Food Allergies, Fluid Milk
Substitutions, and Meal
Modification Forms
June 28, 2016
www.ksde.org | www.kn-eat.org
Welcome
• Skype for Business
• For Audio
•
Listen through computer speakers (if computer has
microphone)
•
1-866-620-7326 enter code 7852962276
• Download handouts and slides
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
CACFP Tuesday Talk & Train
• Ask questions by phone or type message on screen.
• To Mute line: *6
• To Unmute line: #6
• Webinar is available for later reference on the web
site under CACFP, Training, Training Opportunities
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Today’s Topics
• Disability vs. Intolerance differences
• Allergy/Intolerances
• Milk substitution requests
• Milk Substitution List – update
• Q and A
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Child Nutrition Program Regulations
• Require modifications to the standard meal
requirements for participants who are considered
disabled and whose disability restricts their diets; and
• Permit modifications for other participants who are
not disabled but who are unable to consume regular
program meals because of medical or other special
dietary needs.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Child Nutrition Program Regulations, cont.
• The medical statement must include:
•
Child’s disability
•
Explanation of why disability restricts the diet
•
Major life activity affected by the disability
•
Foods to be omitted
•
Foods that must be substituted
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Disability
Under Section 504 of the Rehabilitation Act of 1973, and the Americans with
Disabilities Act (ADA) of 1990, a "person with a disability" means any person who
has a physical or mental impairment which substantially limits one or more
major life activities, has a record of such an impairment, or is regarded as
having such an impairment. The term "physical or mental impairment" includes
many diseases and conditions, a few of which may be:
•
•
•
•
•
•
•
Diabetes
Food anaphylaxis
PKU
Asthma
Inflammatory Bowel Disease
Sickle Cell Anemia
Cancer
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Medical Dietary Substitutions
Disability
• Sponsors are required to make
substitutions for children with food
allergies deemed as disabilities
• A disability can only be determined
and signed by a licensed medical
authority: Medical Doctor (MD), Doctor
of Osteopathy (DO), Advanced
Registered Nurse Practitioner (ARNP), or
Physician Assistant (PA)
• Signed form must also indicate
appropriate substitutions
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Intolerance
• Sponsors have the option to make
substitutions for children with food
intolerances not deemed as a disability
by a recognized medical provider
• Intolerance recommendations can be
determined and signed by Medical
Doctor (MD), Doctor of Osteopathy
(DO), Advanced Registered Nurse
Practitioner (ARNP), or Physician
Assistant (PA)
• Signed form must also indicate
appropriate substitutions
CACFP Meal Modification Form
Required for all meal
modifications
• Disability
• Allergy/Intolerance
• Milk substitution request
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Food or Milk Substitution Chart – Parent or Medical Authority Request
Due to Food Allergy or Intolerance
Parent &/or Medical Authority requests food item
or milk not served to child due to allergy,
intolerance or medical reason as outlined on
completed Meal Modification Form
Due to a Disability
Not a Disability
Facility must
provide substitute
Facility has option to
provide food item
No
Yes
Meal can be
claimed
Substitute is creditable*
Can be Claimed
Substitute not
creditable-cannot claim
meal
Parent provides substitute,
facility provides remaining
meal components
Meal & Substitute is creditable*
- Meal can be claimed
Item is omitted or Parent
provides all food items –
Meal cannot be claimed
Substitute or meal is not creditable
– Meal cannot be claimed
* See Fluid Milk Substitutions in the Child Nutrition Programs: Non-Dairy Beverages Meeting USDA Substitution Criteria and the Crediting Foods handbook.
Parent Request for Food or Milk Substitution - Non Medical Reason
Due to personal preference (vegetarian, religious reason) substitution requested.
If food item – no Meal Modification form needed
If milk – Meal Modification form completed by parent required
Facility sets policy & has option to provide
food item
Facility does not provide item
Facility provides item
Food or Milk Substitute is
creditable *
Can be Claimed
Substitute not creditableCannot be claimed
Parent provides food item or milk
substitute; facility provides
remaining meal components
Meal is creditable –
Meal can be claimed
Not served the component –
Meal cannot be claimed
Substitute or meal is not creditable –
Meal cannot be claimed
* See Fluid Milk Substitutions in the Child Nutrition Programs: Non-Dairy Beverages Meeting USDA Substitution Criteria and the Crediting Foods handbook.
Allergies and Food Intolerances
• These terms are sometimes used interchangeably
• Meal Modification form is required, must be signed by the
medical authority with the appropriate substitutions indicated
• Recommendations are determined and signed by Medical
Doctor (MD), Doctor of Osteopathy (DO), Advanced Registered
Nurse Practitioner (ARNP), or Physician Assistant (PA)
• Any substitution must meet the CACFP meal pattern for the meal
to be reimbursable
• Sponsors have the option to make the substitution
• Parent may request a substitution for milk without a medical
authority signature
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Special Diet Accommodations
• Have completed meal modification form on file.
• Set up a meeting w/parent(s), child, and site staff.
• Discuss menu modifications, child’s preferences, expectations,
and a method of communication.
• Shop for substitute menu items.
• Prepare food substitutions as directed.
• Provide at no additional charge to the child.
• Train food service employees at the site.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Fluid Milk Substitutes
What’s wrong
with our milk?
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Milk Substitution Requests
Meal Modification Form required
• A center/home has the option to make a substitution for fluid cow’s milk that
is requested by a parent/guardian, but that is not prescribed by a medical
authority due to a disability.
• The meal can be claimed if the center provides the substitution which is a
creditable product.
• New Meal Pattern - A parent can provide one component of a meal if the
milk substitution is requested by the medical authority, but not a disability.
•
More guidance is to come on this subject.
Only USDA approved milk substitutes may be used as a substitute unless it’s
due to a disability.
If a fluid milk substitution is served that does not meet the USDA criteria for a milk
substitute, the meal is not reimbursable.
•
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Creditable Fluid Milk Substitutions
• Lactose free milk is used for lactose intolerance. A parent
can request it and would not need the signature of the
medical authority.
• Non-dairy beverages such as soy milk that meets USDA
criteria
• See Administrative Handbook, Chapter 4
• www.kn-eat.org, Child & Adult Care Food Program, What’s
New, then click on:
•
Milk and Milk Substitutions, Policy 11-020
•
Fluid Milk Substitutions in Child Nutrition Programs
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Parent or Guardian Milk Substitute Requests
Parent or guardian must complete the CACFP Meal Modification Form (4-B)
following one of the 3 options explained at the top of the form:
1. Modification due to a disability

Signed by medical authority (MD, DO, PA or ARNP)

Substitute would made as directed by physician
2. Modification due to a food allergy/intolerance, but not a disability

Must meet USDA criteria to qualify as a non-dairy fluid milk substitute

Sponsor has the option to provide the substitute or not
3. Substitution for milk allergy/intolerance, religious, ethical, cultural reasons or
parent request

Must meet USDA criteria to qualify as a non-dairy fluid milk substitute

Sponsor has the option to provide the substitute or not
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
USDA Criteria for Required Nutrient Levels to
Qualify as Non-Dairy Beverage Substitute
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Non-Dairy Beverages Meeting USDA Substitution Criteria
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Products Not Listed
Check the nutrition information on the label against the
USDA criteria.
• If any of the criteria is not met or some of the information is
omitted from the label, the product doesn’t qualify.
• If it seems like it qualifies, contact your CACFP consultant or
Diana Floyd [email protected] to have it reviewed.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Buying Approved Products
• Possible sources are listed, but there may be others
• Contact your local vendor or grocery store for possible options
and to special order the item(s)
• On-line availability is an option, but shipping may be cost
prohibitive
• Container size and packaging are listed on the chart
• Shelf stable products are handy to have for back up
• Storage varies, check label
• All should be chilled before serving to improve taste appeal
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Fluid Milk Substitutions & the New CACFP
Meal Pattern
• The new CACFP meal pattern does not affect the
requirement that fluid milk substitutions meet the
USDA criteria.
• KSDE will continue to update the list as products that
meet the criteria are identified.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Questions
If a child has a ”sensitivity" to milk, does this child need a Meal
Modification form signed by the doctor or can the provider just not
serve the milk?
The Meal Modification form is required and a comparable substitution
must be made to meet CACFP meal pattern requirements and
address the food allergy intolerance. If it is not a disability, the provider
has the option to make the substitution or not.
A sponsor may choose to alter the snack menus to accommodate the
child’s needs for the days the child is in care since 2 other components
could be chosen.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Questions
Is a Meal Modification form needed for an infant since
they have different needs and are still trying different
foods at this stage?
Yes, if the substitution does not meet the infant meal pattern.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Questions
What about an infant that is not developmentally
ready to start milk after 12 months, would a Meal
Modification form be required?
Yes, at 12 months children should be served cows milk.
If a child is not developmentally ready, a meal modification
form would be required.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Questions
Which milk is the least expensive?
The costs vary by area as well as vendor.
Have you done a "taste-test" comparison?
Everyone has different taste preferences. A taste
testing would make a great staff in-service! Be sure to
include the lactose free milk as a choice and challenge
them to choose the cows milk.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Questions
Is almond milk acceptable as a fluid milk substitute if a
doctor prescribes it?
It is creditable only if the medical authority has marked
“disability” on the Meal Modification form.
Can lactose free milk be used if “Food Allergy or
Intolerance” is marked on the meal modification form?
Yes, if that is the substitution needed as indicated by the
medical authority or parent in Part D.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Questions
If a parent requests a milk substitute for their child and they
supply a creditable substitute for the milk, can the meal be
claimed?
Yes, as long as the substitute provided is creditable.
If a parent requests a milk substitute for their child and they
supply rice milk, can the meal be claimed?
No. If the substitute is not creditable, the meal cannot be
claimed unless the medical authority has checked “disability”
on the meal modification form.
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org
Questions after the call?
Contact:
Child Nutrition &
Wellness
785-296-2276
KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org | www.kn-eat.org