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Special Diets in CACFP Child Care Programs

Overview

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The Connecticut State Department of Education's (CSDE) Guide to Meal Modifications in CACFP Child Care Programs provides guidance on meal modifications for children and infants with special dietary needs, based on the federal nondiscrimination laws and U.S. Department of Agriculture (USDA) regulations. This guide applies to all CACFP child care facilities, including child care centers, Head Start centers, at-risk afterschool care centers, emergency shelters, and family day care homes.


Modifications for Disability Reasons  |   Modifications for Non-disability Reasons
Guidance and Resources  |   Developing Policy and SOPs for Meal Modifications


Modifications for Disability Reasons

The USDA requires reasonable meal modifications on a case-by-case basis for children whose disability restricts their diet, based on written documentation from a state licensed healthcare professional or registered dietitian. Meal modifications must be related to the disability or limitations caused by the disability.   

  • A reasonable modification is a change or alteration in policies, practices, and/or procedures to accommodate a disability that ensures children with disabilities have equal opportunity to participate in or benefit from a program.
  • Case-by-case basis means that the meal modifications are specific to the individual medical condition and dietary needs of each child, based on the specific information provided by the state licensed healthcare professional or registered dietitian in the child’s medical statement or, if applicable, the child’s Section 504 plan or Individualized Education Program.
  • A state licensed healthcare professional is an individual who is authorized to write medical prescriptions under state law. The Connecticut State Department of Public Health (DPH) defines these individuals as physicians (MD), physician assistants (PA) and certified physician assistants (PAC), doctors of osteopathy (DO), and advanced practice registered nurses (APRN). 
  • A registered dietitian (RD) or registered dietitian nutritionist (RDN) is an individual with a minimum of a graduate degree from an accredited dietetics program and who completed a supervised practice requirement, passed a national exam, and completes continuing professional educational requirements to maintain registration. For more information, visit the Academy of Nutrition and Dietetics’ (AND) Registered Dietitian Nutritionist Fact Sheet website.

Modifications for Non-disability Reasons

CACFP facilities may choose to make optional meal modifications on a case-by-case basis for children whose dietary needs do not constitute a disability. Optional modifications for non-disability reasons include requests related to religious or moral convictions, general health concerns, and personal food preferences. An example is a family’s preference for gluten-free foods, organic foods, or almond milk because they believe these foods are healthier.  

  • Modifications within the USDA meal patterns: Meal modifications are within the CACFP meal patterns for children or the CACFP infant meal patterns if they are only modified for texture (such as chopped, ground, or pureed foods) or include substitutions within the same meal component, such as a banana for strawberries (fruits component), lactose-free milk for regular milk (milk component), and chicken for pork (meats/meat alternates component). These modifications do not require a medical statement. However, the CSDE recommends obtaining a medical statement to ensure clear communication between parents/guardians and the CACFP facility regarding the appropriate meal modifications for the child.
  • Modifications outside the USDA meal patterns: Meal modifications for non-disability reasons that are outside the meal patterns require a medical statement signed by a state licensed healthcare professional or registered dietitian.

Guidance and Resources


Developing Policy and Standard Operating Procedures (SOPs) for Meal Modifications

The CSDE recommends that CACFP facilities develop a written policy and SOPs for meal modifications in the CACFP. For information on developing policies, go to What's Next in the left navigation bar.



Nondiscrimination Statements (USDA and CSDE)