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Introduction to Risk Codes

Introduction to Risk Codes. 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. 18 Current Dietary Risk Codes (400).

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Introduction to Risk Codes

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  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.

  3. 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

  4. 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 (< 2 years of age)

  5. 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

  6. 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

  8. 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

  9. 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

  10. 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.

  11. Current Revised for 10/01/07 Child Participant Form Dietary Risk Codes 401 428 470

  12. 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.

  14. 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

  15. 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

  16. 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)

  17. 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.

  18. 480 Inappropriate Nutrition Practices for Women • Women umbrella risk code • Includes 402, 403, 421, 423, 424, 426 plus

  19. 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. 480New 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”.

  21. 480 Inappropriate Nutrition Practices for Women No items deleted from the current risk codes, 402, 403, 421, 423, 424, or 426.

  22. 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 Cow’s 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

  23. 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

  24. 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.

  25. 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

  26. 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

  27. 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.

  28. 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.

  29. 460 Inappropriate Nutrition Practices for Infants Item deleted from the current risk code: • 416, Water consumption 4 oz to 8 oz per day.

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

  31. 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

  32. 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

  33. 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

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