • Substance Use: Tobacco, alcohol, or other substance use can affect maternal and infant health.

Dietary-Based Nutritional Risk

This risk category identifies participants with eating patterns that are inadequate or inappropriate for their age and life stage. The evaluation typically involves a diet recall or questionnaire.

Examples of dietary-based risks include:

• Inappropriate Dietary Patterns: Failing to meet the dietary guidelines set forth by the USDA/HHS.
  • Excessive Intake: Overconsumption of fat, sugar, or sodium.
  • Inadequate Intake: Deficiencies in essential nutrients like iron, folate, calcium, or vitamins.
  • Highly Restrictive Diets: Such as vegan or other limited diets that may result in nutrient deficiencies.
• Inappropriate Feeding Practices: Issues specific to infants and children.
  • Early Introduction of Solids: Feeding solid foods before 4-6 months of age.
  • Inappropriate Use of the Nursing Bottle: Leading to baby bottle tooth decay.
  • Feeding Low-Nutrient Foods: Providing beverages or foods low in nutritional value.
• Pica: Craving and consuming non-food items like clay, dirt, or starch.
• Food Allergies/Intolerances: Requiring special formulas or dietary adjustments.

Nutritional Risk by Participant Category

The specific nutritional risk criteria vary depending on the participant’s life stage. The WIC assessment is tailored to the distinct needs of pregnant women, infants, and children.

Pregnant Women

For pregnant women, WIC focuses on addressing risks that could affect both the mother's health and the baby's development. This includes pre-pregnancy weight, gestational weight gain, anemia, age at conception, and certain medical diagnoses like gestational diabetes. Pica is also assessed due to its potential link with nutrient deficiencies.

Infants

Infant risk assessment focuses on growth and feeding practices. Anthropometric risks like low birth weight, prematurity, or faltering growth patterns are key. Dietary risks include inappropriate infant feeding practices, such as feeding cow's milk too early or incorrect formula preparation. Infants can also be certified based on the mother's nutritional risk during pregnancy.

Children

For children up to age five, risk assessment addresses growth patterns (underweight, overweight, obesity) and dietary issues. Inappropriate nutrition practices are a common risk code, encompassing a range of issues from feeding low-nutrient beverages to specific eating problems. Anemia screenings are also conducted at certain intervals.

WIC Risk Categories: A Comparison

Feature	Medically-Based Risk	Dietary-Based Risk
Basis for Eligibility	A diagnosed medical or health condition with nutritional implications.	An eating pattern that is inadequate, excessive, or inappropriate.
Assessment Tools	Anthropometric measurements, blood tests, medical records review.	24-hour dietary recall, health questionnaires.
Examples (Women)	Anemia, gestational diabetes, underweight/overweight.	Low intake of fruits/vegetables, highly restrictive diets.
Examples (Infants/Children)	Low birth weight, failure to thrive, food allergies.	Inappropriate feeding practices, early introduction of solids.
Documentation	Provided by a health care provider or WIC staff.	Assessed by WIC staff based on participant's report.

The WIC Nutritional Risk Assessment Process

During a WIC certification appointment, a health professional determines nutritional risk by performing a nutritional assessment. This typically involves:

1. Reviewing Medical History: Examining information from the participant's healthcare provider regarding diagnoses, conditions, or past pregnancy outcomes.
2. Taking Measurements: Measuring height, weight, and sometimes head circumference for infants to evaluate growth.
3. Conducting Bloodwork: Performing a blood test (hemoglobin or hematocrit) to check for anemia.
4. Asking Dietary Questions: Discussing current eating habits, food preferences, and any specific feeding practices.

Based on this information, the professional assigns one or more nutritional risk codes that correspond to the participant's findings. The assignment of these codes determines eligibility and helps tailor the nutrition education and food package to the participant's specific needs. For more information, visit the USDA Food and Nutrition Service website.

Conclusion

Qualifying for WIC based on nutritional risk is a comprehensive process that goes beyond just meeting income guidelines. The assessment, conducted by qualified health professionals, identifies specific medical conditions and dietary patterns that could negatively impact the health of women, infants, and children. By identifying these risks—from anemia and abnormal growth to inappropriate feeding practices—WIC can provide targeted nutrition education and food support to help improve health outcomes for its participants. The program's focus on both medical and dietary indicators ensures a holistic approach to nutritional well-being for vulnerable populations.

Frequently Asked Questions

What is a medically-based nutritional risk for WIC?

A medically-based nutritional risk is a health condition or factor identified by a health professional that affects a person's nutritional status. Examples include anemia, underweight, or a history of pregnancy complications like gestational diabetes.

What is a dietary-based nutritional risk for WIC?

A dietary-based risk involves inappropriate or inadequate eating patterns. This includes not meeting Dietary Guidelines, consuming excessive amounts of certain nutrients, or having restrictive diets. It also covers inappropriate feeding practices for infants and children.

Is being overweight considered a nutritional risk for WIC?

Yes, being overweight or obese is considered a medically-based nutritional risk for WIC participants. It is evaluated based on pre-pregnancy BMI for women and age-specific weight-for-height or BMI for children.

What happens during a nutritional risk assessment for WIC?

During the assessment, a health professional will review your medical history, take measurements like height and weight, and perform a blood test for anemia. They will also ask questions about your diet and feeding practices to determine eligibility.

Can an infant be certified for WIC based on the mother's risk?

Yes, an infant can be certified for WIC based on the nutritional risk of their mother during pregnancy, in addition to any risks identified for the infant themselves.

What qualifies as inappropriate infant feeding for WIC?

Inappropriate infant feeding for WIC includes issues like feeding solid foods before a baby is ready (4-6 months), giving whole cow's milk before 12 months, or improper formula dilution. This can also include inappropriate use of a nursing bottle.

Is a low-income family automatically eligible for WIC?

No, a family is not automatically eligible for WIC based on income alone. They must first meet the income requirements and then be determined to have a medically-based or dietary-based nutritional risk, identified by a health professional.