WIC

Guidelines for caffeine while breastfeeding

3 cups of coffee per day is okay. Moderate intake of caffeine is okay. Caffeine is detectable in breastmilk 15 minutes after consumption and is at peak levels 1 hour after consumption. If a baby is staying awake and is becoming fussy, avoid caffeine for 2-3 weeks.

Why is there an increase demand for iron during pregnancy?

300mg is used by the fetus and placenta, 250mg is lost at delivery, and 450mg is used to increase red blood cell mass. Marked increase in maternal blood supply during pregnancy greatly increases demand for iron. Normal erythrocyte volume increases by 20-30% in pregnancy

At what gestational age is an infant considered preterm by WIC standards?

<37 weeks gestation

At what weight is an infant considered low birthweight by WIC standards?

<5# 8oz

At what weight is an infant considered large for gestational age (LGA) by WIC standards?

>9#

List 6 major health/long-term health benefits of breastfeeding for the nursing mother:

decreased weight, decreased risk for T2DM, decreased risk for rheumatoid arthritis, decreased incidence of CVD, decreased risk for HTN, decreased risk for breast and ovarian cancer. Improves bone health and reduces risk of osteoporosis. Reduces risk of postpartum depression, reduces postpartum bleeding

Reject foods when they are introduced at a later age:

difficulty developing skills to eat independently; may consume inadequate variety and amount of food to meet nutritional needs

Counseling guidance for alcohol and pregnancy

do not drink alcohol during pregnancy, it can lead to numerous health defects of the child that will affect them for the rest of their lives. Offer information and referrals to all women who drink alcohol. Remind all women who are capable of becoming pregnant that consuming alcohol can put a fetus at risk for birth defects

counseling guidance for smoking during pregnancy

do not smoke. If you are smoking, now would be a good time to try to quit

Weight gain for obese pregnant women

11-20#

"My baby wants to eat all the time".

Can you elaborate "all the time"? It is common to have infant-led feedings 8-12 times in a 24 hour period, which is about every 2-3 hours.

Give one reason why underweight women should gain more weight during pregnancy than normal weight women.

Underweight women tend to retain some of the weight gained during pregnancy. Inadequate weight gain is associated with higher rates of prematurity, delivery of low birth weight and SGA infants and higher rates of infant morbidity and mortality. Weight gain has the biggest impact on fetal growth in underweight women

How long is certification period for breastfeeding women?

Until infant's first birthday as long as mother is breastfeeding at least once per day

Addition of extra water to formula:

will dilute the formula and decrease the nutrients, can lead to water intoxication. Lead to deficiencies and growth problems

At what age should cow's milk be introduced and why?

1 year old; Introduction of cow's milk before 12 months can result in allergy and iron deficiency anemia. Also, the renal solute load of cow's milk is too high for infants under 1 year of age.

How long is certification period for infants?

Before 6 months: until 1st birthday, After 6 months: 6 months

What are some complications of inadequate iron consumption in pregnancy?

Increases the risk of preterm delivery and low-birthweight infants, lower scores on intelligence, language, gross motor and attention tests at 5 years old. Inadequate iron consumption may lead to poor hemoglobin production, followed by compromised delivery of oxygen to the uterus, placenta, and developing fetus. Added workload of the heart from maternal anemia with increased cardiac output can lead to preterm delivery, fetal growth retardation, LBW, or inferior neonatal health

What is the association between a mother's BMI and the infant's risk of becoming overweight?

Increasing birth weights correspond to higher classes of obesity

Why is infant formula fortified with iron?

Iron stores are depleted at 4-6 months

Foods rich in iron with WIC

Iron-fortified cereals, whole grains, beans/peas, eggs, canned fish, dairy products

What benefits (not just food) do participants receive while enrolled in the WIC Program?

Iron-fortified infant formula, infant cereal, infant fruits and vegetables, iron-fortified adult cereal, whole grains, fruits or vegetable juice, eggs, milk, soy beverage, cheese, yogurt, peanut butter, dried or canned beans/peas, canned fish, fruits and vegetables, nutrition education, breastfeeding promotion and support, health risk assessment, healthcare and social services referral.

What role does each have in breastfeeding?

Oxytocin: ejection of milk from mammory glands into the milk ducts. Prolactin: stimulates milk production

Why was the WIC Program developed (what's the purpose/history of WIC)?

The WIC Program provides nutrition education and support, supplemental foods, health and social service referrals and breastfeeding support during critical time of growth and development to improve health and achieve positive health outcomes. The program is for pregnant, breastfeeding and postpartum women, infants and children under age five that meet income eligibility guidelines (185% or below the federal poverty guidelines).

effects of toxoplasmosis on baby

mental retardation, blindness, seizures, death

Counseling guidance for caffeine during pregnancy

moderate intake is okay. If you choose to drink caffeine, especially coffee, no more than 3 cups

What two hormones play an important role in breastfeeding?

prolactin and oxytocin

List 1 benefit for employers of breastfeeding parents:

reduction in company healthcare costs because mothers who breastfeed miss less work due to illness

Examples of satiety cues

turning away from breast or bottle, sealing lips together, decrease in suckling, spitting out nipple

How long is certification period for postpartum women?

until infant is 6 months old or 6 months after end of pregnancy

Weight gain for overweight pregnant women

15-25#

The WIC participant must be offered nutrition education as part of their WIC benefits as mandated by federal regulations. How many contacts per certification period must be offered to the participant per Arkansas WIC policy?

2 nutrition education sessions during each 6 month certification period

What is the appropriate age for introduction of solid foods for infants

6 months: strained/pureed 6-8 months: mashed 8-12 months: ground/finely chopped 11-12 months: chopped

How long is certification period for pregnant women?

6 weeks after delivery/expected delivery date

What is the DRI Recommended Dietary Allowance and Adequate Intake for folic acid for pregnant women of all ages?

600 mcg,

Why is foodborne illness a serious health issue for pregnant women?

Decreased progesterone levels in the mother decrease the ability to resist infectious diseases and are more susceptible to illnesses.Pregnant women have weakened immune systems throughout the pregnancy, this puts them at higher risk for developing a foodborne illness than an otherwise healthy woman. Additionally, the fetus does not have a fully developed immune system and is also at high risk.

Components of Human Milk per liter

Energy: 726kcal Protein: 10.56g CHO: 69.96g Fat: 44.55g Calcium 330mg Sodium: 165mg Potential renal solute load: 93mOsm/L

Components of cows milk/L

Energy:627kcal Protein: 31.68g CHO: 48.18g Fat:32.67g Calcium: 1122mg Sodium:429mg Potential Renal Solute load: 308mOsm/L

What are foods that WIC provides that are iron?

Fortified cereals, whole grains, dairy products, beans and peas

List factors that determine the size of an infant at birth.

Genetics, amount of energy, nutrients, and oxygen available during development. Also, any conditions that interfere with genetically programmed growth and development. Age of mother, weight gain during pregnancy, maternal obesity, gestational diabetes, pregnancy with multiples, smoking/drinking alcohol/illegal drug use

Addition of sugar or corn syrup or honey in water or formula:

Honey can cause SIDS due to bacterial spores, can lead to early childhood tooth decay. Botulism, diarrhea, and increases inappropriate calories

"I don't think my infant is getting enough breastmilk".

How many wet diapers and generous bowel movements does your baby have in one day? How much does your baby weigh? Infant should be feeding on demand every 2-3 hours. Infant is having at least 6-8 wet diapers/day

Foods rich in calcium with WIC

Milk, cheese, yogurt, soy beverages, canned fish, beans

Do infants on iron fortified formula need vitamin or mineral supplements?

No;Infants on iron fortified formula DO NOT need additional vitamin or mineral supplements EXCEPT for vitamin D (if taking in less than 1 quart of formula) and fluoride IF the water supply is low in fluoride.

"Every time I breastfeed it's really painful".

Often times, pain is experienced due to an improper latch. I will be happy to get a lactation consultant here to observe how you are breastfeeding and provide suggestions on how to make it less painful.

Who can receive WIC benefits?

Pregnant, breastfeeding and postpartum women, infants and children under age 5, income eligible, and have a condition or living situation that places them at nutritional risk.

To receive WIC benefits the participant must meet four eligibility criteria. List and give a brief description of each of the eligibility criteria.

Pregnant, breastfeeding, non-breastfeeding postpartum woman, infant, or child up to 5 years old, at "nutritional risk" by a professional (medically-anemia, underweight, overweight, history of pregnancy complications or pregnancy outcomes; dietary risk-failure to meet RDAs or inappropriate nutrition practices), basis of income assessment (fall at or below 185% of US Poverty Income Guidelines-$25,100 annually for family of four; eligible for WIC: $46,435 annually for a family of four), resident of Arkansas

Explain how the WIC Program promotes/supports breastfeeding.

Provides nutrition and breastfeeding education, nutritious foods, and improved healthcare access. Provides breastfeeding peer counselors, lactation consultants, classes and support groups, educational materials, hotlines for questions.

Examples of hunger cues

Rooting reflex, hand-to-mouth activity, small fussing sounds, pre-cry facial grimaces, smacking lips

With what formula company is Arkansas WIC currently contracted for the standard (not requiring a prescription) formula?

Similac to Nestle Gerber

What is the full name for WIC program?

Supplemental Nutrition program for Women, Infants and Children

Define pica. Give examples and list nutritional implications of this practice.

The compulsive intake of non-food substances over a sustained period of time. Can include dirt, ice, freezer frost, laundry starch, soap, ashes, chalk, paint, or burnt matches, cornstarch, and baking soda. The intake of these substances can lead to nutritional deficiencies and lead to potential exposure to toxic substances.

What is colostrum?

The first milk that is thick and yellow. It provides about 580-700kcal/L and is high in protein and lower in carbohydrates and fat.

Why should new foods be introduced one at a time?

To be able to easily determine a food allergy. Allows caregiver to determine infant's acceptance of new foods including adapting to new flavors and textures

What are the risks of introducing complimentary foods too early?

Too much weight gain, increased risk for choking and poor breast milk or formula intake. GI tract not fully developed to digest solid foods

What nutrients should be supplemented in breastfed infants and why?

Vitamin D, Vitamin K, iron- Healthy full term infant - breastmilk provides vitamins/minerals needed in first 6 months of life, except Vitamin D and Vitamin K. Vitamin K is given right after birth to prevent bleeding. Breastfed infants should be supplemented with 400 IU of vitamin D each day. Infants store enough iron in liver during last weeks of pregnancy to meet iron needs for about 6 months. After 6 months, iron-rich solid foods like meat and iron-fortified cereal are recommended.

Nutrition and breastfeeding counseling-WIC vs SNAP

WIC is required to provide this service, SNAP doesn't require it, but provides it

Screening and referrals-WIC vs SNAP

WIC provides service, SNAP doesn't

Can someone be enrolled in both WIC and SNAP? Explain your answer.

Yes, because if someone participates in SNAP, Medicaid, or Transitional Employment Assistance then they will already meet the income eligibility requirement for WIC, they just have to meet the other 3 WIC requirements.

Addition of infant cereal in bottle:

a form of force feeding, infant is not ready for complementary foods. choking and introducing calories when not needed

Nutrition intervention for heartburn during pregnancy

antacids, avoid lying down 3 hours after eating, sleep with head elevated, consume small, frequent meals, avoid greasy, spicy foods, also tomatoes, highly acid citrus products, carbonated drinks and caffeine.

Food choices for SNAP

any food except some prepared foods

expected weight gain up to 1 year

birth weight is tripled

effects of methylmercury on mom

can become sick and die from contamination

Consume an inadequate variety and amount of food to meet their nutritional needs:

can lead to delayed growth, which can lead to delayed brain development

effects of toxoplasmosis on pregnant woman

can lead to serious health defects of the baby.Symptoms typically include: swollen glands, fever, headache, muscle pain, or a stiff neck. Can be difficult to detect. Some women infected with the parasite may not have noticeable symptoms - so a pregnant woman can easily expose her fetus to illness without even being aware that she's ill

Delay of solid foods introduction until 8 months of age or older:

decrease jaw and muscle development for feeding can lead to later speech development

expected weight gain up to 6 months

double birth weight by 5-6 months

Listeria

found in raw or smoked fish, oysters, unpasteurized or soft cheeses, raw or undercooked meat, unpasteurized milk, lunch meats, hot dogs and other processed meats.

Nutrition interventions for N/V during pregnancy

frequent, small meals, avoiding offensive odors, avoid spicy or greasy foods, drink enough fluids, get fresh air, B6 supplements, ginger products

What WIC foods are high in folic acid?

fruits and vegetables and whole grains

foods rich in Vitamin A with WIC

fruits and vegetables, eggs and canned fish

foods rich in Vitamin C with WIC

fruits, vegetables, fruit and vegetables juice

Food choices for WIC

healthy foods recommended by the Institute of Medicine to meet nutritional needs

methylmercury

high levels of mercury that can be found in some seafood.

Letting infant drink from bottle while lying down:

increased risk of choking

Propping bottle during feeding:

increased risk of choking, increased risk for ear infections, no human contact, lead to overfeeding

Periflex Early Years

PKU

List 3 ways to encourage small children to develop positive eating habits.

Parents need to be positive role models for healthy eating for their children, eat together as a family, eat snacks

At what age is low fat or reduced fat milk appropriate and why?

2; Low-fat or reduced fat milk should be offered to prevent excessive caloric intake and excessive weight gain.

Weight gain for normal pregnant women

25-35#

Weight gain for underweight pregnant women

28-40#

Toxoplasmosis

A protozoan illness that can be found in raw and undercooked meats, on the surface of fruits and vegetables and in cat litter

How long is certification period for child?

After 6 months: 6 months

"he just doesn't like meat"-

try serving the meat in an attractive way. Sauces may help make food look more appealing, like spaghetti and meatballs.

effects of listeria on baby

During the first trimester of pregnancy, may cause miscarriage. As the pregnancy progresses to third trimester, the mother is more at risk. Can also lead to premature labor, the delivery of a low-birth-weight infant, or infant death. Fetuses who suffer a late infection may develop a wide range of health problems, including mental retardation, paralysis, seizures, blindness, or impairments of the brain, heart, or kidney. In newborns, can cause blood infections and meningitis

What is adjunctive eligibility?

Applicants with documentation of eligibility of SNAP, TEA, Medicaid for themselves or certain members of the household. Current proof of participation in one of these programs is required

What are some special considerations when counseling a pregnant teen?

Be kind, be patient, establish rapport, use visual aids, economic status, level of independence, psychosocial influence, literacy, cultural environment, irregular eating patterns

Nestle Alfamino Infant

Cow milk allergy, multiple food protein intolerance and food allergy associated conditions, eosinophilic esophagitis, SBS, malabsorption, GI disorders

List 8 major health/long-term health benefits of breastfeeding for the infant:

Decreased risk for hospitalization for lower respiratory tract infections, decreased incidence of gastrointestinal tract infections, decreased risk in necrotizing enterocolitis, decreased risk of SIDS, reduced incidence of allergic diseases, reduce the risk of celiac disease, reduce risk of IBD, decreased incidence of obesity and diabetes, decreased risk of leukemia and lymphoma. Promotes nervous system development and increases IQ

expected weight gain from birth to 2 weeks

Decreases a few days after birth, but should exceed birth weight by 14 days

Give examples of how you would begin a counseling session with parents of an overweight child? What practical suggestions would give to the parents?

Develop a healthy eating plan for the family and improve physical activity behaviors, provide dietary and nutrition education, address sedentary behaviors and provide parent training. I would provide nutrition education for how much of each food group the child needs each day, and provide emphasis on portion sizes and importance of physical activity. Practical suggestions include: using a smaller plate, not serving the child as much food, include healthy snacks, and 60 minutes of physical activity a day (walking, biking, playing outside).

Guidelines for smoking while breastfeeding

Do not smoke while nursing or in the infant's presence. If mother is unwilling to stop or cut back on smoking, delay feedings as long as possible. The half-life for nicotine is 95 minutes. Smoking causes lower fat content of milk and can decrease milk production

Guidelines for alcohol while breastfeeding

Drinking is not recommended, but if a mother choses to drink, let the alcohol pass from the system before feeding her baby. It is dependent on the weight and the number of drinks the mother has had. Having several drinks per day can affect motor development of an infant and can affect mother's ability to care for infant

List 1 major benefit to the nation when breastfeeding is the predominate method of infant feeding:

Economic benefit-$13 billion saved each year

Foods rich in protein with WIC

Eggs, peanut butter, dried or canned beans/peas, canned fish, dairy products

Define slowed/faltering growth in infants based on WIC Nutrition Risk Factor 135?

Growth faltering is defined as a growth rate below that which is appropriate for an infant's age and sex. It can effect length, weight, and head circumferences resulting in values lower than expected. Growth faltering may include weight faltering (a drop in weight-for-age) or slowed growth where both weight and length growth are slower than expected. An example of weight faltering is a drop in weight after a minor illness or a measurement/plotting error

What causes of tooth decay in toddlers and preschoolers?

High consumption of simple sugars, not brushing teeth regularly, snacking throughout the day

she doesn't always eat well but she loves her milk and juice

How often is she given the milk and juice? If she is getting it as a snack right before mealtimes, she won't want to eat her food.

"No, I am definitely not going to breastfeed"

I understand that breastfeeding is not for everyone. Have you received any information about breastfeeding? If not, would you like to learn the benefits of breastfeeding for both you and your baby? If so, may ask why you have chosen to not breastfeed?

What are the risks associated with teenage pregnancy?

Income, inadequate oral intake, undesirable food choices, they are still growing themselves, may be participating in a lifestyle that promotes smoking, drugs or alcohol, lack of knowledge, risks of mmiscarriage, preterm delivery, low birth weight infant and risk of nutrient deficiencies

Identify the common barriers that prevent women from breastfeeding.

Lack of breastfeeding education, nipple pain, perceived low milk supply, dietary and health concerns, concern about infant weight gain, mother's own health. Embarrassment, lack of social support, and time/competing demands

What factors contribute to childhood obesity?

Maternal obesity, prenatal obesity, low family income, lower cognitive stimulation, increased screen time

Nutramigen with Enflora LGG

Milk or soy allergy, food allergies, sensitivity to intact protein, chronic diarrhea, GI bleeds, galactosemia

all my kids will eat are hot dogs and peanut butter

Offer new foods to children in addition to the old foods. For example, try a peanut butter and jelly sandwich with fruit. This will help them accept new foods.

Boost Kid Essentials

Oral motor feeding disorders, FTT from underlying medical condition hat increases kcal requirement beyond what is expected, tube feedings

List causes of iron deficiency in children and iron rich food sources provided by WIC.

Rapid growth coupled with inadequate intake of dietary iron is the main cause for iron deficiency in children, and consuming more than 24 ounces of milk or soy milk (displaces high iron foods). Foods: iron-fortified cereal, whole grains, beans/peas, eggs, and dairy products.

List 5 foods that may easily choke small children.

Round or hard candy, peanut butter, popcorn, whole grapes, hot dogs

What are the developmental changes that indicate an infant is ready to introduce infant foods?

Sitting with little support, opening mouth and keeping tongue down when a spoon is offered, doubling birth weight. Hold head steady and straight. Keeps food in mouth and swallows

"Yes, I am definitely going to breastfeed".

That is fantastic! Would you like information on breastfeeding to provide you with the tools you need to make it as successful as possible for both you and your baby?

"I might breastfeed; I haven't decided yet."

That is okay. I have information available that might help you in your decision. Would you like me to share this information with you?

faltering growth for infants 2 weeks to 6 months age

any weight loss; use 2 separate weight measurements taken at least eight weeks apart

faltering growth for infants from birth to 2 weeks

excessive weight loss after birth, >7% birth weight

Term Formula (Similac Advance/ Gerber Good Start Gentle)

healthy newborns

Use of bottle for drinking juice:

increases risk for early childhood tooth decay. Increases inappropriate calories and sugar. Lead to diarrhea, abdominal pain, bloating from CHO. Not recommended for infants

Nutrition intervention for constipation during pregnancy

increasing fluids, increase fiber intakes (if low), increase physical activity

Portagen

pancreastic insufficiency, bile acid deficiency or lymphatic anormalities

EnfaCare

premature infants

effects of methylmercury on baby

small head size, brain damage, developmental delay, intellectual disability, blindness, muscle weakness, and seizures

effects of listeria on pregnant woman

spontaneous abortion, stillbirth. The symptoms can take a few days or even weeks to appear and may include fever, chills, muscle aches, diarrhea or upset stomach, headache, stiff neck, confusion, and loss of balance. In more serious cases, could also lead to the mother's death. Most of the time, pregnant women who are infected don't feel sick. However, they can pass the infection to their unborn babies without even knowing it.

the only vegetable she will eat is French fries

try serving other vegetables that are not strong in flavor to her. Start with mashed potatoes and green beans and see how she does with that.