Meeting Childrens Special Food and Nutrition Needs in Child Nutrition Programs 2006 Breakfast Lunch

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Meeting Childrens Special Food and Nutrition
Needs in Child Nutrition Programs2006 Breakfast
Lunch Training National Food Service Management
Institute The University of Mississippi

• Alicia Casteel (Alicia.Casteel_at_Arkansas.gov)
• Sheila Brown (Sheila.Brown_at_Arkansas.gov)
• [phone]
• Fax [phone]

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Meeting Childrens Special Food and Nutrition
Needs in Child Nutrition Programs Lesson 1
Getting to Know the Regulations
Learning Objectives

• Learn that federal regulations require schools to
  make reasonable accommodations for children with
  special dietary needs.
• Describe ways school nutrition staff can comply
  with the regulations.

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Laws and Regulations

• Rehabilitation Act of 1973
• Individuals with Disabilities Education Act
  (IDEA)
• Americans with Disabilities Act (ADA)
• U.S. Department of Agriculture's (USDA)
  nondiscrimination regulation (7 CFR 15b)
• FNS Instruction 783-2, Revision 2, Meal
  Substitutions for Medical or Other Special
  Dietary Reasons

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Disability

• Anyone who has a physical or mental impairment,
  which substantially limits one or more of the
  major life activities, has a record of such
  impairment, or is regarded as having such an
  impairment.

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Section 504
IDEA

• Disability
• Special education needed
• IEP completed
• Accommodations made

• Disability
• Special education not needed
• 504 plan completed
• Accommodations made

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USDA Regulations and Guidance
Child with disability must have a licensed
physicians statement that includes

• the child's disability
• an explanation of why the disability restricts
  the child's diet
• the major life activity affected by the
  disability
• the food or foods to be omitted from the child's
  diet, and the food or choice of foods that must
  be substituted.

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USDA Regulations and Guidance
Child with medical conditions that are NOT
disabilities must have a medical statement that
includes

• an identification of the medical or other special
  dietary condition which restricts the child's
  diet
• the food or foods to be omitted from the child's
  diet and the food or choice of foods to be
  substituted.

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Accommodations

• Use food already purchased when possible
• May require special training
• May require professional help of a registered
  dietitian
• State agencies may be of assistance

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Food Service Assistants

• Keep confidentiality
• Provide substitutions and modifications
• Exercise care
• Document
• Do not overcharge
• Be consistent

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Meeting Childrens Special Food and Nutrition
Needs in Child Nutrition Programs Lesson 2
Helping Students with Diabetes
Learning Objectives

• Define diabetes and explain the difference
  between type 1 and type 2 diabetes
• Learn dietary treatments for diabetes
• Describe six accommodations that school food
  service can make for a student with diabetes

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Diabetes

• Diabetes the body cannot produce or use
  insulin
• Insulin a hormone that helps the body to use
  glucose as energy
• Type 1
• Type 2

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Dietary Considerations

• Carbohydrates (grains and starches)
• Protein
• Fat
• Meals and snacks

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Diabetic Meal Plans

• Food Guides

From ADA website http//www.diabetes.org/nutritio
n-and-recipes/nutrition/foodpyramid.jsp USDA
website http//mypyramid.gov/
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Diabetic Meal Plans

• Diabetic Exchanges
• Carbohydrate (includes starch, fruit, milk and
  vegetable), meat/meat alternate, fat
• Carbohydrate Counting
• Number of grams of
  carbohydrate in each meal
  (labels, lists)

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Food Service Assistants

• Plan on file followed carefully
• Correct portion sizes are crucial
• Labels or computerized nutrient information
• Snacks
• Offer a variety of healthy choices for all
  students
• Use resources

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Meeting Childrens Special Food and Nutrition
Needs in Child Nutrition Programs Lesson 3
Managing Food Allergies
Learning Objectives

• Summarize key components regarding food allergies
• Explain ways food service assistants can prevent
  exposing students with allergies to the allergen.

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Food Allergies

• Definition
• Symptoms
• Anaphylaxis

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Common Food Allergies

• peanuts
• tree nuts (such as almonds, pecans, walnuts)
• milk
• eggs
• soy
• wheat
• fish (such as bass, cod, flounder)
• crustacean shellfish (such as crab, lobster,
  shrimp)

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Food Intolerance
Definition Food intolerance is an adverse
reaction to food that does not involve the immune
system. Examples

• Lactose Intolerance
• Gluten Intolerance

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Treatment for Allergies

• Antihistamines/Bronchodilators
• Epinephrine
• Prevention and Strict Avoidance

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Regulations
Accommodations with Approval of Food Service
Director
Accommodations Required

• Allergies with the potential of anaphylaxis
• Celiac disease

• Allergies with no anaphylaxis
• Food intolerances

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Food Service Assistants
Preventing exposure to allergens starts in the
kitchen.

• Read food labels.
• Know what to avoid and how to substitute.
• Designate allergy-free zones in the kitchen.
• Follow safe food handling practices.

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Food Service Assistants
Preventing exposure to allergens continues in the
cafeteria and throughout the school.

• Understand the allergy plan.
• Identify the students with documented food
  allergies.
• Develop standardized cleaning procedures for the
  cafeteria.
• Learn to recognize signs of anaphylaxis, and know
  how to activate the schools emergency plan if
  anaphylaxis should occur in a student with a life
  threatening food allergy.

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Meeting Childrens Special Food and Nutrition
Needs in Child Nutrition Programs Lesson 4
Understanding Inborn Errors of Metabolism
Learning Objectives

• Define inborn errors of metabolism, identify the
  more common errors, and explain dietary treatment
  for children with inborn errors of metabolism.
• Describe cafeteria accommodations for these
  children and understand the need for a
  professional consultant in difficult cases.

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Which of these foods would you be able to eat?

• Low-fat Vanilla Yogurt
• Baked Beans
• Multi-grain Crackers

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Low-fat Vanilla Yogurt

• INGREDIENTS cultured pasteurized grade A nonfat
  milk, high fructose corn syrup, modified corn
  starch, whey protein concentrate, kosher gelatin,
  natural flavor, aspartame, potassium sorbate
  added to maintain freshness, vitamin A acetate,
  colored with turmeric and annatto extract,
  vitamin D3.

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Baked Beans

• INGREDIENTS water, prepared white beans, sugar,
  mustard, salt corn starch, onion powder, caramel
  color, tapioca maltodextrin, autolyzed yeast
  extract, natural flavors.

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Multi-grain Crackers

• INGREDIENTS whole grain wheat flour, enriched
  flour, barley flakes, soybean oil, sugar, high
  fructose corn syrup, rye, triticale, millet,
  molasses, salt, whole wheat, leavening,
  emulsifiers, rolled oats, onion powder,
  cornstarch.

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Inborn Errors of Metabolism

• Rare genetic disorders in which the body cannot
  metabolize food normally
• By-products of metabolism, amino acids, sugars,
  fatty acids build up in the body, causing serious
  complications
• Dietary treatment strict diet management to
  avoid toxic buildup of dietary
  by-products
• Special foods or formulas may be needed

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Phenylketonuria (PKU)

• Cannot process the amino acid phenylalanine
• Dietary treatment
• low-protein diet (to prevent increase in
  phenylalanine)
• special formula to provide protein

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Galactosemia

• Cannot process the sugar galactose
• Dietary treatment no milk or dairy products

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Hereditary Fructose Intolerance

• Cannot process the sugar fructose
• Dietary treatment
• no fructose (high-fructose corn syrup, honey,
  fruit)
• no sucrose (table sugar)

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Maple Syrup Urine Disease

• Cannot process the branched chain amino acids
  leucine, isoleucine, valine
• Dietary treatment
• low-protein diet
• special formula to provide protein

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Food Service Assistants

• Maintain communication among parents, teacher,
  school nurse, food service, and consultant if
  needed
• Understand the dietary restrictions prescribed in
  the plan kept on file with the school nurse
• Obtain and serve special formula or foods
• Follow prescribed portion sizes
• Report mistakes immediately
• Keep information confidential

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Meeting Childrens Special Food and Nutrition
Needs in Child Nutrition ProgramsTexture
Modifications

• May be needed when a child has oral motor
  problems
• Close communication with the teacher or therapist
  is required
• Some foods do not require special preparation
• Preparation of foods that are difficult to chew
  may be part of the physicians instructions

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Modification of Food Texture

• Chopped- food is cut into bite-sized pieces
• Ground- food is soft or small enough to swallow
  with little or now chewing
• Pureed- food has a smooth texture similar to
  pudding

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Thickened Beverages

• Requested by the speech or occupational therapist
  or the physician
• Powdered thickeners and pre-thickened beverages
  are available
• Use resources

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Meeting Childrens Special Food and Nutrition
Needs in Child Nutrition ProgramsOther
considerations How to Handle Mistakes

• Report mistakes to the parents immediately
• Child may need emergency care
• Parent can adjust the childs intake for the
  remaining day, if needed
• Will provide an explanation of an unusual blood
  level