WIC

Categories WIC, Work

Literally Lying

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Names and other details have been changed to comply with HIPAA; otherwise, this story is closely based on a true story :-)

“Are you going to get Shirley some new food?” she asked.

I agreed that yes I was–I would be back in a few minutes.

I returned with checks in hand, delivered them to Sherry and Shirley’s mom, and wished the family a good day.

“She said she was going to get Shirley some new food.” Sherry told her mom.

Mom explained. “She did. She gave me checks, which are sort of like money so I can get Shirley her food. Now we have to go to the grocery store to get the food.”

“Can I tell her something?” Sherry asked her mother.

When Mom said yes, Sherry turned to me. “You said that you were going to give Shirley some new food.”

I tried to explain while Mom laughed, “Sherry, you take this so literally.”

Finally, I realized that the abstractness of a check was beyond Sherry’s 3 year old mind. “I’m sorry, Sherry. I should have been more clear. I was going to get checks so your mom could buy Shirley some new food.”

As Sherry and her family left, I heard mom trying to explain again while Sherry continued to insist: “But she said she was going to get Shirley some new food.”

There’s never a boring moment when you’re working with kids.

Have you ever unintentionally “lied” to a child?

Categories WIC

Formula, Apples, and Oranges

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“We had to switch him to Enfamil because he was vomiting up the Similac.”

I clarify. “So he was vomiting on Similac Advance?”

Mom agrees.

“Unfortunately,” I tell her, “we only have a limited selection of formulas we can offer your baby, and that specific formula you’re providing your baby now isn’t one that I can give him. We could try Similac-”

As soon as I say the word, mom visibly starts and begins shaking her head.

I try to push through. “We could try Similac Total Comfort, which is another milk-based formula except that it has some of the proteins broken down so they’re…”

Mom is having none of it. “You can’t give me any Enfamil?”

“Not the type you’re using,” I say. “The only Enfamil product we provide is Enfamil ProSobee, a soy-based formula. That’s going to be different from what you’re using right now because you’re currently using a milk-based formula.”

I never did manage to get it through to mom that the BRAND isn’t the important thing to look at when you’re evaluating formula.

You, dear readers, will listen, won’t you?

When your child seems to be having tolerance issues to a formula, switching brands may help–but the brand isn’t really the issue. The issue–if there’s a formula issue at all (most of my clients wouldn’t believe it, but most of the things people switch formulas over are actually normal parts of infancy and the “improvement” they see once they switch has more to do with baby getting a bit older than with the new formula). Anyway, enough rabbit trails. The issue with the formula is that there’s some ingredient in that particular formula that baby isn’t tolerating.

So, you want to find another formula without that ingredient–except that you don’t know what the ingredient is, so you’re going to be playing a bit of a guessing game.

Almost every formula manufacturer (I’ve used Abbott/Similac and Mead Johnson/Enfamil, the two biggest formula suppliers, for my examples in the following list, but there are other brands of formula available) has at least four or five different varieties of formula*.

  1. Standard milk-based formula
    This formula contains milk proteins (from whey and casein) and milk carbohydrates (lactose). Examples include the aforementioned Similac Advance, as well as Enfamil for Infants. Most babies do well on this type of formula.
  2. Low/No Lactose milk-based formula
    This continues to use milk proteins, but exchanges some or all of the lactose with another sugar. Most of these types of formulas also have other changes (such as adding rice starch or partially or fully breaking down the milk proteins), but one formula (Similac Sensitive for Fussiness and Gas) is virtually identical to the standard milk-based formula except for this change. Infants who have a hard time digesting lactose (which is less common than many parents think) will do better on this type of formula. This type of formula is often used if a child seems unusually bloated or gassy.
  3. Milk-based formula with hydrolyzed proteins
    This type of formula uses milk proteins but breaks them down into smaller pieces, which may be more easily digestible by infants. The proteins may be partially hydrolyzed into small protein fragments (Gerber Good Start does this) or fully hydrolyzed into the component amino acids. Most of the fully hydrolyzed milk-based formulas are also lactose-free. Examples include Enfamil Gentlease and Similac Total Comfort. Hydrolyzed protein formulas are used if a protein allergy or intolerance is suspected, often when an infant experiences constipation.
  4. Soy-based formula
    This type of formula uses soy proteins and a non-lactose form of sugar. Examples include Similac Soy and Enfamil ProSobee. These are used by parents who are vegetarian or when milk-protein allergy or lactose intolerance is suspected.
  5. Formulas for Acid-Reflux
    Maybe you’ve heard the old wive’s tale about adding rice cereal to a bottle to keep baby from spitting up. Maybe you’ve even heard it from a doctor. Like many old wive’s tales, there’s a grain of truth and plenty of risk in following this advice. Added rice starch does seem to reduce acid reflux for many babies. But adding rice cereal to a bottle can pose a choking or aspiration (getting food in lungs) risk and can increase risk of obesity. Choosing a formula specially formulated with added rice starch may help with the reflux while minimizing the risk associated with adding cereal to a bottle. (Please note that there is virtually NO evidence that adding cereal to a bottle will help a baby sleep through the night. All the risks, none of the benefits–DON’T do it!) Examples of these formulas include Enfamil A.R. and Similac Sensitive for Spit Up. Infants with acid-reflux (this is spitting up beyond the normal spit up 0-3 month olds do after every feeding and includes additional symptoms) may benefit from this type of formula.

So, now that you know a little bit about formula, you can educate your friends. If someone is having a problem with their formula, let them know that it doesn’t matter which BRAND they’re using. It matters what KIND they’re using.

Compare apples to apples, people.

*Actually, the big couple have dozens of formulas–but most of the other types of formula NOT noted in the above have changes made to treat specific conditions and should only be used on a doctor’s recommendation.

Categories WIC

WICBits: Contaminated Food Risk Code

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Nutrition Risk Factor:
Consuming potentially contaminated foods

What it means:
Consuming potentially contaminated foods includes

  • consumption of cold hot dogs, lunch meat, or deli meat
  • consuming tuna or salmon more than two times a week
  • consuming raw milk or soft cheeses made with unpasteurized milks
  • consuming sprouts

Why it’s a risk:

  • Tuna or salmon may contain mercury, which is toxic in sufficient amounts
  • Cold hot dogs, lunch meats, or deli meats may contain listeria, which can cause miscarriage or fetal abnormalities when consumed by pregnant women or can cause brain or blood infections when consumed by children under the age of 12
  • Raw milk and soft cheeses made with unpasteurized milk may also contain listeria
  • Sprouts put pregnant women and young children at risk for Salmonella or e-coli infections, which can be even more dangerous for these populations because of their weakened immune systems

What I might educate/counsel regarding:

  • Eat fish, including tuna and salmon, but no more than twice a week
  • Heat hot dogs, lunch meat, ham, and other deli meats to steaming before eating. This can be done in the microwave, on the stovetop (just fry both sides of lunch meat in a skillet, no need to add fat), or can be done by making a grilled sandwich. At the sub store, ask to have your meat toasted in their little oven thing.
  • Purchase pasteurized milk and soft cheeses (feta, Brie, blue, queso fresco, queso blanco, etc.) made with pasteurized milk
  • Avoid sprouts during pregnancy and don’t serve to children. If you must have them, heat them to steaming before eating.

Generally, the most surprising information for my clients is that deli meats carry a risk of listeria. Clients know to heat hot dogs, but are shocked to learn that cold deli meats and lunch meats carry the same risks.

Occasionally, I’ll have parents say they’ve been eating cold deli meats for forever, or been feeding their children cold deli meats for forever and haven’t had a problem. I ate cold deli meats as a child and never got listeriosis. Truth is, listeriosis is relatively uncommon–but when someone with a weakened immune system gets it (for example, a child, a pregnant woman, or an elderly person), it can have devastating effects. So, even though the event we’re trying to avoid is rare, we still recommend heating. It’s not THAT hard, and if it does keep you from Listeria, it makes a big difference.

Categories WIC

WICbits: What does a WIC appointment look like?

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When a WIC applicant walks into our doors, they’ll be asked to sign in at a book in the lobby and then wait for the first available staff person to check them in.

Check-in includes verifying eligibility by evaluating proof of identity, proof of residency, and proof of household income. The check-in staff will tell the applicant about the WIC program, including their rights and responsibilities as a WIC participant. Check-in staff will also assess the applicant’s use of other programs and will make referrals as necessary.

Once the client has been checked in, they will wait for the medical data staff who will weigh and measure them and do a finger-stick for hemoglobin.

Next, the client will see a professional (either an Registered Dietitian or a Registered Nurse), who will assign risk codes based on a diet questionnaire and interview, will provide appropriate education and assist the client in setting goals for improvement, and will tailor and print checks for the food package. Professionals also provide referrals as needed.

In Kansas at least, most WIC clients (that is, children from 1-5) are re-certified every 6 months–which means they have to go through the entire process including verifying eligibility again. In between recertification visits (about once every 3 months), clients have to come in for at least one nutrition education meeting.

Low risk clients have an option of completing an online educational module or reading an educational poster in our facility for their nutrition education meeting. High risk clients (for example, obese children or women with a low Hgb) have to see a dietitian for their nutrition education meeting.

My job, then, is to evaluate clients using a combination of questionnaire and interview, assess their risk factors, certify them for WIC, counsel them regarding their risks and give them the needed education to make changes, and assist them in setting goals for themselves and/or their children.

I love it.

I spend the majority of my time dealing directly with mothers and fathers, helping them obtain the necessary knowledge and skills to feed their families well. Sometimes I get to do breastfeeding counseling with prenatal women, sometimes I get to talk to postpartum women about restoring their nutrient balances. Sometimes I get to help parents learn how to introduce solids to their babies. Sometimes I help them understand how to help their picky children learn to accept a greater variety of foods.

I get to talk a little child psychology and parenting techniques, a little physiology, a little cooking, a little child development. And, of course, I throw in a little economics while I’m at it.

It’s wonderful. I love what I do.

Categories WIC

WICbits: What is WIC?

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Whenever I tell someone where I work, I get a half dozen questions ranging from “What’s that?” to “My friend was telling me that she saw a liquor store that accepts WIC. What exactly does WIC give people?”

Since I happen to like my job–and I know that lots of people have questions about it, I figured I would answer some of the most frequently answered questions here, on my blog.

WHAT is WIC?
WIC, more properly titled the “Special Supplemental Nutrition Program for Women, Infants, and Children”, is a federal nutrition program administered by state and local agencies.

WHAT does WIC do?
WIC provides 1) nutrition education, 2) food packages, and 3) referrals.

What does “Food Packages” means?
Our “food packages” are specially tailored for different times of life and try to target the most vital nutrient needs in these different times of life. For example, for children our standard packages include a fruit and vegetable voucher (for a certain dollar amount worth of any vegetable except white potatoes), a certain amount of milk (whole if under age 2, reduced- or low-fat otherwise), eggs, beans or peanut butter, 100% fruit juice, whole grains, and breakfast cereal. These foods specifically work to meet children’s protein, calcium, iron, and vitamin needs. Clients can purchase only WIC approved items. They may not purchase candy, pop, cigarettes, alcohol, or potato chips with their WIC package. Neither can they purchase TV dinners or macaroni and cheese. They get exactly what is on their checks (or card, if they live in a state who uses electronic debit-type cards for food packages), nothing more.

WHO is eligible for WIC?
In order to be eligible for WIC, one must meet the following criterion:

  1. Meet categorical criterion: be a pregnant woman, a post-partum woman no less than 6 months after delivery, a breastfeeding woman up to one year after delivery, an infant (age 0-12 months), or a child (age 1-5 years)
  2. Meet income qualifications: have a household income within 185% of the federal poverty line
  3. Meet residency requirements: be a resident of the state in which the program is administered
  4. Have a nutritional risk

What is nutrition risk?
WIC has specific risk codes which professionals assign to applicants based on a diet questionnaire and client interview. These codes have different levels of severity, which help to prioritize eligible applicants should there be a waiting list for available WIC funds. Examples of risk codes include overweight or obesity, inadequate weight gain during a pregnancy, inadequate vitamin supplementation, or improperly diluted formula. Because the majority of women, infants, and children in the United States are at nutritional risk, we do also have a code for “Presumed nutrition risk” if a specific risk cannot be found. This is the lowest priority code, and honestly, I don’t know that I’ve ever used it. Applicants always have at least one clear nutrition risk.

HOW can you, being a fiscal conservative, justify working for a government program like WIC?
Actually, there aren’t a lot of government programs quite like WIC. Unlike most other government “welfare” programs, WIC isn’t an entitlement program. In other words, just because someone is eligible for WIC doesn’t mean they’re guaranteed WIC. WIC’s funding is not guaranteed by the federal government. WIC has to reapply for funding every year–which means they need to continually provide proof that their program is actually accomplishing something. And accomplish something we do. A number of studies show that for every dollar spent on WIC, as much as 3 dollars is saved in Medicaid spending. WICs targeted nutrition education and food packages means healthier kids–and less government spending on health care. I can justify working for WIC because I know that WIC is ultimately reducing government expenditures.