New Food Packages for Mom and Baby

1
New Food Packages for Mom and Baby
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Breastfeeding

• The WIC Program recognizes that breastfeeding is
  the normal method for feeding infants and thus,
  breastfeeding must be considered the first and
  preferred method to feed infants, unless
  otherwise contraindicated for health reasons.
• Staff should assume that fully breastfeeding is
  the normal method of infant feeding and encourage
  the selection of the fully breastfeeding package
  without formula.
• At any time a mother may change her infants
  breastfeeding status.
• Request for formula (or additional formula) must
  be assessed to determine the appropriateness of
  supplementation for the infant. Counseling must
  address the mothers interests, barriers and
  problems.

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Food Package Implications for the Breastfeeding
Mom and Baby

• Greater variety and quantity of food is available
  to mother and baby.
• No more than 1 can of formula can be issued in
  first month to mostly breastfed infants to help
  mother maintain milk supply.
• After the first month, mostly breastfeeding
  formula allowance has been reduced.
• Women who request more than the allowed formula
  but continue to breastfeed longer than 6 months
  will not receive a food package.

4
Why WIC Limits Formula Amounts for Breastfeeding
Babies

• Affects the milk supply and demand balance
• Decreases the mothers confidence
• Reduces the duration of breastfeeding
• WIC provides
• Breastfeeding education
• Support
• Referrals

5
WICs definition of breastfeeding hasnt changed.

• The practice of feeding a mothers breast milk to
  her infant(s) on the average of at least once per
  day

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Remember - Mothers food package is determined by
babys feeding option.
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Womens Food Package Names

• Fully Breastfeeding
• Infant receives no formula from WIC
• Mostly Breastfeeding
• Infant receives less than 50 of the full formula
  food package.
• Some Breastfeeding
• Infant receives more than 50 of the full formula
  food package.
• Delivered
• Infant is not breastfed.

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Fully Breastfeeding Food Package

• Receive WIC foods for up to 1 year
• Whole grains, cereal, juice, peanut butter and
  beans same as in pregnancy
• MORE fruits and vegetables, milk, cheese, and
  eggs
• PLUS canned tuna or salmon

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Partially Breastfeeding Food Packages

• Mostly Breastfeeding

• Some Breastfeeding

• Receive WIC food for up to 1 year
• Food quantities same as in pregnancy

• Receive WIC foods for 6 months
• Same food package as delivered women
• Amounts of milk, cereal, cheese, eggs and fruits
  and vegetables same as in pregnancy
• No whole grains and less juice
• Need to choose either beans or peanut butter

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Fully Breastfeeding Multiples

• Fully Breastfeeding Multiples is defined as
  fully breastfeeding two or more infants from the
  same pregnancy.
• These moms receive the fully breastfeeding food
  package times 1.5.

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WICnet and Women with Multiples

• Pregnant with Multiples Answer question 3 on
  the health questionnaire after participant finds
  out she is having multiples .
• Fully breastfeeding food packages will be
  available on the Food Package tab.
• Breastfeeding Multiples 2 infants tied to the
  same mom with breastfeeding statuses of Exclusive
  or Other Food or Beverage.
• Fully breastfeeding multiples food packages
• will be available on the Food Package tab.

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Breastfeeding Key Points

• All breastfeeding mothers should be certified as
  active participants.
• If mom and baby certify after infant is 6 months
  old and status is gt ½ WIC formula, she would be
  certified as an active participant but receive no
  food package.
• This may be difficult to explain to mom but as an
  active participant she would receive other
  benefits including nutrition education,
  breastfeeding support and if needed, a breast
  pump.
• This also adds to your agencys caseload numbers
  as these moms are counted as active participants.

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Breastfeeding Key Points cont

• All breastfeeding mothers infants must be
  assessed for individual needs.
• Formula amounts for breastfeeding infants must be
  tailored to meet the babys individual needs.
• Model food packages set at maximum amounts must
  tailor down
• Ask How many times do you breastfeed each day?
  instead of How much formula do you need? when
  assessing how much formula to give to
  breastfeeding moms.

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Issuing Formula During the First Month to
Breastfed Infants

• One can of powdered formula may be issued to
  mostly breastfed infants during the first month
  of life if determined appropriate during the
  CPA/nutritionists assessment.
• If concentrate or ready-to-feed formula needs to
  be issued, contact the state office for help in
  figuring amounts.
• Breastfeeding moms who decide to take one can of
  formula will be issued the mostly breastfeeding
  food package.
• Breastfeeding moms who decide to take more than
  one can of formula will be issued the some
  breastfeeding/delivered food package.

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Reasons to Issue the One Can

• Listed in policy 04-05-08 Breastfeeding, Food
  Package
• Maternal Medical Indications
• Infant Medical Indications
• Non-Medical Reasons
• Document the reason why one can of formula was
  provided in the participants record, either Food
  Package Comments or Care Plan in WICnet.

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Changes in Breastfeeding Status

• At any time a mother may change her infants
  breastfeeding status.
• A status change to terminated could result in a
  change in certification for the mom.
• A change in status may require a change in food
  package for both the mom and baby.

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WICnet Breastfeeding Statuses
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WICnet Breastfeeding Statuses

NOTE These 2 statuses will be the only options
for breastfed infants receiving formula during
the first month of life.
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WICnet Breastfeeding Statuses

20
WICnet Breastfeeding Statuses

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Historical Breastfeeding Data

• When collecting breastfeeding data on infants who
  were not on WIC starting at birth, collect the
  following information about the participants
  breastfeeding history.
• Record first breastfeeding status at date of
  birth ex. Exclusive, Never Breastfed
• New record date when something else was
  introduced formula, solids, etc.
• New record - current status
• Dont worry about exact dates. Parent/guardians
  best guess is just fine.

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Breastfeeding The First Month

• The first 30 days of breastfeeding is a critical
  period when support must be provided.
• The first WIC appointment should be as close to
  birth as possible.
• An appointment must be scheduled the following
  month after birth to check on status and provide
  support and assistance as needed. Do not give 2
  months of checks.
• Encourage involvement of peer counselors during
  this period.
• Mostly breastfeeding infants may receive a
  maximum of 1 can of formula if determined
  necessary by the CPA after assessment and
  counseling.

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Breastfeeding Baby at 6 Months

• Solids (infant cereal, baby food vegetables,
  fruits meats) are introduced into food packages
  at this time.
• Formula amounts should be tailored to the
  infants individual needs.
• Staff must provide the maximum monthly allowance
  of solids unless the participant chooses a lower
  amount.
• Mothers should be counseled on readiness signs
  and the best practices for properly introducing
  solids.

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Infant Feeding - Formula
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Standard Contract Infant Formulas

• Good Start Gentle Plus and Good Start Soy Plus
• Issued unless there is a medical reason to issue
  a ND WIC approved non-contract formula or special
  formula
• Similac Advance issued only for religious issue
  to pork enzyme
• GS Gentle Plus 2 and GS Soy Plus 2 provided for
  older babies with medical documentation only

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Issuing Other Formulas

• Allowable Standard Non-contract Infant Formulas

• Special Formulas

• Similac Sensitive
• Enfamil AR LIPIL
• Medical documentation is required to issue.

• Medical documentation is required.
• Examples of these formulas include
• EleCare
• Enfamil EnfaCare LIPIL
• Neocate Infant
• Nutramigin LIPIL with Enflora LGG
• PediaSure

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Infant Feeding Formula Issuance

• Monthly issuance is based on Full Nutritional
  Benefit.
• The full nutritional benefit (FNB) is defined as
  the maximum monthly allowance of reconstituted
  fluid ounces of liquid concentrate infant
  formula for the food package category and feeding
  option.
• Powdered and concentrate issuances are both based
  on the number of reconstituted ounces.
• State agencies must issue whole containers to
  provide at least the FNB but not to exceed the
  USDA maximum allowance for the food package and
  feeding option.

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Infant Feeding Formula Issuance

• FNB and USDA maximum allowances for an infant age
  0-3 months
• FNB for this food package is 806 fluid ounces.
• USDA maximum allowance is different depending on
  form.

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Infant Feeding Formula Issuance

• Formula Reconstitution Amounts by Can
• Reconstitution amounts vary widely which leads to
  variations in the number of cans allowed per
  month.

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Infant Feeding Formula Issuance

• To meet USDA regulations for formula issuance,
  the monthly issuance is calculated by dividing
  the FNB by the number of reconstituted ounces in
  one can of formula to be issued and then rounding
  that number up to the next whole can
• You will not need to work through the
  calculations because they have been done for you
• Refer to Infant Formula Ranges Cheat Sheet.

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Infant Feeding Formula Issuance

• Example 1
• The powder form of Good Start Gentle Plus
  reconstitutes to 87 ounces.
• The FNB of 806 divided by 87 equals 9.264.
• 9.264 rounded up to the next whole can equals 10
  cans.
• 10 cans multiplied by 87 ounces equals 870
  ounces.
• 870 ounces meets the FNB and does not exceed
• the USDA maximum, therefore 10 cans would be
  issued.

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Infant Feeding Formula Issuance

• Example 2
• The powder form of Good Start Soy Plus
  reconstitutes to 91 ounces.
• The FNB of 806 divided by 91 equals 8.857.
• 8.857 rounded up to the next whole can equals 9
  cans.
• 9 cans multiplied by 91 ounces equals 819 ounces.
  
• 819 ounces meets the FNB and does not exceed the
  USDA maximum, therefore 9 cans would be issued.

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Infant Feeding Formula Issuance

• FNB and USDA Maximum Allowances

Contact the state office for amounts if these
need to be issued.
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Infant Feeding Formula Issuance

• FNB and USDA Maximum Allowances
• Infants Age 4-5 Months

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Infant Feeding Formula Issuance

• FNB and USDA Maximum Allowances for
• Infants Age 6-11 Months

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Ready-To-Feed Formula

• Current policy for the issuance of ready-to-feed
  formula has not changed.
• It is only for
• homeless
• water issues
• inability to prepare
• Special formula prescribed by a physician only
  available in ready-to-feed
• Document reason issued in Food Package Comments
  in WICnet.

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Food Package III for Infants

• Infants qualify for Food Package III if they
  require a special formula.
• To receive Food Package III an infant must have
  medical documentation of a qualifying medical
  condition requiring a special formula.
• Infants 6-11 months old must have a completed
  medical documentation form detailing which foods
  offered through the WIC program are restricted or
  contraindicated.
• If an infant receiving a special formula is
  unable to consume solid foods and this is
  documented by the health care provider, the
  infant may be issued the 4-5 month fully formula
  feeding amount of formula.

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Changes to the Infant Food Package

• No juice for infants
• Baby food provided at 6 months
• Fruits, vegetables
• Meats fully breastfed infants only
• Reduction in infant formula amounts
• Maximum allowances of formula for partially
  breastfed infants

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Staff Resources

• Formula Issuance Guide
• Infant Formula Ranges Cheat Sheet
• Formula Manual being revised

Go to our website at http//www.ndhealth.gov/wic/W
IC20Foods20-20Participant.htm.
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Questions from You!
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Do we have to do breastfeeding midcerts at 6
months for the some breastfeeding moms even
though they will not be receiving a food package?

• Yes, breastfeeding midcerts would need to be
  done as the some breastfeeding moms are still
  considered active participants even though they
  will not receive a food package. As a reminder,
  all you have to do is a weight measurement and
  complete a diet questionnaire.

Answer
42
How to we handle breastfeeding moms who change
breastfeeding statuses after they have already
received 2 months of checks?

• If the participant is still eligible for a
  food package, have the participant return any
  unused checks and reissue those checks based on
  the new food package. Dont forget to change the
  infants breastfeeding status in WICnet. You may
  want to re-evaluate how often you provide 2
  months of checks to breastfeeding moms who are
  also taking formula.

Answer
43
Can we still alternate between the fully
breastfeeding food package and the mostly
breastfeeding food package if a breastfeeding mom
takes formula one month and no formula the next?

• Yes, her infants breastfeeding status in
  WICnet will need to be adjusted each time she
  would switch. Make sure that the mom is being
  provided the best possible food package for her
  situation (ex. switching from fully breastfeeding
  to some breastfeeding).

Answer
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How To Handle Questions From Participants
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WIC used to provide more formula for breastfed
babies during the first month. Why dont you do
this anymore?
Answer

• I can understand your questions about WICs new
  policy.
• WIC wants to protect breastfeeding. Breast milk
  is all your baby needs to be healthy and to grow.
  Giving formula decreases your milk supply,
  especially in the first month.

46
Why am I not getting food even though I am still
breastfeeding my baby?(6 to 11 months postpartum)
Answer

• I can understand how you want to get all the food
  WIC might provide.
• When you are breastfeeding, the more breast milk
  you give your baby, the more foods WIC provides.
  If you are receiving more than four cans of
  formula after your baby turns six months of age,
  we can no longer provide you with a food package.
  WIC will continue to support you by providing
  breastfeeding services and nutrition education
  during this time.
• Would you like to talk about how to increase your
  milk supply, so you will need less formula?

47
Why does the amount of formula change depending
on the age of my baby?
Answer

• I can understand your concerns about the amount
  of formula changing depending on the age of your
  baby.
• Fully formula-fed infants will now receive
  formula amounts that are more age-appropriate.
  From birth to 3 months, the amount is close to
  the same. From 4-5 months, babies receive more
  formula since they have higher energy needs at
  this time. After 6 months, babies get extra
  nutrients through baby foods, so less formula is
  needed.

48
The amount of baby food we get seems like a lot.
Does my baby need this much?
Answer

• The amount of baby food offered is about 1 jar of
  food per day (3 jars per day for breastfed
  infants), but different babies eat different
  amounts. The amount of food provided offers the
  flexibility to add variety of tastes and
  nutrients and encourages healthy eating.
  However, if it is more than your baby needs, you
  may purchase less.

49
Doesnt my older baby need 3rd Foods/Stage 3
baby foods?
Answer

• The baby foods for older infants have the same
  nutrients that Stage 2 foods have. The only
  difference is that foods for older babies offer
  different textures and consistencies. As your
  baby develops, he will benefit from eating table
  foods or homemade baby food that are different
  textures and consistencies.

50
Why do fully breastfed babies get more baby food
than babies who are not fully breastfed?
Answer

• Fully breastfed babies get extra baby food as an
  incentive for moms to continue breastfeeding.
  Also, since fully breastfeeding babies dont
  receive any formula, the cost that would have
  been used for formula is used for baby food
  instead.

51
Why doesnt my baby receive baby food meats?
Doesnt he need iron and zinc, too?
Answer

• For fully breastfed babies, its an incentive for
  moms to keep breastfeeding. Around 6 months of
  age, all infants need a source of iron. As your
  baby grows, offering meats will give him
  different nutrients and help him develop an
  interest in a variety of foods.

52
Is commercially prepared baby food better for my
baby than homemade baby food?
Answer

• WIC includes baby foods to ensure that all babies
  eat enough fruits and vegetables. Homemade baby
  food is also very good for your baby and is a
  great way to introduce different textures and
  consistencies into your babys diet.

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Breastfeeding Counseling Points to Remember
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What Prenatal Women Need To Know

• Discuss the advantages of breastfeeding.
• Encourage participants to initiate and continue
  breastfeeding as long as possible.
• Encourage mothers to develop a support plan.
• Inform participants about who they should call
  when they need help.
• Involve peer counselors, if available, in
  conversations with pregnant women and new moms.

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Anticipatory Guidance

• Breastfeed as soon as possible after delivery.
• Importance of skin-to-skin contact
• Importance of colostrum
• How to position/latch the baby to the breast
• Hunger/satiety cues

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Anticipatory Guidance

• Signs the baby is getting enough
• Appropriate weight gain/loss
• Breast fullness/engorgement
• Appetite/growth spurts

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What if I dont have enough breast milk?
Possible Answer

• Many women have the same concern.
• It is rare for mom not to make enough milk to
  feed her baby. The more often you breastfeed your
  baby the more milk you will make.
• Would you like to learn more about how to know if
  your baby is getting enough breast milk?

58
Doesnt feeding breast milk and formula give my
baby the best of both?
Possible Answer

• That is great that you are thinking about how to
  give your baby whats best.
• Breast milk is all your baby needs to be healthy
  and to grow for the first six months. Feeding
  formula actually makes you produce less breast
  milk for your baby.
• What other questions do you have about feeding
  your baby?

59
My mother/sister/friend said my baby is not
gaining enough weight. Shouldnt I start giving
formula?
Possible Answer

• It is great you have caring family and friends
  that are concerned about your baby.
• If the babys assessment is within normal limits,
  then Your baby is growing very well, and your
  breast milk is the best food for her right now.
  Keep breastfeeding your baby when she is hungry,
  and she will get the best nutrition and continue
  to grow.
• Would you like to talk about ways to know your
  baby is getting enough breast milk?

60
Will I need formula for when I go to work/school?
Possible Answer

• Many women have the same concern.
• Instead of using formula, consider pumping breast
  milk as soon as you can and store it in the
  freezer. Pumping helps establish a good milk
  supply, and someone else can feed this stored
  milk to your baby when you are away. WIC wants
  to protect breastfeeding, and giving formula in
  the first four to six weeks will reduce your milk
  supply.
• Would you like to discuss how to pump and store
  your milk?

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Thanks!

• Thanks to the New York State, Colorado, and
  Missouri WIC programs for use of their materials
  to adapt in creating this presentation.