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)

There are 18 different dietary risk codes.

Children = 8 risk codes

Women = 8 risk codes

Infants = 13 risk codes

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 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

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

428 Dietary Risk Associated with Complementary Feeding Practices

PresumedInfants 4 to12 months/Children 12 through 23

monthsDoes not include 0 to 3 months Must do a complete nutrition assessment,

before assigning Not to be used with any other risk codes

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

8 Current Child Dietary Risk Codes

402 Vegan403 Highly Restrictive Diets419 Inappropriate Use of Nursing Bottles421 Pica422 Inadequate Diet (deleted)423 Inappropriate or Excessive Intake of Dietary

Supplements Including Vitamins, Minerals and Herbal Remedies

424 Inadequate Vitamin/Mineral Supplements425 Inappropriate Feeding Practices for Children

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.

Child Participant Form Dietary Risk Codes

Current Revised for 10/01/07

401428

470

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

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.

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

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

8 Current Women Dietary Risk Codes

402 Vegan403 Highly Restrictive Diets420 Excessive Caffeine Intake (BF only) - deleted421 Pica422 Inadequate Diet - deleted423 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)

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.

480 Inappropriate Nutrition Practices for Women

Women umbrella risk code

Includes 402, 403, 421, 423, 424, 426 plus

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

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”.

480 Inappropriate Nutrition Practices for Women

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

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

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

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.

460 Inappropriate Nutrition Practices for Infants

Infant umbrella risk codeIncludes 402, 403, 411, 412, 413, 414,

415, 416, 417, 418, 419, 423, 424, plus

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

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.

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.

460 Inappropriate Nutrition Practices for Infants

Item deleted from the current risk code:

416, Water consumption 4 oz to 8 oz per day.

Procedures

What is staying the same:

Income Height and weight, BMI Blood draw Identify all risk codes that apply with

information that is obtained

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

Risk Code Scenario 1

Healthy 2 ½ year old boyGrowing wellLow hematocritEats lot of cold hot dogs from the

refrigeratorDrinks orange juice at mealtime for a

total of 24 ounces/day

Risk Code Scenario 2

4 year old girlBMI for age plots above the 95th

percentileHemoglobin is goodEats well and a variety of foods