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DEDICATED TO THE HEALTH OF ALL CHILDREN
Winner of Outstanding Chapter Award 1966, 1996, 2000 & 2004 |
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How WIC can help you support breastfeeding
Georgia Physicians Breastfeeding Advisory Committee
Return to the GA Chapter AAP Homepage
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Please contact the Chapter's WIC/Nutrition Coordinator, Kylia Crane, RD, LD, with any questions regarding the information on this site at kcrane@gaaap.org.
"WIC Physicians Outreach Campaign"What are we doing?Goal: To maximize utilization of WIC nutrition services through a collaborative partnership between primary care physicians and providers of WIC services. The Georgia Chapter of the American Academy of Pediatrics and the Georgia WIC Program have established a statewide physicians outreach campaign to educate physicians and their office staff about WIC benefits/referral process and help address infant and child feeding issues, which can be supported by physicians and WIC staff to improve the nutrition status of women, infants and children. Implementation and evaluation of the effectiveness of the WIC Physicians Education model to assist physicians and office staff to effectively utilize WIC referrals, WIC benefits and nutrition in the following geographical areas of the State: Dublin (District 5-1 South Central Health District) We are providing education to the primary care physicians, physician’s office staff and health department staff in each district using 3 different mediums of communication:
Mapping of the
WIC Education Pilot Project:
Utilize the WIC physician's advisory board with representation from chapter members and other State medical specialty societies (Georgia OB-GYN Society, Ga. Academy of Family Physicians, Academic Representative) to help coordinate the efforts of the WIC physicians outreach campaign.
October 1, 2006 – September 30, 2009
The Georgia WIC Program has awarded the new infant formula contract to Ross Pediatrics. The newly awarded contract will transition to Ross from the incumbent Mead Johnson. The contract with Ross encompasses October 1, 2006 through September 30, 2009. With the new contract, Similac Advance with Iron, Isomil Advance with Iron, Similac with Iron and Isomil with Iron will become the new contract formulas. WIC eligible moms that decide not to breastfeed should be given a WIC contracted formula unless an alternative formula is indicated. Every three years, state WIC agencies are required by law to competitively bid infant formula rebate contracts with formula manufacturers. This means that WIC state agencies agree to provide one brand of infant formula and in return, the manufacturer gives a rebate for each can of formula purchased by WIC participants. The brand of formula varies from state to state depending on which company is awarded the rebate contract in that particular state. Since 1998, the single source, cost containment initiative has yielded approximately $529 million in rebate reimbursement for the Georgia WIC Program. This translates into more mothers and infants who can be served, and increased nutrition programming for you, your patients and their families. In accordance with Georgia WIC Program policy, alternative iron fortified soy formulas or special formulas are only available for WIC infants with documented special nutritional needs. Should you decide that an alternative formula best meets the nutritional requirements of your patient, a physician’s written order, including a documented medical condition, the name of the alternative product and the expiration date of the order must be provided to the local WIC nutritionist. Thus, formulas such as Enfamil A.R., premature formulas and protein hydrolysates are available with a prescription for approved indications. Emphasis should still be placed on encouraging mothers to breastfeed to provide optimal nutrition for their children. Below is the WIC Formula Guide to use as reference to ease you through this transition. It describes which formulas are approved contract formulas and not approved non-contract formulas. The Chapter will continue to provide your practices with information and resources via The Georgia Pediatrician, and on our website www.gaaap.org. If you have any questions regarding this information, please contact Kylia Crane, RD, LD, WIC/Nutrition Coordinator at (404) 881-5093 or via email at kcrane@gaaap.org Stanley Cohen, MD, FAAP, Chairman, Committee on Nutrition _________________________________________________________________
Below is the WIC Formula Guide to use as reference to ease you through this transition. It describes which formulas are approved contract formulas and not approved non-contract formulas. Click here for a printable version of this guide.
Georgia WIC Formula Guide A reference for WIC approved formulas October 1, 2006 – September 30, 2009
“Human Milk is considered to be the gold standard for infant feeding.”
Follow WIC guidelines for prescription documentation for all other formulas.
Lactose Free Formula (Prescription Required):
All participants who receive a milk-based, lactose free formula will receive the contract formula Similac Sensitive (Similac Lactose Free Advance). Prescriptions will not be accepted for Enfamil LactoFree Lipil.
Questions or concerns please contact:
Todd R. Stormant RD, LD Kylia Crane, RD, LD Nutrition Program Consultant WIC/Nutrition Coordinator DHR, Nutrition Section, WIC Georgia Chapter, AAP (404) 657-2884 (404) 881-5093 trstormant@dhr.state.ga.us kcrane@gaaap.org
The
Committee on Nutrition of the Georgia Chapter, American Academy of
Pediatrics is committed to decreasing the prevalence of obesity in the
children of this state. You
are probably familiar with the statistics.
The newest studies are even more frightening.
Preliminary data indicates that in Georgia, eighteen percent of
eighth graders and twenty five percent of 4th graders are over the 95th
percentile for weight.
The
task will not be easy, but it is obviously important.
We are asking the pediatricians of Georgia to help evaluate these
children and guide their families. The
following materials should be helpful to you in evaluating your
patients: 1) Parents
a Nutritional Help for you and your children is a listing of
recommendations from the Georgia Chapter’s Committee on Nutrition that
you can give to your patients.
You are welcome to adapt this to your practice and substitute your own
practice name if you wish. 2)
Instructions for calculating the Body Mass Index (BMI) for your
patients, and the appropriate charts for converting these raw numbers
into a meaningful percentile for age (please remember these scores may
not be entirely accurate for active athletes).
3)
A list of ICD-9 Codes that may be appropriate in billing for your
services. We
hope this will help in your care of obese children and those at risk.
Please let us know of any organized community based programs
emphasizing physical activity, eg Step Programs.
We would like to publish a list of available programs to increase
awareness and participation.
Thank you for efforts to combat the obesity epidemic in Georgia.
Stanley A. Cohen, MD Chair, Nutrition Committee
Assessment of Overweight
Body Mass Index (BMI)
How do you
measure overweight and obesity in children? Expert Committee Recommendations1 on obesity evaluation and treatment suggest using Body Mass Index (BMI) as the main tool to assess weight. BMI is a single number that evaluates an individual's weight status in relation to height. Unfortunately, only a small percentage of health care professionals report using BMI in their practice.2
Why use
Use of BMI to assess
children provides a consistent measure across age groups. It
correlates with measures of body fatness in children and adolescents.
BMI is the standard measure used by the Centers for Disease Control and
Prevention in the revised U.S. growth charts that were released in May
2000
and are available at the following website:
www.cdc.gov/growthcharts
;
www.rosspediatrics.com
or order from the American Academy of Pediatrics.
How do I calculate BMI using handheld calculator:
There are various
computer and palm pilot applications available to calculate BMI.
You will enter the child’s age, height and weight and it will calculate
the BMI.
On-line: http://www.nhlbisupport.com/bmi/ http://www.cdc.gov/nccdphp/dnpa/bmi/
Palm Pilot: http://hin.nhlbi.nih.gov/bmi_palm.htm. http://www.keepkidshealthy.com/pediatricpilotpage/mathpad.html
How do I define
overweight in my patients? Being “OVERWEIGHT” means that a child has a body mass index that is above the 95th percentile for his or her age. A body mass index that is above the 85th percentile for his or her age puts a child “AT RISK” of becoming overweight. Use the attached BMI growth charts to plot the BMI and assess growth percentiles.
1.(PEDIATRICS Vol. 102
No. 3 September 1998, p. e29,
http://www.pediatrics.org/cgi/content/full/102/3/e29 )
2. (PEDIATRICS,
Supplement to Pediatrics, Volume 110, NO. 1, July 2002)
Obesity Reimbursement and Coding
The AAP Committee on Nutrition (CON) with other AAP committees and sections has recognized the difficulties in getting reimbursement for obesity treatment and prevention. Until the Centers for Medicare and Medicaid Services recognize obesity as a disease, coverage and reimbursement will be denied. AAP is addressing this issue to advocate for improved coverage and reimbursement by managed care plans and private and public insurers.
Correct diagnosis coding rules stipulate that the code for the diagnosis, condition, problem or other reason for an encounter shown in the medical record to be chiefly responsible for the services provided be reported. Additional codes can and should be reported describing any coexisting conditions that require or affect patient care treatment or management during a particular visit. If these conditions are not addressed during the course of a particular visit, they would not be reported. History codes (V10 – V19) may be used as secondary codes if the patient or family history impacts current care or influences treatment. These reported codes must be shown by documentation that the condition requires or affects patient care or management.
At times there are no other problems, history or diagnoses that can be reported in addition to the diagnosis of obesity (278.00) or morbid obesity (278.01).
Obesity related conditions or diagnoses that are commonly treated and addressed include:
780.71
Chronic fatigue syndrome
780.79
General fatigue
786.05
SOB
401._
Hypertension
780.57
Sleep apnea
530.81
Reflux
250.__
Diabetes
701.2
Acanthosis nigricans
277.7
Dysmetabolic syndrome X
V18.0
Family history diabetes
V18.1
Family history endocrine/metabolic disturbance
732.4
Blount’s Disease
313.81
Oppositional behavior disorder
300.4
Depression
V61.20
Parent-child dysfunction
259.1
Early pubertal development
Breastfeeding-Best for Baby and MotherBackground:
Scientific research overwhelming indicates that breastfeeding is the superior method of feeding. Breastfeeding significantly lower rates of diarrhea ear infections and lowers respiratory illness. There are a number of studies that show a protective effect of human milk feeding against necrotizing enterocolitis, sudden infant death syndrome, allergic disease, early childhood caries, insulin-dependent diabetes, and obesity. Developmentally, breastfed infants have better visual acuity, and evidence suggests that their cognitive development is very good! Breastfeeding BenefitsBenefits to Mom:
Benefits to Baby:
Special attention should be given to barriers to breastfeeding for all women especially African American and other minority women. Below are several barriers to breastfeeding that where identified in focus group findings.
Studies show that mothers who receive advice, information and encouragement from their physicians to breastfeed are more likely to breastfeed than those who do not receive such advice. The American Academy of Pediatrics Policy Statement outlines physicians roles in the promotion and protection of breastfeeding. (Pediatrics, Vol. 100 No. 6 December 1997, Pgs. 1035-1039) or view it on the web by accessing www.aap.org/policy/re9729.html We can work together to increase breastfeeding in Georgia!
Pleas see the American Academy of Pediatrics recent policy statement, which highlights the need for important collaboration between Pediatricians and local WIC Programs to ensure that infants and children receive high-quality, cost-effective health care and nutrition services. (Pediatrics, Vol. 108 No. 5 November 2001, pgs. 1216-1217) or view it on the web by accessing: www.aap.org/policy/re0066.html
Breastfeeding Handout:
The Georgia Physician Breastfeeding Advisory Committee (PBAC) is a
collaborative effort among Family Physicians, OB/GYNs, Pediatricians,
and lactation experts to promote breastfeeding in the state.
We have developed a patient handout, which you are encouraged to
copy and distribute, to assist our patients in initiating breastfeeding
successfully and continuing to nurse for a significant time period. You
can access the handout by visiting:
http://www.gaaap.org/duringpregnancyhandout.pdf)
Books and Manuals:
Breastfeeding: A Special Relationship (also available in Spanish) Breastfeeding EventsJuly 23-27, 2008 ILCA Annual Conference The theme is “One Voice, Uniting the Profession – Practice, Professionalism, Policy”. The conference will be held July 23 – 27, 2008 at the Red Rock Resort, Spa, Casino in Las Vegas, Nevada. Click here for more information
Oct. 1-3 2008 VELB/ILCA Conference and Annual Meeting. The theme is “A World Wide View on Breastfeeding.” The conference will be held October 1 - 3, 2008 at the Austria Center Vienna, Austria. Please see www.ilca.org and www.velb.org for more information on the conference.
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Georgia
Chapter
Breastfeeding
is acknowledged as the preferred method of infant feeding by the
American Academy of Pediatrics, the American College of Obstetrics and
Gynecology, the National Association of Pediatric Nurse Practitioners,
The National Healthy Mother/Healthy Babies and others.
