Meal Pattern Accommodations in CACFP

Nicole Patterson: The goal of the USDA's Child Adult Care Food Program, or CACFP, is to improve the health and nutrition of children in the program while promoting the development of good eating habits through nutrition education. Implementing the CACFP meal patterns helps to ensure children receive wholesome and nutritious meals.

We know many Head Start children live in communities where access to affordable, fresh, nutritious food can be a challenge, and CACFP helps make it possible for programs to offer children wholesome meals and snacks while in care. The meal patterns themselves focus on providing a variety of nutrient-dense foods, including whole grains, a variety of fruits, vegetables, fat-free foods, low-fat dairy products, milk is provided daily, all while reducing added sugar intake and saturated fats. CACFP plus healthy meals supports a child's development and learning.

Carolina Martinez: CACFP Provider play a critical role in supporting nutrition security, which is having consistent access to safe, healthy, and affordable food and beverages to promote optimal health and well-being. Serving nutritious meals is incredibly important. We have the opportunity to positively impact our participants' health in the long term. Our goal is to not only provide healthy meals for children — which each and every one of you is doing and making a significant impact — but to teach kids early in life about the importance of good nutrition and healthy behaviors.

Melissa Daigle Katz: We have heard that Head Start providers would like guidance on providing meal pattern accommodations when requested by parents. CACFP rules allow you to make modifications for children with disabilities on a case-by-case basis. If a requested modification doesn't meet the meal pattern, the parent must provide a written statement from a state-licensed health care professional, like a physician or nurse practitioner.

This is required in order for you to claim the meal for reimbursement. The return statement should include a description of the child's physical or mental impairment so that you understand how it restricts their diet. It should also include an explanation of what must be done to accommodate the disability, including suggested substitutions.

You can choose to meet their request for accommodation without a medical statement if the requested modifications are within the meal pattern. You're not required to provide the exact substitution or other modification that's requested. For instance, if a child needs a gluten-free bread, you don't have to provide the particular brand of bread, just a bread that's gluten-free.

However, you must work with the parent or guardian to offer a reasonable modification that effectively accommodates the child's disability. In fact, we strongly encourage providers to take a team approach and include other Head Start staff with training in this area, such as nurses or registered dieticians.

We have a policy memo with guidance on the subject, and we'll make sure that you get a link to it. We've also heard that you have questions about responding to requests from parents to make meal modifications based on religious needs or parental preferences. FNS strongly encourages providers to work with families to ensure that their children receive meals that meet their needs, including for religious reasons or for the parents' preference.

All substitutions and modifications must meet the meal pattern. If the Head Start center serves a meal that doesn't meet the meal pattern or a non-disability, then the center would not be able to claim the meal for reimbursement. Accommodating request just for milk substitutions is its own hot topic lately.

CACFP allows milk substitutions under certain circumstances. If parents request a milk substitute that's for a non-disability reason and it's nutritionally equivalent to milk, you can provide that substitution, and the meal will be reimbursable. A medical statement is not required. Starting July 1, 2022, that includes lactose-free milk and reduced lactose milk.

You're probably wondering what it means for a beverage to be nutritionally equivalent to milk. It means that it meets F&S' standards for vitamins, minerals, and protein. If parents request a milk substitute that is not nutritionally equivalent to milk, a signed medical statement which states the recommended substitution is required for the meal to be reimbursed.