Overview

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The Connecticut State Department of Education's (CSDE) guide, Accommodating Special Diets in CACFP Child Care Programs, provides guidance on meal modifications for children and infants with special dietary needs, based on the federal nondiscrimination laws and U.S. Department of Agriculture (USDA) regulations. This guide applies to CACFP child care centers (including at-risk afterschool care centers and emergency shelters) and family day care homes.

Children with a Disability  |   Children without a Disability
Guidance and Resources  |   Developing Policy and SOPs for Meal Modifications

Children with a Disability

The USDA requires reasonable meal modifications on a case-by-case basis for children whose disability restricts their diet, based on a medical statement signed by a recognized medical authority. “Case-by-case basis” means that the meal modifications are specific to the individual medical condition and dietary needs of each child. The Connecticut State Department of Public Health defines a recognized medical authority as a state-licensed health care professional who is authorized to write medical prescriptions under state law. This includes licensed physicians (doctors of medicine or osteopathy), physician assistants, and advanced practice registered nurses (APRN).

Children without a Disability

The USDA allows, but does not require, meal modifications for children whose special dietary needs do not constitute a disability. Examples of optional modifications include requests related to religious or moral convictions, general health concerns, and personal food preferences, such as parents who prefer that their children eat a gluten-free diet or organic foods because they believe it is healthier. CACFP facilities may choose to make these accommodations on a case-by-case basis. Meal modifications for children without disabilities must comply with the CACFP meal patterns for children. Meal modifications for infants without disabilities must comply with the CACFP infant meal patterns.

Guidance and Resources

• Allowable Milk Substitutes for Children without Disabilities in the CACFP
• CSDE Guide: Accommodating Special Diets in CACFP Child Care Programs
• CSDE Operational Memorandum No. 2C-18 and 2H-18: Requirements for Meal Modifications in CACFP Child Care Programs
• CSDE Operational Memo No. 3A-16, 4C-16 and 3H-16: Statements Supporting Accommodations for Participants with Disabilities in the Child Nutrition Programs
• CSDE Operational Memo No. 3C-07 and 3H-07: Reimbursement for Meals Provided by Parents for Medical Reasons in CACFP
• CSDE Presentation: Requirements for Meal Modifications in CACFP Child Care Programs
• Medical conditions (celiac disease and intolerance, diabetes, food allergies, inborn errors of metabolism, and lactose intolerance): Go to Documents/Forms in the left navigation bar.
• Medical Statements (Documents/Forms section)
• Milk Substitutes (Documents/Forms section)
• Resource List for Special Diets in Child Nutrition Programs 
• Self-assessment of Child Care Practices for Special Diets in the CACFP
• Summary of Requirements for Accommodating Special Diets for Children in the CACFP
• Training for Special Diets (see CSDE's Resource List for Special Diets in Child Nutrition Programs)
• USDA Memo CACFP 14-2017 and SFSP 10-2017: Modifications to Accommodate Disabilities in CACFP and SFSP

Developing Policy and Standard Operating Procedures (SOPs) for Meal Modifications

The CSDE recommends that CACFP facilities develop a written policy and SOPs for meal modifications in the CACFP. For information on developing policies, go to What's Next in the left navigation bar.

Nondiscrimination Statements (USDA and CSDE)