1. Understanding Special Dietary Needs and How to Claim CACFP meals Community Nutrition Programs WI Dept of Public Instruction

2. Objectives of this Session Understand the CACFP requirements for disabilities and non-disabilities relating to special dietary needs Understand the CACFP requirements for disabilities and non-disabilities relating to special dietary needs Address lifestyle preferences and parental choices relating to food Address lifestyle preferences and parental choices relating to food Follow CACFP requirements for claiming meals that accommodate special dietary needs Follow CACFP requirements for claiming meals that accommodate special dietary needs Differentiate between a food allergy and intolerance Differentiate between a food allergy and intolerance Plan meals to accommodate special dietary needs Plan meals to accommodate special dietary needs

4. The CACFP Role Provides reimbursement for serving nutritious meals that are in compliance with the CACFP Meal Pattern

5. The CACFP Role The CACFP Meal Pattern is based on average nutritional needs of a healthy child

6. The CACFP Role Requires medical documentation for meals that do not meet the CACFP Meal Pattern and/or have parent supplied items (for 1 year – 12+ years)

7. Your Child Care’s Role Accommodates special dietary need requests when they are the result of a disability Serves each child a meal/snack that is in compliance with the CACFP Meal Pattern

8. Your Child Care’s Role May accommodate special dietary need requests when they are not the result of a disability Claims meals with special dietary needs only when CACFP requirements are met

9. The Challenge More children have food allergies and intolerances than ever before FARE – Food Allergy Research and Education http://www.foodallergy.org /

11. Disability or Not? Medical Statement Flow Chart

13. What is a Disability? Americans with Disabilities Act (ADA) of 1990 Americans with Disabilities Act (ADA) of 1990 A mental or physical impairment that substantially limits a major life activity. A mental or physical impairment that substantially limits a major life activity.

14. Food Related Disabilities Metabolic Diseases such as Diabetes and PKU Metabolic Diseases such as Diabetes and PKU Food Anaphylaxis Food Anaphylaxis Heart Disease Heart Disease Cancer Muscular dystrophy Sometimes Celiac Disease

15. Child Care’s Responsibilities Must offer to purchase and supply the required substitution based on the special dietary need Must offer to purchase and supply the required substitution based on the special dietary need Physician prescribed supplements that are in addition the standard CACFP meal pattern requirements do not have to be supplied by child care. Physician prescribed supplements that are in addition the standard CACFP meal pattern requirements do not have to be supplied by child care.

16. Written Medical Statement Special Dietary Needs Resulting from a Disability Must be signed by a licensed physician Must Identify… The child’s disability and why it restricts the child’s diet The major life activity affected by the disability The food(s) to be omitted and the food(s) that must be substituted or the modification(s) that must be made

17. Written Medical Statement

19. for Non-Disabilities It is o.k. to request parents to provide substitutions. But, to claim the child’s meals then, the child care must… Have statement from a medical authority on file Supply all other components of the meal

20. WI Recognized Medical Authorities Licensed Physician Physical Therapist Licensed Nurse Registered Dietitian Respiratory Care Practitioner Speech & Language Pathologist Chiropractor

21. Written Medical Statement Should identify… The special dietary need The food(s) to be omitted from the child’s diet The food(s) that may be substituted

22. Written Medical Statement

23. If a food allergy or intolerance is suspected by the parents, but… there is no medical statement The child care cannot claim meal unless it supplies the substitute and no required components are excluded from the meal

24. Ramadan Diet The full meal pattern must be supplied by the child care in order to claim meals for reimbursement unless justified by a medical statement

25. Exception to the Rule Non-dairy milk substitutes Must be nutritionally equivalent to milk Parents must provide written request that includes reason for substitution specific type of non-dairy milk substitute Parents or child care can supply All other components must be supplied by child care

26. Non-Dairy Milk Substitutes Medical Statement Flow Chart

27. Approved Non-Dairy Milk Substitutes

28. Same Component Substitutions When the special dietary need does not omit an entire meal component and foods are not supplied by parent (1-12+ olds), a medical statement is not required for claiming meals Examples?

29. Flow Chart

30. Resources Found at: http://fns.dpi.wi.gov/fns_guidememos http://fns.dpi.wi.gov/fns_guidememos Guidance Memorandum 12C or L Guidance Memorandum 12C or L Claiming Meals with Special Dietary Needs Flow Chart Claiming Meals with Special Dietary Needs Flow Chart Medical Statement Flow Chart Medical Statement Flow Chart Fluid Milk Substitution for Child Nutrition Programs Fluid Milk Substitution for Child Nutrition Programs

31. Case Studies What should the child care do? Tyler Samantha Dillon Lilliana