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 CACFP child care centers (including at-risk afterschool care centers and emergency shelters) and family day care homes.

Children with a Disability  |   Children without a Disability
Guidance and Resources  |   Developing Policy and SOPs for Meal Modifications

Children with a Disability

The USDA requires reasonable meal modifications on a case-by-case basis for children whose disability restricts their diet, based on a medical statement signed by a recognized medical authority. “Case-by-case basis” means that the meal modifications are specific to the individual medical condition and dietary needs of each child. The Connecticut State Department of Public Health defines a recognized medical authority as a state-licensed health care professional who is authorized to write medical prescriptions under state law. This includes physicians (MD), physician assistants (PA) and certified physician assistants (PAC), doctors of osteopathy (DO), and advanced practice registered nurses (APRN).

Children without a Disability

The USDA allows optional modifications within the CACFP meal patterns for children and the CACFP infant meal patterns on a case-by-case basis for children whose dietary restrictions are not related to a disability. A medical statement is required if these optional modifications are outside the school meal patterns. Examples of optional modifications include requests related to religious or moral convictions, general health concerns, and personal food preferences, such as parents who prefer that their children eat a gluten-free diet or organic foods because they believe it is healthier.

Guidance and Resources

• Implementation Guidance
  • CSDE Guide: Guide to Meal Modifications in CACFP Child Care Programs
  • Milk Substitutes (Documents/Forms section)
  • Resource List for Special Diets in Child Nutrition Programs (CSDE)
  • Self-assessment of Child Care Practices for Meal Modifications in the CACFP (CSDE)
  • Summary Chart: Summary of Requirements for Meal Modifications for Children in the CACFP (CSDE)
• Medical Conditions
• • Information about celiac disease and intolerance, diabetes, food allergies, inborn errors of metabolism, and lactose intolerance: Go to Documents/Forms in the left navigation bar.
• Medical Statements
  • Medical Statements (Documents/Forms section)
• Policy Memos (CSDE and USDA)
  • CSDE Operational Memorandum No. 2C-18 and 2H-18: Requirements for Meal Modifications in CACFP Child Care Programs
  • CSDE Operational Memo No. 3A-16, 4C-16 and 3H-16: Statements Supporting Accommodations for Participants with Disabilities in the Child Nutrition Programs
  • CSDE Operational Memo No. 3C-07 and 3H-07: Reimbursement for Meals Provided by Parents for Medical Reasons in CACFP
  • USDA Memo CACFP 14-2017 and SFSP 10-2017: Modifications to Accommodate Disabilities in CACFP and SFSP
• Training 
  • CSDE Presentation: Requirements for Meal Modifications in CACFP Child Care Programs
  • Food Allergies (Documents/Forms section)
  • Training for Child Nutrition Programs (CSDE webpage)

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)