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Nutrition

WHAT IS WIC?

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a short-term intervention program designed to influence nutrition and health behaviors in a targeted, high-risk population.

WHO IS ELIGIBLE TO PARTICIPATE?

Pregnant, breastfeeding, or postpartum women, infants and children under five years of age who meet the following:

• Resident of Georgia
• Income level ≤185% of poverty guidelines, or enrolled in Medicaid, TANF, or Food Stamps
• Nutrition risk must be documented

Those eligible may receive WIC services even if they are working, are under the care of a private physician, and/or have private insurance. To determine eligibility, clients must provide proof of ID, proof of residency and proof of income or Medicaid/food stamp enrollment.

CURRENT INCOME ELIGIBILITY GUIDELINES

The United States Department of Agriculture, Food and Nutrition Service publishes the annual Income Eligibility Guidelines for WIC.

To view the guidelines, please visit here.

WHAT DO PARTICIPANTS RECEIVE?

  • Quality Nutrition Education Services
  • Breastfeeding Promotion and Education
  • A Monthly Food Prescription – Nutritious foods tailored to supplement the dietary needs of participants
  • Infants- formula/medical food, infant cereal, baby food fruits & vegetables (and infant meats if exclusively breastfed)
  • Children- milk, cheese, tofu[1], eggs, juice, cereal, beans/peas or peanut butter, fruits & vegetables, and whole grain bread or alternative
  • Women- milk, cheese, tofu1 eggs, juice, cereal, beans/peas or peanut butter, fruits & vegetables, whole grain bread or alternative, and fish
  • Referrals to other public health programs
  • Referrals to healthcare and community services

WHEN AND HOW DOES THE PARTICIPANT RECEIVE WIC VOUCHERS?

The participant receives monthly food vouchers from their local health departments. These vouchers specify which foods the recipient is to receive. The vouchers are then redeemed by the participant through an approved vendor.

How long will participants receive WIC Services

  • Prenatal women can stay on the WIC program throughout their pregnancy until six weeks postpartum.
  • Postpartum women may continue (if still eligible) until six months postpartum.
  • Breastfeeding women may remain on the program for up to one year after delivery (if they continue to breastfeed).
  • Infants may remain on the WIC program until their first birthday.
  • Children may be eligible for WIC up to five years of age. They must be reassessed for eligibility every six months.

How to I refer my patients or provide a WIC perscription?

Please use Georgia WIC Referral Form for referrals. To access the GA WIC referral and medical documentation forms, and other WIC resources:

• Please visit  http://wic.ga.gov/hcprovider.asp

• Contact the State WIC Office at 1-800-228-9173

• Contact your closest health department/WIC clinic, visit the WIC website at http://health.state.ga.us/wic_clinics/clinic_lookup.aspx

WIC Infant & Child Formula Algorithm Webinar and Resources

The Committee on Nutrition will be unveiling its new Formula Algorithm for Children on Georgia WIC soon!  The Georgia AAP has been working with the Georgia WIC Program to develop a child formula algorithm to assist pediatricians and WIC Staff in the decision-making process of providing formulas for children.  This project is similar to the work that was done with the infant formula algorithm.  The algorithm, authored by Jay Hochman, MD, FAAP and Stan Cohen, MD, FAAP will be disseminated soon!

A webinar on the infant and child algorithm was presented September 29, 2017 by Jay Hochman, MD and Kylia Crane RDN, LD. To view the recording, click here.

The Georgia WIC Referral Poster

This poster was designed to remind practices to refer their patients to WIC. There are many eligible pregnant, postpartum women, infants, and children that can benefit from WIC if enrolled, yet many referrals are submitted just for infants that are  on special formulas that require a medical documentation form. A gap exists for the many patients that can benefit from all the resources and services that WIC provides. Click Here to download the poster.

If you’re interested in receiving a hardcopy of the Infant Formula Algorithm or Referral Poster, please contact Kylia Crane at kcrane@gaaap.org or 404-881-5093.

WIC Physician Outreach Campaign

What are we doing?

Goal: To maximize utilization of public health programs services through a collaborative partnership between primary care physicians and public health.

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. Education is provided to pediatricians and their office staff on:

Outline of Discussion Topics

  • Certification period-encouraged referrals
  • Referral Form
  • Breastfeeding services (Peer Counselor Program, Nutrition Education, Breast Pumps)
  • Medical Documentation Form
  • Qualifying Diagnoses for WIC Special Formulas
  • USDA Guidelines for special formula based on medical necessity
  • WIC resources- WIC.GA.GOV
All participants will receive an outreach folder with the following items:

  • Infant Formula Algorithm & Resource Guide
  • Referral Poster
  • Formula Guide
  • WIC Approved Formulas Listing
  • WIC Outreach Flyer
  • WIC Approved Food List
  • NWA WIC Pocket Calendar
  • Business cards

Georgia’s WIC Rebate Formula Contract: Mead Johnson Nutriton

Georgia WIC is currently in a contract with Mead Johnson Nutrition. They won the competitive bid to be the rebate contractor of infant formula for Georgia’s WIC.  The contract with Mead Johnson went into effect October 2019.

Approximately every three years, WIC State agencies are required by law to seek competitive bids for the provision of contract infant formulas.  WIC State agencies receive a rebate for each can of contract infant formula purchased by WIC participants. Having a formula contract maximizes resources such as nutrition services for WIC clients and the patients we serve. As a result of awarding the contract to a new formula manufacturer, there will be changes to Georgia’s WIC approved formulas.

With the contract, the following contract formulas will not require a prescription:

  • Milk Based Formula: Enfamil Infant
  • Lactose-Reduced Formula:Enfamil Gentlease
  • Soy Based Formula: Enfamil ProSobee

The complete listing of all Georgia’s WIC approved formulas and medical foods requiring medical documentation can be found at www.wic.ga.gov under the Health Care Provider link.

Please remember that we share the vision to encourage and support WIC mothers to breastfeed as the optimal source of nutrition. WIC eligible moms that decide not to breastfeed should be given a WIC contracted formula or an alternative formula that is medically indicated.

The Chapter will continue to provide your practice 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, Nutrition Coordinator at (404) 881-5093 or via email at kcrane@gaaap.org.

Changes to the Georgia WIC Food Packages 

WIC Food Packages

On October 1, 2009, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)  significantly changed the food packages that participants receive. The changes to the WIC food packages are designed to improve the nutrition and health of pregnant women, breastfeeding and non breastfeeding postpartum women, infants and children up to age five. The new food packages promote and support the establishment of successful, long-term breastfeeding, provide WIC participants with a wide variety of foods including fruits, vegetables, and whole grains, and provide greater flexibility in tailoring food packages to accommodate the cultural food preferences of WIC participants.

Highlights of the Food Package

  • Addition of baby foods – fruits and vegetables for all infants and meat for exclusively breastfed infants
  • Modified infant formula amounts to reflect varying needs at different ages
  • Addition of a fruit and vegetable voucher (Fresh / Frozen / Canned)
  • New Whole Grain Options for Women and Children (Bread / Brown Rice / Whole Grain Tortillas)
  • Whole Grain Cereals- At least half of the cereals on the Approved Food List MUST be Whole Grains
  • Required issuance of low fat milk for children over 2 years of age and women
  • Soy Milk and Tofu allowed
  • Reduced quantities of milk, eggs, and juice and cheese for women and children

Reinforces Nutrition Education Messages

The new food packages are consistent with the nutrition education messages provided to participants:

  • Eat more fruits and vegetables
  • Decrease saturated fat
  • Increase whole grains and fiber
  • Drink less sweetened beverages and juice
  • Babies are meant to be breastfed

How does this impact my practice?

Approximately 51% of Georgia infants and children qualify for the WIC program, which means a significant number of your patients are receiving WIC benefits. These changes will not only affect the choices of foods that your patients can receive but it will also require you to individualize the package based off your patient’s unique medical needs. Significant changes have been made for the process for writing WIC prescriptions for special formulas & medical foods.

Provides greater consistency with infant feeding practice guidelines

Modifies infant formula amounts based on age and feeding method. Infant foods are added and juice eliminated in the packages for older infants in order to promote healthy dietary patterns.

Provides culturally diverse foods

The new food packages provide more participant choice and a wider variety of foods than the previous food packages. Foods such as tortillas, brown rice, soy-based beverage, canned salmon, and a wide choice of fruits and vegetables will provide State agencies increased flexibility in prescribing culturally appropriate food packages.

Promotes Breastfeeding

The food packages for the breastfeeding infant-mother dyad provide stronger incentives for continued breastfeeding, including providing limited formula to partially breastfed infants during the first month of life. Additional quantities and types of food are provided to breastfeeding mothers.

How does this impact my practice?

Approximately 51% of Georgia infants and children qualify for the WIC program, which means a significant number of your patients are receiving WIC benefits. These changes will not only affect the choices of foods that your patients can receive but it will also require you to individualize the package based off your patient’s unique medical needs. Significant changes have been made for the process for writing WIC prescriptions for special formulas & medical foods.

Medical Documentation

Medical documentation ensures that you have approved the issuance of special formulas & medical foods that are appropriate for your patient’s specific medical needs. The goal of the new medical documentation requirements is to improve communication and coordination of care between WIC, the family, and the medical home. This will also ensure that there is appropriate justification for the use of special formulas & medical foods.

  • Medical documentation is required in the following situations:
  • Any infants receiving non-contract/exempt or specialty infant formula or WIC eligible medical food
  • Allowable supplemental foods to be provided in addition to the formula, for those participants receiving exempt or specialty infant formula or WIC eligible medical food
  • Children receiving milk substitutions of soy beverage, tofu, or extra cheese

The new requirements for GA WIC approved special formulas and medical foods include:

  • Name of authorized WIC formula or WIC-eligible medical food. Must be prescribed in ounces (reconstituted fluid) per day
  • Qualifying condition(s) for issuance of WIC formula prescribed and/or supplemental food authorized and ICD-9/ICD-10 code
  • Length of time (1-6 months) the prescribed WIC formula and/or supplemental food is required by the participant
  • Original signature, date and contact information of the requesting health care provider. No signature stamps will be accepted
  • Must specify foods allowed for all clients on special formulas (age 6 months & older)
  • Can ONLY be signed by a physician, physician assistant, or nurse practitioner
  • Physician must authorize the issuance of any tofu or soy milk to children

Qualifying Medical Diagnoses Guide for Special Formulas & Medical Foods

Examples of Qualifying Medical Conditions

  • Premature birth
  • Low birth weight
  • Failure to thrive
  • Inborn errors of metabolism & metabolic disorders
  • Gastrointestinal disorders
  • Malabsorption syndromes
  • Immune system disorders
  • Severe food allergies requiring the use of an elemental formula
  • Other life-threatening disorders, diseases, or medical conditions that impair the ingestion, digestion, absorption or utilization of nutrients that could adversely affect the participant’s nutritional status

Examples of Non-Qualifying / Excluded Medical Conditions

  • Solely for the purpose of enhancing nutrient intake or managing body weight without an underlying condition
  • Non-specific formula intolerance or food intolerance
  • Participant preference, parental preference, or food dislikes

Examples of Non-Specific Diagnoses that will not be accepted for special formulas and medical foods include: colic, milk allergy, milk/formula intolerance, feeding problems, poor appetite, inadequate intake, and digestive disturbances

Medical Documentation Forms have been created to make it easier to document the specific information required by the United States Department of Agriculture regulations. Using the GA WIC Medical Documentation Forms (Form #1 and Form #2) and completing them appropriately will save your practice valuable time and effort.

Use Form #1 to prescribe special formulas and/or medical foods and to approve the WIC foods allowed based on a patient’s medical condition(s). Instructions and resources for form completion are included.

Use Form #2 to provide referral data and to authorize special food substitutions for children

These fillable forms can be saved, printed, signed and then faxed to the local WIC clinic or provided to the WIC participant.

The Georgia WIC Program has developed a webpage for healthcare providers to access GA WIC forms and resources ( Medical Documentation forms 1 & 2, WIC Formula Guide, WIC Approved Food List, and Medical Community Video)

Please visit the following link to view this information
http://wic.ga.gov/hcprovider.asp

Frequently Asked Questions (FAQs) – Georgia WIC Medical Documentation

How often do WIC participants need to provide new medical documentation paperwork?
Medical Documentation must be renewed at least every 6 months. New copies must also be provided at every certification, recertification, or mid-certification appointment if the date the authorized health care provider signed the most recent medical documentation form is more than 30 days old at the time of the certification appointment.
Can providers use their own prescription pads for formula/medical food prescriptions?
The GA WIC Program will allow you to use the doctor’s prescription pad for WIC special formulas and approved WIC foods, but it must have ALL of the following information:

  1. Patient’s first & last name
  2. Patient’s Date of Birth
  3. Parent/Caregiver’s first & last name
  4. Qualifying diagnosed medical condition and applicable ICD-9 or ICD-10 code
  5. Name of formula/medical food requested
  6. Prescribed amount of special formula per day (oz/day)
  7. Form of special formula (powder, concentrate, or ready-to-feed)
  8. Planned length of use for special formula (1-6 months)
  9. WIC Foods- Patient may receive supplemental foods appropriate to their WIC participant category in addition to the approved special formula. If you have no restrictions to WIC Supplemental Foods- It must say “No Supplemental Food Restrictions.” If there are restrictions, you must list which food that should not be issued to participant. Infants 6-11 mo. (infant cereal, baby food fruits & vegetables), Children >12 mo. & women (milk, beans/peas, vegetables, fruits, juice, cheese, peanut butter, whole grains, canned fish, cereal, & eggs)
  10. Must have provider’s name, title, provider’s original signature/credentials, and date
  11. Medical Office Name, street address, city, zip code, phone number, and fax number

Due to the amount of detailed information that has to be included for documentation, it is highly recommended that providers use the Medical Documentation Form 1.

Can WIC accept a verbal order for medical documentation?
Yes, WIC must document all details of the verbal order in the participant’s WIC record and sign & date the documentation. Only one month of vouchers may be issued to the participant. The WIC clinic must receive written medical documentation within 2 weeks of the verbal order. No additional voucher may be issued until written medical documentation is received (e.g., cannot accept a 2nd verbal order).
Which infants ages 6-11 months are eligible to receive more formula if they cannot tolerate solid foods?
Only infants who have a qualifying medical condition and who are receiving an “exempt infant formula” or a “medical food” are eligible to receive additional formula in place of solid foods, if medically indicated. Infants ages 6-11 months who are receiving a standard “infant formula” cannot receive additional formula even if they are unable to consume solid foods (e.g., are being tube-fed a standard infant formula).
What are examples of non-specific medical diagnoses that cannot be accepted on Form #1?
Colic, milk allergy, multiple food allergies, spitting up, milk intolerance, formula intolerance, feeding problems, feeding difficulties, picky eater, poor appetite, inadequate intake, constipation, cramps, digestive disturbances, fussiness, gas. The following diagnoses must have another underlying medical condition present and documented: “underweight,” “inadequate / poor weight gain,” “inadequate / poor growth,” and “feeding disorder.” The Georgia WIC Program cannot accept any of these diagnoses alone – a more specific, primary medical condition must be present and listed among the diagnoses (e.g., Cerebral Palsy, Failure To Thrive, Oral-Motor Feeding Disorder, Prematurity, Dysphagia, etc.).
What if the number of ounces of formula prescribed per day on Form #1 is more or less than WIC can issue to a participant?
If the health care provider prescribes more than the maximum monthly allowance of special formula or medical food for any participant, WIC can only issue the maximum monthly amount allowed by WIC policy. The participant should be educated about the maximum monthly allowance of formula based upon the participant category, age, feeding method, etc.

If the health care provider prescribes less than the maximum monthly allowance of special formula or medical food on Form #1 for an infant, WIC must still issue the maximum monthly allowance based on age and feeding method. This is to ensure that the full nutritional benefit is provided and to account for infant age changes and corresponding formula maximum allowance changes that may occur during the 1-6 month time period during which the medical documentation is valid.

If the health care provider prescribes less than the maximum monthly allowance of special formula or medical food on Form #1 for a child or woman, WIC must only issue the amount prescribed by the health care provider in addition to any authorized supplemental foods.

Can WIC accept a range of ounces for the formula prescribed per day on Form #1?
Yes. Ranges of formula can be accepted. However, the amount of special formula or medical food issued to the participant can never exceed the maximum monthly allowance based on WIC policy.
Can the health care provider write “up to,” “ad lib,” “PRN,” or “WIC maximum” for the amount of formula prescribed per day on Form #1?
No. An actual quantity of formula must be listed.
What is the cutoff for accepting medical documentation based on the date it was signed by the provider?
Medical documentation must have been signed by the health care provider no more than 30 days prior to when it is received by the WIC clinic.

Childhood Obesity

Expert Committee Recommendations

The Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity were released in June 2007, with the writing papers published in the December Supplement of Pediatrics.  The committee, made up of representatives from fifteen health professional organizations including the American Academy of Pediatrics, was convened by the American Medical Association (AMA) and co-funded in collaboration with the Department of Health and Human Services’ Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).

The AMA, HRSA and the CDC, recognizing that obesity is a major public health problem, assembled an expert committee of representatives from organizations involved in medicine, nutrition, mental health, epidemiology and psychology to update the 1997 recommendations for the care of overweight and obese children. The National Initiative for Children’s Healthcare Quality (NICHQ), together with key partners, has created an Implementation Guide to accompany the newly released Obesity Recommendations.

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.

How do you measure overweight and obesity in children?

Expert Committee Recommendations on obesity evaluation and treatment encourage using Body Mass Index (BMI)/ Age Percentile as the main tool to assess weight in children age 2-20.  BMI is a single number that evaluates an individual’s weight status in relation to height.

Why use BMI?

Use of BMI/Age Percentile 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 or order from the American Academy of Pediatrics.

How do I calculate BMI using handheld calculator:

  • Metric      [Weight in kilograms ÷ Height in cm ÷ Height in cm] x 10,000
  • English     [Weight in pounds ÷ Height in inches ÷ Height in inches] x 703

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.cdc.gov/nccdphp/dnpa/bmi/

How do I define overweight & obesity in my patients?

A child that has a body mass index above the 95th percentile for his or her age is considered obese.  A child with a body mass index above the 85th  percentile for his or her age is considered overweight.

3)  A list of ICD-9 Codes that may be appropriate in billing for your services.  (see below)

We hope this will help in your care of obese children and those at risk.  Thank you for efforts to combat the obesity epidemic in Georgia.

Breastfeeding-Best for Baby and Mother

Background:

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.

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 Benefits – Benefits to Mom:

  • Women who breastfeed have less vaginal bleeding and less risk of hemorrhage after birth.
  • Milk production requires 500-1000 calories a day. One-half of the calories from body fat stored during pregnancy. Women who breastfeed lose pregnancy weight more easily than women who formula-feed.
  • Breastfeeding reduces the risk of breast cancer in young women. The longer you breastfeed, the lower your risk.
  • Breastfeeding reduces the risk of uterine cancer and ovarian cancer.
  • Breastfeeding improves bone density and reduces the risk of hip fractures in older women.
  • Breastfeeding requires no mixing, no measuring, and no clean-up, making nighttime feedings quick and easy.
  • Breast and babies are portable.
  • Breastfeeding promotes a special relationship between a mother and her baby.
  • Parents who breastfeed save more than $1000 in infant feeding cost during the first year alone
  • Benefits to Baby:
  • Human milk is nutritionally perfect for human infants.
  • Human milk changes to meet the needs of a growing baby.
  • Human milk is easily digested, so breastfed babies have less gas, colic and spitting up.
  • Human milk contains important nutrients as well as special protective factors that we listed earlier: Less diarrhea, fewer urinary tract infections, fewer ear infections etc.
  • Breastfeeding gives babies a chance to touch, to smell, to hear, to see, to taste, to know their mother from the first moment of birth.

Barriers to Breastfeeding:

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.

  • Embarrassment
  • Lack of social support
  • Worried about not enough milk
  • Lack of support at work or school
  • Worried about having to eat well

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!

How WIC can help you support Breastfeeding

  • WIC encourages all pregnant women to breastfeed their infants unless contraindicated for health reasons.
  • Breastfeeding women receive nutrition counseling and a greater variety and quantity of food than non-breastfeeding, postpartum  women.

Breastfeeding Resources:

  • Are you looking for local breastfeeding and lactation resources?  This helpful guide provides you with resources specific to your area.
  • Georgia Lactation Resources and Support Directory
  • American Academy of Pediatrics Breastfeeding Section http://www.aap.org/breastfeeding/
  • Georgia Breastfeeding Coalition, http://georgiabreastfeedingcoalition.freewebspace.com/
  • Healthy Mothers Health Babies of Georgia Powerline; (770) 451-0020 and 1-800-822-2539
  • Georgia Poison Control Center; Grady Memorial Hospital, Atlanta, GA.; (404) 616-9000 or (800) 282-5846
  • Answers to questions on Drugs and Lactation
  • The National Women’s Health Information Center http://www.4woman.gov/breastfeeding/; 1-800-994-WOMAN
Please contact the Chapter’s Nutrition Coordinator, Kylia Crane, RD, LD,
with any questions regarding the information on this site at kcrane@gaaap.org or 404-881-5093.

The Georgia Chapter of the American Academy of Pediatrics is incorporated in the state of Georgia.