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Changes to Dietary Risk Criteria Affect Participant Forms
On October 1, 2007, Texas WIC implemented FNS Policy Memorandum 98-9, Revision 8, Nutrition Risk Criteria. This implementation revised and consolidated 18 Texas WIC dietary risk criteria to only five risks:
- Failure to Meet Dietary Guidelines for Americans,
- Inappropriate Nutrition Practices for Infants,
- Inappropriate Nutrition Practices for Children,
- Inappropriate Nutrition Practices for Women, and
- Dietary Risk Associated with Complementary Feeding Practices.
The most dramatic change is the inclusion of the allowable nutrition risk Failure to Meet Dietary Guidelines for Americans, and is based on presumptive risk. This new criterion applies only to women and children older than two and is the result of two significant findings from the 2002 Institute of Medicine’s (IOM) Report Dietary Risk Assessment in the WIC Program:
- Nearly all low-income women in the childbearing years and children ages 2 to 5 years usually consume fewer than the recommended number of servings specified by the Food Guide Pyramid and, therefore would be at dietary risk based on the WIC nutrition risk criterion Failure To Meet Dietary Guidelines for Americans.
- IOM also concluded that all dietary assessment methods are not adequate to precisely identify an applicant’s eligibility status using criteria based on the Food Guide Pyramid or on dietary intake. Note: This criterion will apply only to women and children older than two.
To ensure that all WIC applicants and participants receive a thorough assessment, this risk may only be assigned after a complete nutrition assessment has been performed including growth, biochemical, health/medical, and diet, and no other risks have been identified.
What takes the place of the 24-hour diet recall and the diet questions previously asked on the Diet Assessment Form?
A complete diet assessment will be performed when assessing for Inappropriate Nutrition Practices. This risk criterion is category specific and consolidates previous dietary risk criteria that applied to infants, children, or women. Texas WIC took this opportunity to implement the new Value Enhanced Nutrition Assessment (VENA) philosophy at the same time we implemented the revised diet criteria. Rather than collecting diet intake information and asking specific questions to identify each and every dietary risk, a conversation occurs to identify potential dietary risks. But more important, it also serves to bring out the concerns and questions our participants have specific to their immediate needs and allows WIC staff to provide more meaningful and valued education to our participants.
Dietary Risk Associated with Complementary Feeding Practices is a new criterion for infants 4 to 12 months and children 12 to 24 months. This risk was added as a predisposing risk due to the fact that inappropriate complementary feeding practices are common and well documented in this population. Also, there are no nationally accepted dietary guidelines for children under the age of two. WIC plays a key role in the prevention of nutrition-related health problems, but also in the promotion of lifelong healthy eating behaviors. A complete nutrition assessment must be completed prior to assigning this risk, similar to Failure to Meet Dietary Guidelines for Americans, including Inappropriate Nutrition Practices for Infants or Children. Although Texas WIC made the decision to use this risk only if no other risk(s) are identified, this criterion allows WIC staff to focus on this vulnerable group and assist caregivers in making appropriate feeding decisions for their infants and young children related to the nutritional needs and developmental stage of this age group.
Other changes of note include:
- 152, Low Head Circumference – A correction to FNS Policy Memorandum 98-9, Revision 7, April 2004 – This criterion applies to the infant category only and has been deleted for children 12 to 24 months.
- 420, Excessive Caffeine Intake – This is no longer an allowed criterion. A recent scientific literature review was unable to confirm that caffeine transferred into breast milk would have a deleterious effect on the breastfed infant.
- 422, Inadequate Diet – This criterion has been deleted as it is no longer necessary as a result of the revision of the dietary risk criteria and the inclusion of the IOM recommended presumptive dietary risk criterion.
Ongoing IDL trainings is available to provide more information and guidance in implementing the new dietary criteria. The Texas WIC program looks upon these changes as an opportunity to enhance the services we provide and to make each visit to the WIC clinic a valued and meaningful experience for all participants.