Mealtime Memo
FOR CHILD CARE
2001
Special Needs Care for the Young Child
Introduction
Good communication skills and a broad-based
knowledge in many areas are especially important when
pre-school children have special dietary needs. Special
dietary needs may include increasing or decreasing calories, avoiding certain foods, or modifying the texture of
foods or beverages. Child care facilities participating in
the USDA Child and Adult Care Food Program are
required to accommodate special dietary
needs of children when a
written diet prescription
authorizing
these
changes is provided by a
recognized
medical
authority, such as a medical doctor. The diet prescription should be specific enough to give the
caregiver a clear understanding of the menu modifications needed and to justify that the modified meal is
reimbursable.
Follow the regular menu as much as possible when
accommodating children with special diet prescriptions.
This helps minimize feelings on the part of the child that
he/she is different. It also helps ensure that the special
needs child receives the variety of foods and nutrients
needed to promote health and growth and reduces taste
fatigue from the unnecessary repetition of the same
foods.
There are many different disabilities or chronic health
conditions which could necessitate menu changes. For
example, a child may be born with a genetic disorder or
syndrome such as phenylketonuria (PKU), down syndrome, cystic fibrosis, or Prader-Willi Syndrome.
2001-6
Other health problems are not inherited but may occur at
birth or develop later such as cerebral palsy, diabetes mellitus, or food allergies.
Allergies
An area of growing concern and confusion is in the
area of food allergies. While food allergies can be associated with any food, most allergic reactions are caused
by the following eight foods: milk, eggs, fish, shellfish,
soy, wheat, peanuts, and tree nuts. The physiological
symptoms caused by a food allergy range from mild to
life-threatening. Symptoms of an allergic reaction may
involve the skin, respiratory tract, gastrointestinal tract,
and cardiovascular system. Types of symptoms include
itchy skin or eyes, hives, difficulty breathing, abdominal
cramps or stomach ache, nausea, and vomiting. For a
child who is severely allergic, even tiny amounts of the
offending food can cause a reaction. It is important to
know that children who are allergic to the same food
may exhibit very different reactions or symptoms when
exposed to that food. Historical information regarding
severity of the reaction and types of symptoms, along
with instructions for emergency treatment from the parents or guardian
should be kept on
file. This information can be invaluable to day care staff
in providing care for
the allergic child.
Even if a child has
not had a severe
reaction in the past,
this is no guarantee
that a severe reaction
National Food Service Management Institute • The University of Mississippi
Mealtime Memo
F O R
C H I L D
will not occur. If food allergies exist among the children in your care, have a written policy regarding storage of allergenic foods to keep them separate from
other foods. Keep any emergency medications and
phone numbers accessible—even on field trips.
It is helpful to understand the differences between
food allergies and food intolerances. A food intolerance
refers to an adverse reaction to food which does not
involve the body’s immune system. An example of a
food intolerance is lactose intolerance.
An allergy is a reaction between a food protein and
C A R E
the body’s immune system. The most serious type of
allergic reaction is called anaphylaxis, a severe lifethreatening allergic response resulting in lowered blood
pressure, swelling, and hives. It is considered the most
serious reaction because if left untreated, it can result in
death. Immediate medical attention is the best practice
when a severely allergic child has been exposed to a
known allergen or if an exposure has occurred and the
caregiver is uncertain as to the severity of the allergy.
There is no cure for food allergies. Avoidance of the
offending food is the only way to prevent a reaction.
Special Needs Tips
■
Good documentation is important. Check with your
state agency regarding what documentation is
required related to special needs or allergies. In
addition to maintaining the diet prescription, other
items to consider documenting are conversations
with parent or guardian and conversations with medical professionals.
■
■
Tailor dietary modifications to the needs of the individual child.
If uncertain about how to handle allergies or special
diet prescriptions, seek help from parents, community
resources, state agency staff, and appropriate medical
professionals to clarify diet prescription and to provide needed training for the child care staff.
■
The same safe food handling principles should be
used when preparing, serving, and holding special
foods and supplements that you would use in handling any other foods.
■
Keep emergency
medications and
phone numbers
accessible.
■
Children who are
allergic to the same
food may exhibit
different reactions
when exposed to
the offending food.
References/Resources
Alabama Department of Education (1995). CARE: Special nutrition for kids. (Revised by USDA). University, MS.
National Food Service Management Institute
Kansas State University and Kansas State Board of Education
Nutrition Services. (n.d.) Special foods for special kids.
[University, MS: National Food Service Management
Institute].
Healthy School Meals Resource System (n.d.) Resources on
food allergies, special diets & special needs. Retrieved
August 28, 2001, from http://schoolmeals.nal.usda.gov:
8001/Resources/specialdiets.html.
Lumina Training Associates (1997). CARE connection.
University, MS: National Food Service Management
Institute.
International Food Information Council Foundation. (2001).
Understanding food allergy. Washington, DC: Author.
Munoz-Furlong, A. (Ed.). (1999). The school food allergy program (Rev. ed.). Fairfax, VA: The Food Allergy Network.
This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture, Food and Nutrition Service through a grant agreement with The University of
Mississippi. The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or
organizations imply endorsement by the U.S. Government. The University of Mississippi complies with all applicable laws regarding affirmative action and equal opportunity in all its activities and programs and does not discriminate against anyone protected by law because of age, color, disability, national origin, race, religion, sex, or status as a veteran or disabled veteran.
For more information, contact NFSMI at 1-800-321-3054 or www.nfsmi.org