Meeting Special Dietary Needs in Child Nutrition Programs

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Meeting Special Dietary Needs in Child Nutrition
Programs
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Objective

• To understand Legal and Regulatory Requirements
  for managing special dietary needs in Child
  Nutrition Programs.

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Meeting the Needs of Children with Special Diets
in the USDA School Nutrition Programs

• USDA issued guidance on special diets for schools
  operating school nutrition programs
• Accommodating Children with Special Dietary Needs
  in the School Nutrition Programs (1991, reissued
  in 1995, and 2001)
• Written to provide operational guidance on
  regulations and statutes

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Accommodating Children with Special Dietary Needs
in the School Nutrition Programs

• Five laws and regulations ensure children with
  disabilities have access to USDA Child Nutrition
  Programs
• The Rehabilitation Act of 1973
• The Individuals with Disabilities Education Act
• Americans with Disabilities Act
• 7 Code of Federal Regulations Part 15b
• 7 Code of Federal Regulations 210.10(g)

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Nonacademic Services 7 CFR 15b.26

• Students with disabilities MUST have an equal
  opportunity to participate in nonacademic and
  extracurricular services.
• Examples physical education and athletics, food
  services, transportation, health services,
  recreational activities, special interest groups
  or clubs sponsored by the recipient. Classroom
  activities such as parties would fall under this
  regulation.
• THESE THINGS DO NOT NECESSARILY INVOLVE THE FOOD
  SERVICE STAFF, BUT SOMEONE AT THE SCHOOL NEEDS TO
  ADDRESS THESE

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Food Services - 7 CFR 15b.26(d)

• Food services. In providing food services to any
  of its students, a recipient to which this
  subpart applies may not discriminate on the basis
  of handicap. (1) Recipients shall serve special
  meals, at no extra charge, to students whose
  handicap restricts their diet. Recipients may
  require students to provide medical certification
  that special meals are needed because of their
  handicap.
• (2) Where existing food service facilities are
  not completely accessible and usable, recipients
  may provide aides or use other equally effective
  methods to serve food to handicapped persons.
  Recipients shall provide all food services in the
  most integrated setting appropriate to the needs
  of handicapped persons as required by 15b.23(b).

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School Requirements for Children with
Disabilities

• Accommodation MUST be made
• A disability determination can only be made by a
  licensed physician (or other recognized medical
  authority)
• No extra charge
• In the most integrated setting appropriate

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What are Disabilities?

• Disability is defined in
• Part B of the Individuals with Disabilities
  Education Act (IDEA)
• Section 504 of the Rehabilitation Act of 1973
• Americans with Disabilities Act of 1990

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What is the definition of Disability?

• A condition that substantially limits one or more
  major life activities or
• A record of such a condition or
• Being regarded as having such a condition.
• EATING is a major life activity that can be
  substantially limited by a food intolerance.
• BREATHING can be impacted by food intolerances
  and food allergies.

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Examples of Diet-Related Disabilities

• Diabetes
• Severe Food Allergies (anaphylaxis)
• Celiac Disease
• Phenylketonuria (PKU), other metabolic
• Epilepsy
• Emotional illness
• Heart disease
• Autism

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Required Statement For Children With Disabilities

• Signed by a licensed physician
• Identify the disability
• How it restricts diet
• Major life activity affected
• Foods to be omitted
• Foods to be substituted

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In SummarySchool Foodservice Responsibilities

• Must make food substitutions or modifications for
  students with disabilities
• Must make accommodations based on a physicians
  statement or recognized medical authority
• Under no circumstances are school foodservice
  staff to revise or change a diet or medical order
• No requirement for yearly updated diet orders,
  but schools are encouraged to obtain updated
  orders.

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Children Who Are Not Disabled But Have Other
Special Dietary Needs

• Food allergies or intolerances
• NOT generally disabilities UNLESS anaphylactic
• Accommodation MAY be made BUT is NOT Required
• In many cases, allergies can be dealt with
  through Offer-Versus-Serve or by providing
  additional selections.

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Statement For Children Who Are Not Disabled

• Substitutions for non-disabled students must be
  supported by a statement signed by a recognized
  medical authority such as
• physicians,
• physician assistants,
• nurse practitioner,
• other professionals specified by the State
  agency.

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Statement For Children Who Are Not Disabled
(continued)

• Identify the medical condition or special dietary
  need
• How it restricts diet
• Foods to be omitted
• Foods to be substituted

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Food Intolerances

• Adverse reaction to a food that does not involve
  immune system
• Symptoms similar to food allergy
• Lactose Intolerance most common
• School does not have to accommodate

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Meeting Special Dietary Needs Related to
Disabilities School Issues

• What are the responsibilities of school
  foodservice?
• Where can additional funds be obtained?
• Who can provide more information and assistance?

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Accommodating Children with Special Dietary Needs
in the School Nutrition ProgramsIncurring
Additional Expenses Potential Funding Sources

• School Districts General Fund
• Individuals with Disabilities Education Act
  (IDEA)
• Medicaid
• Supplemental Security Income (SSI)

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Practical Applications

• School MEALS
• Talk with the parent and physician. Get an
  understanding of what the child is not allowed to
  eat and determine reasonable alternatives.
• Example Baked chicken and baked potato or
  steamed veggie with chicken and rice for someone
  who has celiac disease. The meal does not have
  to be exactly the same as what is provided to
  others.

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Possible Situations and Solutions
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Situation 1 Peanut Allergy

• Child has anaphylactic reaction to peanuts
• To what lengths must school food service go to
  accommodate the child?

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Situation 1 Peanut allergy, cont.

• School is responsible for providing a safe,
  non-allergic meal to the child
• Ensure that all food items offered to the
  allergic child are free of allergy-provoking
  foods
• Check labels, contact manufacturer, contact
  parents

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Situation 2 Food Service Management Companies
(FSMC)

• A school district is contracted with a FSMC
• Is the FSMC obligated to accommodate children
  with disabilities?

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Situation 3 Substitutions

• Because of his or her medication, a child
  requires specific foods, as indicated in a
  physicians statement
• When these specific foods are out of stock,
  should the school determine alternate
  substitutions?

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Situation 3 Substitutions

• No, school should not revise or change a diet
  order.

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Situation 4 Feeding in Separate Facilities

• A school wishes to serve meals to children with
  disabilities in an area separate from the
  cafeteria where the majority of school children
  eat.
• Can the school feed these children separately?

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Situation 4 Feeding in Separate Facilities

• School must not segregate children with
  disabilities based on convenience of the school
  or other children.
• School must ensure children with disabilities are
  allowed to participate with others to maximum
  extent possible.
• Rare cases may warrant separate feeding.
• References Section 504 of the Rehabilitation Act
  of 1973, IDEA, and Title II of the ADA

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Practical Applications

• RESPECT HEALTH INFORMATION PRIVACY
• Do NOT overtly identify children who have food
  intolerances. They do not need the extra burden
  of dealing with potential taunting from
  classmates.

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Summary

• Accommodations need to be individualized one
  size does NOT fit all!
• People with the same or similar disabilities may
  require different accommodations.
• USDA regulations and FNS guidance allow for
  flexibility.
• It is essential to talk with parents and
  physicians to determine appropriate
  accommodations.
• Never second guess the physician.

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Summary

• Recognize that food accommodations differ from
  Department of Education learning plan
  accommodations.
• Be sure the designated Section 504 coordinator
  understands requirements and regulations for ALL
  Federal programs from which the school receives
  assistance even if someone else handles food
  issues.
• Be prepared for push back from some parents who
  do not understand the requirements.

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Summary

• Some parents whose children are not disabled may
  find bans on some foods burdensome be prepared
  to address their concerns and to explain how
  exposure to a food might be life threatening.
• Costs can be considered, but some type of
  accommodation is needed.
• Creative thinking might be required.
• Describe your situation and ask for suggestions.
• Network with other food service professionals.

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Summary

• Consider using volunteers to check food labels,
  etc.
• Know the law and dont be intimidated by threats
  of law suits.
• Take time to meet with parents and document your
  attempts at reasonable accommodations.
• Use the regulations and FNS guidance and contact
  FNS if you have questions.

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QUESTIONS?
Gina OBrian, R.D. Regional Nutritionist USDA,
FNS, Special Nutrition Programs Mountain Plains
Region 303-844-0369 Gina.obrian_at_fns.usda.gov