Introduction to Risk Codes

1
Introduction to Risk Codes
2
Current Risk Code Categories

• 100s Anthropometrics
• 200s Biochemical
• 300s Medical/Clinical/Health
• 400s Dietary
• Other Risks 500s, 600s, 700s, 800s, 900s
• These are included in a Complete Nutrition
  Assessment.

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18 Current Dietary Risk Codes (400)

• There are 18 different dietary risk codes.
• Children 8 risk codes
• Women 8 risk codes
• Infants 13 risk codes

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5 New Dietary Risk Codes (400)

• 401 - Failure to meet Dietary Guidelines for
  Americans
• Pregnant
• Breastfeeding
• Post-partum
• Children 2 years of age
• 428 - Dietary Risk Associated with Complementary
  Feeding Practices
• Infant 4 to 12 months
• Children 12 to 23 months (

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5 New Dietary Risk Codes (continued)

• 460 Inappropriate Nutrition Practices for
  Infants
• All Infants
• 470 Inappropriate Nutrition Practices for
  Children
• All children
• 480 Inappropriate Nutrition Practices for Women
• Pregnant
• Breastfeeding
• Post-partum

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401 Failure to Meet Dietary Guidelines

• Replaces 422 (Inadequate Diet)
• Presumed Dietary Risk
• Must do a complete nutrition assessment (A
  through F) before assigning
• Assign if no other risk codes can be assigned

7
428 Dietary Risk Associated with Complementary
Feeding Practices

• Presumed
• Infants 4 to12 months/Children 12 through 23
  months
• Does not include 0 to 3 months
• Must do a complete nutrition assessment, before
  assigning
• Not to be used with any other risk codes

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Umbrella Dietary Risk Codes

• 460 Inappropriate Nutrition Practices for
  Infants
• All Infants
• 470 Inappropriate Nutrition Practices for
  Children
• All children
• 480 Inappropriate Nutrition Practices for Women
• Pregnant
• Breastfeeding
• Post-partum

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8 Current Child Dietary Risk Codes

• 402 Vegan
• 403 Highly Restrictive Diets
• 419 Inappropriate Use of Nursing Bottles
• 421 Pica
• 422 Inadequate Diet (deleted)
• 423 Inappropriate or Excessive Intake of Dietary
  Supplements Including Vitamins, Minerals and
  Herbal Remedies
• 424 Inadequate Vitamin/Mineral Supplements
• 425 Inappropriate Feeding Practices for Children

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3 New Child Dietary Risk Codes

• 401 Failure to meet Dietary Guidelines (2 to 5
  years) (use alone)
• 428 Dietary Risk Associated with Complementary
  Feeding Practices (12 through 23 months only)
  (use alone)
• 470 Inappropriate Nutrition Practices for
  Children
• May be used with 100s, 200s, 300s, 600s, 700s,
  800s, and 900s.

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Child Participant Form Dietary Risk Codes

• Current

• Revised for 10/01/07

401 428 470
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470 Inappropriate Nutrition Practices for
Children

• Child umbrella risk code
• Includes 402, 403, 419, 421, 423, 424, 425 plus
• Feeding foods to a child that could be
  contaminated with harmful microorganisms
• Unpasteurized fruit and veg. juices, dairy
  products, soft cheeses
• Raw or undercooked meat, fish, poultry, eggs,
  tofu
• Raw vegetable sprouts (alfalfa, clover, bean and
  radish)
• Deli meats, hot dogs, and processed meats if not
  heated until steaming hot

13
470 New Inappropriate Nutrition Practices for
Children

• Allowing a child to carry around and drink
  throughout the day from a covered or training
  cup.
• Current 411 Infant
• Imitation or substitute milks (such as inadequate
  or unfortified rice- or soy-based beverages,
  non-dairy creamer), or other homemade
  concoctions.
• Using a pacifier dipped in sweet agents such as
  sugar, honey or syrups.

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470 New Inappropriate Nutrition Practices for
Children

• Current 419 reworded
• Routinely feeding a child any sugar-containing
  fluids. (soda/soft drinks, gelatin water corn
  syrup solutions and sweetened tea)
• Focuses on decay, not bottle

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470 Inappropriate Nutrition Practices for
Children

• Items deleted from the current risk codes
• Propping the bottle is for infants only, not
  children
• 12 or more ounces of any fruit juice per day

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8 Current Women Dietary Risk Codes

• 402 Vegan
• 403 Highly Restrictive Diets
• 420 Excessive Caffeine Intake (BF only) - deleted
• 421 Pica
• 422 Inadequate Diet - deleted
• 423 Inappropriate or Excessive Intake of Dietary
• Supplements Including Vitamins, Minerals and
  Herbal Remedies
• 424 Inadequate Vitamin/Mineral Supplements (PG
  only)
• 426 Inadequate Folic Acid Intake to Prevent
  Neural Tube Defects, Spinal Bifida, and
  Anencephaly (BF and PP only)

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2 New Women Dietary Risk Codes

• 401 Failure to meet Dietary Guidelines (use
  alone)
• 480 Inappropriate Nutrition Practices for Women
  (not to be used with 401)
• May be used with 100s, 200s, 300s, 600s, 700s,
  800s, and 900s.

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480 Inappropriate Nutrition Practices for Women

• Women umbrella risk code
• Includes 402, 403, 421, 423, 424, 426 plus

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480 New Inappropriate Nutrition Practices for
Women

• PG women ingesting foods that could be
  contaminated with pathogenic microorganisms
• Unpasteurized fruit and veg. juices, dairy
  products, soft cheeses
• Refrigerated smoked seafood if not in a cooked
  dish (casserole)
• Raw or undercooked meat, fish, poultry, eggs,
  tofu
• Raw fish, shellfish, vegetable sprouts (alfalfa,
  clover, bean and radish)
• Deli meats, hot dogs, and processed meats if not
  heated until steaming hot

20
480 New Inappropriate Nutrition Practices for
Women

• Impaired caloric intake or absorption of
  essential nutrients following bariatric surgery.
• This is part of consuming a diet very low
  calories/essential nutrients category.

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480 Inappropriate Nutrition Practices for Women

• No items deleted from the current risk codes,
  402, 403, 421, 423, 424, or 426.

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13 Current Infant Dietary Risk Codes

• 402 Vegan
• 403 Highly Restrictive Diets
• 411 Inappropriate Infant Feeding Practices
• 412 Early Introduction of Solid Foods
• 413 Feeding Cows Milk During First 12 months
• 414 No Dependable Source of Iron for Infants at
• 6 Months of Age or Later
• 415 Improper Dilution of Formula
• 416 Feeding Other Foods Low in Essential Nutrients

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13 Infant Dietary Risk Codes (continued)

• 417 Lack of Sanitation in Preparation, Handling,
  and
• Storage of Formula or Expressed Breastmilk
• 418 Infrequent Breastfeeding as a Sole Source of
• Nutrients
• 419 Inappropriate Use of Nursing Bottles
• 423 Inappropriate or Excessive Intake of Dietary
• Supplements Including Vitamins, Minerals
  and
• Herbal Remedies
• 424 Inadequate Vitamin/Mineral Supplements

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2 New Infant Dietary Risk Codes

• 428 Dietary Risk Associated with Complementary
  Feeding Practices
• (4 to 12 months only) (use alone)
• 460 Inappropriate Nutrition Practices for
  Infants
• May be used with 100s, 200s, 300s, 600s, 700s,
  800s, and 900s.

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460 Inappropriate Nutrition Practices for
Infants

• Infant umbrella risk code
• Includes 402, 403, 411, 412, 413, 414, 415, 416,
  417, 418, 419, 423, 424, plus

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460 Inappropriate Nutrition Practices for
Infants

• Feeding foods to an infant that could be
  contaminated with harmful microorganisms or
  toxins.
• Unpasteurized fruit and veg. juices, dairy
  products, soft cheeses
• Raw or undercooked meat, fish, poultry, eggs,
  tofu
• Raw vegetable sprouts (alfalfa, clover, bean and
  radish)
• Deli meats, hot dogs, and processed meats if not
  heated until steaming hot

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460 New Inappropriate Nutrition Practices for
Infants

• Reworded from current risk code
• 414, Low iron formula without iron
  supplementation
• 411, Adding sweet agents such as sugar, honey, or
  syrups to any beverage (including water) or
  prepared food, or used on a pacifier.

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460 New Inappropriate Nutrition Practices for
Infants

• Allowing an infant to carry around and drink
  throughout the day from a covered or training
  cup.
• Breastfed and non-breastfed infants who are
  ingesting less than 500 mL (16.9 ounces) per day
  of vitamin-D fortified formula and are not taking
  a supplement of 200 IU of vitamin D.

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460 Inappropriate Nutrition Practices for Infants

• Item deleted from the current risk code
• 416, Water consumption 4 oz to 8 oz per day.

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Procedures

• What is staying the same
• Income
• Height and weight, BMI
• Blood draw
• Identify all risk codes that apply with
  information that is obtained

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Procedures

• What is changing
• No 24 hour diet recall (except for non-contract
  formula approval)
• Dietary/Environmental/Family assessment through
  interviewing
• Dietary risk codes are assigned based on the
  interview
• Using the VENA concept
• Counseling do not counsel on every risk code
  INSTEAD counsel on what the parent/guardian wants
  to discuss, learn about, or is concerned about

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Risk Code Scenario 1

• Healthy 2 ½ year old boy
• Growing well
• Low hematocrit
• Eats lot of cold hot dogs from the refrigerator
• Drinks orange juice at mealtime for a total of 24
  ounces/day

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Risk Code Scenario 2

• 4 year old girl
• BMI for age plots above the 95th percentile
• Hemoglobin is good
• Eats well and a variety of foods