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Milk Substitutes - Frequently Asked Questions
MN WIC Program
- Should CPAs recommend low fat milk to 1 year olds who are "overweight"? (07/23/09)
- Will we need to have a doctor’s order to give 1% or skim milk to 1-2 year olds? (07/23/09)
- We have an autistic child >2 years whose doctor wants him on whole milk as a primary source of calories and nutrition. Does this meet the criteria? (07/23/09)
- Should WIC provide higher fat milk if a participant brings a Milk Substitute form from the MD requesting whole milk with "Underweight" checked as the reason, but the child's BMI is at the 15%? (07/23/09)
- If a qualifying condition for more cheese or whole milk is current inadequate weight gain in pregnancy, is there any dietary support to provide the extra cheese/ whole milk – does it really address the issue causing the weight loss or poor weight gain? (07/23/09)
- Does a participant who qualifies for whole milk and additional cheese have to get it? (07/23/09)
- Once the Authorization of Milk Substitutes form has been completed by the health care provider, who determines how much cheese will be provided to the participant? (07/23/09)
- Will the Milk Substitution form be provided to Health Care Providers? (07/23/09)
- May our agency eliminate cheese from the food packages and provide only milk as a dairy option to participants? (07/23/09)
Should CPAs recommend low fat milk to 1 year olds who are "overweight"? (07/23/09)
No. The Institutes of Medicine continued the general recommendation of whole milk for 1 year olds in the WIC program. While new medical guidelines recommend low fat milk for certain children in this category, that is a determination to be made by the Health Care Provider. If a CPA has concerns about the appropriateness of whole milk for a 1 year old, the CPA should refer the parent to the child’s provider for further guidance.
In cases where weight may be a concern, CPAs should assess the diet and feeding patterns for factors that may be contributing to inappropriate weight gain. Changing those behaviors can have a significant effect on weight gain and is an area that WIC can impact: These include
- Ensuring that the child is drinking appropriate amounts of milk (2 cups/day)
- Weaning from the bottle around 12 months of age
- Avoiding sweetened beverages
- Avoiding sippy cups (and other covered containers that a child can carry and drink from throughout the day)
- Ensuring snacks are structured and appropriate
- Preparing and providing appropriate foods; limiting fast food
Will we need to have a doctor’s order to give 1% or skim milk to 1-2 year olds? (07/23/09)
The voucher for children 12-24 months will list all four varieties of milk: Whole, 2%, 1% or Fat Free/Skim milk. This is a point-of-purchase decision. WIC CPAs will not be selecting the type of milk in CHIP. Therefore, medical documentation is not required.
We have an autistic child >2 years whose doctor wants him on whole milk as a primary source of calories and nutrition. Does this meet the criteria? (07/23/09)
No. This child does not have a qualifying condition for whole milk. However, milk is just one component of the diet. There are various other ways to increase calories and nutrients. Refer to the High Risk CPA for more in-depth assessment and counseling for ways to ensure adequate intake. Also see the High-Risk Counseling Guide for counseling suggestions.
Should WIC provide higher fat milk if a participant brings a Milk Substitute form from the MD requesting whole milk with "Underweight" checked as the reason, but the child's BMI is at the 15%? (07/23/09)
Only participants determined to be underweight by WIC risk code definition (i.e., risk codes 101 and 103) may receive whole milk for the reason "Underweight".
That situation should be unusual. In most cases it is the CPA who initiates the discussion and provides the form to the participant to take to their health care provider. CPAs should determine when whole milk or additional cheese would be appropriate and provide the form only to those participants. Participants who request whole milk, but who do not meet the criteria, should not be given the form.
In cases where the Health Care Provider may have acquired copies of the approval form and inappropriately initiated a request for a milk substitute, the Local Agency should contact the physician and work with him or her in understanding WIC procedures. It is recommended that one staff person, such as the WIC Coordinator, Nutrition Coordinator or High Risk CPA, be the WIC contact person for local medical providers so that they may develop a relationship with them.
If a qualifying condition for more cheese or whole milk is current inadequate weight gain in pregnancy, is there any dietary support to provide the extra cheese/ whole milk – does it really address the issue causing the weight loss or poor weight gain? (07/23/09)
The CPA should assess for potential causes of weight loss or inadequate weight gain and help the pregnant woman address those issues. (See the High-Risk Counseling Guide for ideas for assessing weight loss or inadequate weight gain during pregnancy. Suggestions for addressing these high-risk conditions are included.) Adjusting the WIC food package is just one option for enhancing a woman’s weight gain. Before offering increased cheese or whole milk and starting the Medical Documentation process, the CPA should assure that the individual woman is able to use these food items to improve her weight gain.
Does a participant who qualifies for whole milk and additional cheese have to get it? (07/23/09)
No. The CPA should assess the situation and determine whether those items are appropriate. Whole milk and/or additional cheese should not automatically be given when there are weight issues.
Once the Authorization of Milk Substitutes form has been completed by the health care provider, who determines how much cheese will be provided to the participant? (07/23/09)
The CPA should work with the participant/parent to determine the appropriate quantity based on the participant’s needs.
Will the Milk Substitution form be provided to Health Care Providers? (07/23/09)
As with the Medical Formula Documentation form, Minnesota Health Care Providers are being informed in several ways. They are also encouraged to visit the WIC website where the forms can be accessed. However, in most cases if a milk substitute is needed, it should be the CPA who assesses appropriateness of the request and then initiates the form.
May our agency eliminate cheese from the food packages and provide only milk as a dairy option to participants? (07/23/09)
No. USDA specifies that participants may substitute 1 lb. of cheese for milk (2 lb if fully breastfeeding). Also, differences in foods provided by different agencies appears unfair to participants. CPAs should assess the individual’s situation and target counseling based on those factors. Also:
- CPAs can point out that the participant will receive more food by choosing the "all milk" option.
- If fat content is a concern, CPAs can counsel on lower fat cheese options, discuss how cheese is used in the diet, limiting other sources of fat in the diet, etc.
