1. Institute of Medicine Recommendations for the Child Meal Pattern Ann McCormack, MPH, RD Missouri Department of Health and Senior Services Bureau of Community Food and Nutrition Assistance

2. Age Groups 1 year olds Age 2 through age 4 Age 5 through age 13 Age 14 through age 18

3. Lean meat or meat alternates must be served at breakfast 3 days per week. On the days without meat or meat alternates, must serve an additional ½ ounce equivalent grain/bread for 1 year old children, and an additional 1 ounce grain/bread equivalent for all other ages. Breakfast

4. Lunch/Supper Meal Pattern One fruit and two vegetables must be served at each lunch/supper meal ◦ Dark green vegetables at least twice per week ◦ Orange vegetables at least twice per week ◦ Legumes at least once per week ◦ Starchy vegetables no more than twice per week ◦ Other vegetables at least three times per week

5. Fruit Fruit, rather than juice is to be served at most meals 100% fruit juice is allowed only once per day in a serving size tailored to the child’s age

6. Grains/Bread Over the course of the week and day, at least half of the grains/breads served in meals and snacks must be whole grain rich ◦ Whole grain rich food must meet at least one of the following two specifications:  The product contains the FDA approved health claim on its packaging  The product ingredient listing lists whole grain first, in both mixed and non-mixed dishes

7. Milk Fat free on low fat Restrict flavored milk to children 5 years of age and above. Restrict sugars in flavored milk to 22 g. per 8 fluid ounces.

8. Snacks Each snack will provide two different food components ◦ Over the course of a five day week, the food components provided will include:  Two servings of fruit  One serving of an orange vegetable  One serving of a non-starchy vegetable  Two servings of grain/bread  Two servings of lean meat  Two servings of low fat or non-fat milk

9. Fat, Sugar and Sodium The amount of solid fat, trans fat, sugar, and sodium are to be limited in all meals and snacks.

10. Enhanced Snacks Providers should have the option of offering an enhanced snack in both the morning and afternoon ◦ The enhanced snack would have the same requirements as two smaller snacks

11. Weekly Meal Pattern-Breakfast 1 year2-4 years5-13 years14-18 years Fruit or non- starchy vegetables ¼ cup½ cup Grain/bread (ounce equiv) ½ ounce1 ounce1 ½ ounce2 ounces AND Lean Meat or Meat Alternate ½ ounce1 ounce 2 ounces OR Grain/bread1 ounce2 ounce2 ½ ounce3 ounces Milk½ cup ¾ cup1 cup

12. Weekly Meal Pattern – Lunch/Supper 1 year2-4 years5-13 years14-18 years Fruit¼ cup½ cup Vegetable (offer two different) ¼ cup½ cup1 cup Grain/Bread½ ounce1 ounce2 ounces2 ½ ounces Lean meat or meat alternate ½ ounce1 ounce2 ounces2 ½ ounces Milk½ cup 1 cup

13. Weekly Meal Pattern - Snack 1 year2-4 years5-13 years14-18 years Fruit (2 X per week) ½ cup 1 cup Orange vegetable (1 x per week) 1/8 cup¼ cup½ cup Non-starchy vegetable (1 x per week) 1/8 cup¼ cup½ cup1 cup Grain/Bread (2 x per week) ½ ounce equiv.1 ounce 2 ounces Meat or meat alternate (2 x per week) ½ ounce1 ounce Milk (2 X per week) ½ cup

14. Enhanced Snack 5-13 years14-18 years Fruit (4 X per week) ½ cup1 cup Orange vegetable (2 x per week) ½ cup Non-starchy vegetable (2 x per week) ½ cup1 cup Grain/Bread (4 x per week) 1 ounce2 ounces Meat or meat alternate (4 x per week) 1 ounce Milk (4 X per week) ½ cup

15. Enhanced Snacks Recommended as an option for children 5 years of age and older For each age group, the snack will include four servings Recommended as an option for the afternoon snack only Not recommended for children under age 5

16. Orange Vegetables Acorn squash Butternut squash Carrots Hubbard squash Pumpkin Sweet potatoes

17. Starchy Vegetables Corn Green peas Lima beans Potatoes

18. Dark Green Vegetables Bok choy Turnip greens Broccoli Mustard greens Collard greens Watercress Dark green leafy lettuce Spinach Kale Mesclun Romaine lettuce

19. Additional Recommendations Limit grains/breads that high in added sugars to one time per week Ready to eat and hot cereals must have less than or equal to 21.2 grams of sugar per 100 grams dry weight of cereal (WIC food package) which is equal to 6 grams or less sugar per 1 ounce cereal dry weight.

20. Additional Recommendations Baked or fried grain products high in solid fat and added sugars are limited to one serving per week across all eating occasions. Limit highly processed meat, poultry, and fish to one time per week across all eating occasions. This includes breaded and fried products.