Being “sensitive” to formula changes in WIC

Being “sensitive” to formula changes in WIC

Staff discussion guide – February 2014

Objective of this discussion guide

2014 Formula Changes in WIC 2

Before beginning, please review the Formula Changes Overview and FAQs

This discussion guide is intended to give staff the chance to think about issues related to the formula changes, talk with their co-workers, and practice how to handle different situations.

All WIC staff will need to use their knowledge and skills to address participant concerns with the transition. It will be important to use: Critical thinking Knowledge of baby behaviors Customer service and participant centered skills

Resources to use during discussions


All resources are posted to the WIC website on the Staff Training page under In-services. Formula Changes Overview, Plan and FAQ’s Using PCS During Formula Changes Baby Behaviors for Formula-fed Infants: What is Normal

and When to Refer? Infant formula changes in WIC handout Case Study Discussion Questions Common Infant Problems handouts (Texas WIC )

Colic Spitting up Constipation Diarrhea Food Allergies

Baby Behavior handouts – on publications page Why Do Babies Cry? Understanding Your Baby’s Cues

What is the situation?

Section 1: Background information and discussion


Let’s recap what is changing


Abbott Nutrition changed the formulation of these 3 infant formulas from 20 to 19 kcal/oz

They no longer meet the qualifications as a standard milk-based formula and are not rebated

WIC cannot provide Similac Sensitive or Total Comfort

Similac for Spit-Up requires med doc to provide

How many Oregon WIC babies are on these formulas?


Formula marketing


Abbott Nutrition designed and marketed these formulas for healthy babies.

Many caregivers chose Similac Sensitive or Similac Total Comfort because WIC allowed it, and almost all babies are fussy, gassy, sensitive, or spitting-up at times.

How can we be breastfeeding friendly in the midst of formula transitions?


Maintain a breastfeeding friendly clinic environment

Focus on WIC’s messages rather than on the formula company’s

Think about your words when you talk to partially breastfeeding women

Similac Advance - Another label change


Similac Advance will continue as WIC’s standard milk-based bid formula in 12.4 oz powder, 13 oz concentrate, and 32 oz ready-to-feed

These sizes stay at 20 kcal/oz The formula with the new labels will

gradually change as stock runs out

Gradual change to new labels


Look for “OptiGRO” emblem

On powder cans, look for 12.4 oz size Birth to 12 months Stage 1

Other size cans of powder or stages are not WIC eligible

Look for Birth-12 months

Look for Stage 1

12.4 oz.

New emblem

How does the rebate come into this?


Rebates from formulas support about 25% of our caseload

These formulas have been rebated in the past, so providing them did not cost the program extra

WIC can’t afford to provide similar formulas without a rebate, especially if they are not medically necessary





Practice

Section 2: Case studies


What do you hear from caregivers?


When a parent asks for Similac Sensitive or Similac Total Comfort:

Is it about a medical need?

Is it about addressing a parent or caregivers worry?

Is it because a health care provider has recommended it?

What is normal for most babies?


If most babies are fussy at some point and grow out of it…

If half of babies are “happy spitters”…

If only 2-4% of all infants are really truly lactose intolerant…

What is the solution?

Discuss Case Study #1


Myra comes to her postpartum appointment with her 6 week old infant, Kyle. Myra reports that she is breastfeeding and started Kyle on one bottle of Similac Total Comfort. Kyle’s doctor recommended it for him because he is a little gassy.

Case Study #1


Considerations…What further assessment or BF support would you want to do with Myra and Kyle?How do you frame your response when you cannot give mom Similac Total Comfort?How do you respond to the doctor’s recommendation?

How do we help babies currently getting vouchers for Sensitive or Total Comfort?


Most do fine on any formula May switch anytime or can

stay on the same formula until May 2014

By May, these babies will be older, more likely to be on solid foods, and developmentally past any feeding issues

May need ideas on how to transition to a new formula

Help for parents changing formulas


Many babies can easily change formula, so can just be offered a bottle of the new formula

Caregivers may need help with instructions if using different size bottles

Be sure to use the scoop that comes with the can of formula when measuring

May work best to mix up each formula separately, then mix some of the two formulas together

To ensure understanding, ask the caregiver to describe how they will mix the two formulas together



Cara stops by the WIC office to request a change in her infant’s formula vouchers. She reports that her 3 month old baby Lynn is very fussy on Similac Advance. Mom is sure that she would do better on Nutramigen which she used in the past when her older sister had similar symptoms.

Case Study #2


Considerations… What reflections might

you make when mom shares her concerns?

What additional information would you want to gather?

How would your knowledge about baby behaviors be useful in this situation?



Pearl brings her 6 month old daughter Liza to her MI appointment. Pearl says Liza has just started eating baby cereal, is sitting up unassisted and is growing and gaining weight well. Pearl says Liza has been on Similac Sensitive since she was one month old when she had colic.

Case Study #3


Considerations…What factors would be key for reassuring mom about transitioning off of the current formula?What would you recommend regarding the process of transitioning from one formula to another?

Constipation and formula


Parents may not know the difference between normal stooling and constipation

Parents may not know how to deal with a temporary issue

Some providers recommend whey-based formulas for softer stools when there may be other ways to address the concern



Tammy is Mabel’s five month old granddaughter. Mabel calls to report that Similac Advance is making Tammy constipated. She rarely stools every day and she strains so hard when she does go that Mabel thinks she needs to be switched to a different formula.

Case Study #4


Considerations…What clarifying questions would you ask?What reflections might you offer based on Grandma’s comments?What advice or information might you offer to address her concerns?

Spitting up and formula


Parents worry about any spitting up and don’t understand “happy spitters”

Sometimes parents feel better if they make a change, so offering concentrate might help

Lactose intolerance is very rare and AAP doesn’t suggest routine use of lactose reduced formula



Sammy is two months old and spits up after every feeding of Similac Advance. His mother, Grace, is very worried that something is wrong with her son and thinks she should try a new formula since Sammy obviously does not tolerate this formula well.

Case Study #5


Considerations… How would you

respond? What other

underlying issues might be present?

What further assessment is needed?

Use of special medical formulas


Sometimes babies need special medical formulas for a little while To rest the gut after illness To assess an underlying medical

condition These babies can often return

to the standard milk-based formulas after one to two months

Soy formulas are most appropriate for vegan families.

When would you refer to your WIC Nutritionist?

Discuss Case Study # 6


Jeff is 7 months old and has been on Alimentum for 2 months. He switched from Similac Advance to Alimentum at age 5 months following a week long hospitalization for dehydration due to a bacterial infection. He is finally eating solid foods again, has been crawling and his weight for length is at the 40th percentile.

Case Study #6


Considerations… How do you know when it

is the appropriate time to move from a medical to a milk-based formula?

How would you approach the subject of switching formulas with mom?

What support would you offer for changing from one formula to another?

Wrap up


What other formula situations have you encountered?


What was the issue? What assessment

questions did you ask? What was the outcome? What were you glad you

said? What did you wish you

would have thought of then?

What other ideas are there?

If you have additional questions


Talk to your agency’s WIC Coordinator or WIC Nutritionist

Talk to your agency’s State Nutrition Consultant

Offer the state formula warm line (503-866-5106) to parents or health care providers if they have questions you don’t feel comfortable answering. The warm line will be staffed by State Nutrition Consultants during normal business hours for the months of the transition.

Thank you!


Thank you for all the work you do to help parents and caregivers make this transition.

WIC continues to be a great resource for information, support and assistance for families!

Documents

Being “sensitive” to formula changes in WIC