What Is the HighRisk Guidebook?
The Arizona Women, Infants and Children (WIC) program publishes a HighRisk Guidebook for Children to help WIC staff, health professionals, and families identify infants and toddlers who are at increased risk for nutritionrelated problems. The guidebook provides clear criteria, screening tools, and referral pathways so that atrisk children receive timely nutrition counseling, supplemental foods, and medical followup.
Why It Matters
- Early detection: Identifying risk factors before they become chronic conditions can prevent growth faltering and developmental delays.
- Targeted resources: WIC can allocate nutrition packages, breastfeeding support, and education to families who need them most.
- Collaboration: The guidebook bridges WIC with pediatricians, community health workers, and social service agencies.
Key Risk Categories
1. Low Birth Weight & Prematurity
Infants born < 2500g or before 37 weeks gestation are screened for feeding difficulties, thermoregulation problems, and iron deficiency. Parents receive tailored lactation support and fortified formula options.
2. Failure to Thrive (FTT)
Children whose weightforage falls below the 5th percentile for two consecutive visits are flagged. The guidebook outlines a stepbystep assessment, including diet recall, oralmotor evaluation, and a homevisit checklist.
3. Food Allergies & Intolerances
When a child has a documented allergy to cows milk, soy, or wheat, WIC staff can prescribe alternative protein and calcium sources, such as lactosefree formula or fortified plantbased milks approved by the USDA.
4. Chronic Medical Conditions
Children with cystic fibrosis, congenital heart disease, or gastrointestinal disorders are at heightened risk for nutrient deficiencies. The guidebook provides diseasespecific nutrient targets and referral forms for dietitianled care.
5. Socioeconomic & Environmental Stressors
Households experiencing homelessness, food insecurity, or limited transportation are screened using the USDA Food Security Survey Module. Families receive emergency nutrition vouchers and connections to local shelters.
How Screening Works
- Initial Enrollment: Every child enrolled in WIC receives a baseline anthropometric measurement (weight, length/height, head circumference).
- Routine Checks: Followup visits occur every 30 days for infants 6months, then every 60 days until age 2. At each visit, staff compare growth curves to risk thresholds.
- Risk Flagging: If a measurement falls below the defined cutoff, the system automatically flags the case for a highrisk assessment.
- Comprehensive Review: A trained WIC nutritionist completes the HighRisk Checklist, which includes questions about feeding practices, medical history, and household conditions.
- Referral & Intervention: Based on the checklist outcome, the child may receive:
- Intensive nutrition counseling (weekly for 4 weeks)
- Special supplemental foods (e.g., highcalorie formula, fortified cereals)
- Referral to a pediatric dietitian, speech therapist, or medical specialist
- Connection to community resources (food banks, housing assistance)
- Followup Monitoring: After intervention, the childs growth is reevaluated at the next scheduled visit. Success is defined as moving at least two percentile points upward on the growth chart.
Nutrition Packages for HighRisk Children
The guidebook lists the specific WIC foods eligible for highrisk participants. Examples include:
- Readytouse therapeutic foods (RUTF) for severely malnourished toddlers.
- Ironfortified infant cereals and pureed meats for anemia.
- Highcalorie, nutrientdense formulas (e.g., Pediasure) for failuretothrive.
- Calciumrich fortified plant milks for dairyintolerant children.
- Special lowsodium, highprotein foods for children with cardiac conditions.
Training & Resources for WIC Staff
Effective use of the guidebook requires ongoing education. Arizona WIC offers:
- Quarterly webinars on interpreting growth charts and applying risk criteria.
- Interactive case studies that simulate realworld highrisk scenarios.
- Printed quickreference cards for the most common risk factors.
- Access to an online portal where staff can submit complex cases for specialist review.
Measuring Success
Arizona tracks the impact of the HighRisk Guidebook through three key performance indicators:
- Reduction in FTT prevalence: Aim for a 15% decrease in children below the 5th percentile within two years.
- Increase in appropriate referrals: Target 90% of flagged cases receiving a specialist referral within 10 days.
- Family satisfaction: Maintain a minimum 85% positive rating on postservice surveys.
Annual reports are published on the Arizona WIC website and include actionable recommendations for program improvement.
How Families Can Get Involved
Parents and caregivers play an essential role in the success of the highrisk program. Helpful steps include:
- Attend all scheduled WIC appointments and bring any recent medical records.
- Ask questions about the nutrition packages and how to prepare them correctly.
- Report any changes in the childs health, feeding behavior, or home environment promptly.
- Utilize the WIC mobile app to track appointments, receive reminders, and access educational videos.
- Connect with local support groups for shared experiences and peer encouragement.
