Infant Meals Component of the Child and Adult Care Food Program -CACFP

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Infant Meals Component of the Child and Adult
Care Food Program -CACFP

• Ann-Marie Martin
• CACFP Coordinator
• Alaska Department of Education Early
  Development

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Definition of Infant in the CACFP
Birth through 11 Months
Up to the childs first birthday
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Infant Meals

• CACFP Centers/Providers caring for infants must
  offer meals to them

All centers/providers must offer iron-fortified
formula to infants under one year of age
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To claim infant meals for reimbursement

• To Claim Reimbursement for Infant Meals
• Parents complete CACFP Enrollment form that
  includes infant section or complete an Infant
  Formula/Feeding Selection form
• Include infants in your One Month Enrollment
  Report (OMER)
• Follow the CACFP Infant Meal Pattern
• Take point of service meal counts
• Maintain Infant Menus/Meal Count records

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• One Month Enrollment Report (OMER
• Infants must be listed on the Centers One Month
  Enrollment Report (OMER) that is completed each
  year

Center administrators complete the OMER annually
for documenting family income which is directly
associated with reimbursement for the center. For
more information on completing the OMER please
contact EED.
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USDA Infant Meal Pattern

• Meal pattern is grouped into three age
  categories
• birth-3 mo
• 4-7 mo
• 8-11 mo

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Required Components

• May offer either
• Breast Milk and/or
• Iron-fortified Infant Formula (IFIF)
• Solids when infants are developmentally ready
• 4-7 months optional (only if not developmentally
  ready)
• 8-11 months required

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• Must provide at least one infant formula
• Parents may decline infant formula
• Bring their own iron-fortified infant formula
• Bring their own pumped breast milk

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When parents provide non-creditable infant
formulas

• Provide a Specialty Formula
• That does not meet CACFP Requirements
• Need
• Signed Medical Statement
• Diagnosis must be identified and authorized

Example Low-iron formulas lt1 mg iron per 100
kcals
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Breast Milk

• Credited the same as formula
• Chapter 3 provides
  information on handling breast milk

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CACFP Infant Meal Pattern
Age Breakfast Lunch and Supper Snack
Birth through 3 months 4-6 fluid ounces formula1 and/or breast milk 4-6 fluid ounces formula1 and/or breast milk 4-6 fluid ounces formula1 and/or breast milk
4 through 7 months 4-8 fluid ounces formula1 and/or breast milk 0-3 Tbsp infant cereal2 (ready) 4-8 fluid ounces formula1 and/or breast milk 0-3 Tbsp infant cereal2 (ready) 0-3 Tbsp fruit and/or vegetable (ready) 4-6 fluid ounces formula1 and/or breast milk
8 through 11 months 6-8 fluid ounces formula1 and/or breast milk and 2-4 Tbsp infant cereal2 and 1-4 Tbsp fruit and/or vegetable 6-8 fluid ounces formula1 and/or breast milk and 2-4 Tbsp infant cereal2 and/or 1-4 Tbsp lean meat, fish, poultry, egg yolk, cooked dry beans or cooked dry peas5 or ½-2 ounces (weight) cheese or 1-4 ounces (volume) cottage cheese or 1-4 ounces (weight) of cheese food or cheese spread and 1-4 Tbsp fruit and/or vegetable 2-4 fluid ounces formula1 and/or breast milk or fruit juice3 0 to ½ slice of crusty bread4 (optional) or 0 to 2 crackers4 (optional)

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Birth through 3 months
Breakfast Lunch or Supper Snack
Breast Milk or 4-6 oz Formula Breast Milk or 4-6 oz Formula Breast Milk or 4-6 oz Formula

• Required at all meals and snacks
• Iron-fortified formula and/or
• Breast milk
• OK to offer less than the minimum amount of
  breast milk

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Reimbursable meals forBirth through 3 months

• Center provided formula
• Parent provided breast milk
• Parent provided formula
• Staff mother breast feeding during work hours
  (not on break)
• Only exception is when visiting mother
  (non-staff) breastfeeds infant (not reimbursable)

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4 through 7 months
Breakfast Lunch or Supper Snack
Breast Milk or 4-8 oz. Formula Breast Milk or 4-8 oz. Formula Breast Milk or 4-6 oz. Formula
0-3 Tbsp. Infant Cereal 0-3 Tbsp. Infant Cereal
0-3 Tbsp. Fruit and/or Vegetable

• Required at all meals and snacks
• Iron-fortified formula and/or
• Breast milk
• Solid foods when developmentally ready

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Reimbursable meals for4 through 7 month olds

• Center provided formula
• Parent provided formula
• Parent provided breast milk
• Foods added, as appropriate per infant, provided
  by Center

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Reminders

• Ages 4-7 months
• 0-3 T cereal or veg./fruit means that the meal
  component is optional dependent on the infants
  needs.
• Portion size not listing zero as a measurement
  indicates the component must be offered, i.e.
  formula.

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8 through 11 months
Breakfast All 3 components must be offered Lunch or Supper All 3 components must be offered Snack
Breast Milk or 6-8 oz. Formula Breast Milk or 6-8 oz. Formula Breast Milk or 2-4 oz. Formula
2-4 Tbsp. Infant Cereal 2-4 Tbsp. Infant Cereal Or 1-4 Tbsp. Meat Or 2 - 4 oz. Fruit Juice
1-4 Tbsp. Fruit and/or Vegetable 1-4 Tbsp. Fruit and/or Vegetable 0-1/2 Crackers/ Bread
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Reimbursable meals for 8 through 11 month olds

• Center must offer meal components with either
  breast milk or formula

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8 through 11 months

• Required at Breakfast
• Iron-fortified formula and/or breast milk
• Iron-fortified infant cereal (IFIC)
• Fruit and/or vegetable (not juice)

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8 through 11 months

• Required at Lunch and Supper
• Iron-fortified formula and/or breast milk
• Fruit and/or vegetable (not juice)
• Iron-fortified infant cereal (IFIC) and/or
• Meat/meat alternate
• Lean meat, fish, poultry, egg yolk, cheeses, and
  beans or peas

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Meat Portions for 8 - 11 Month OldsLunch and
Suppers

• 1 - 4 tablespoons of meat, poultry, egg yolk,
  cooked dry beans or peas
• or
• 1/2 - 2 ounces of cheese
• or
• 1 - 4 ounces (volume) of cottage cheese

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8 through 11 months

• Required at Snacks
• Iron-fortified formula and/or
• Breast milk or
• Fruit Juice (full strength)

• When developmentally
• ready
• Crusty bread or
• Crackers

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Reminders

• Ages 8-11 months
• Breakfast - infant cereal
• is required to be offered
• (you can add fruit to the cereal you can make
  with formula vs. water)
• Lunch Supper
• infant cereal and/or meat/meat alternate must be
  offered

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Introducing Solids

• Introduce new food one at a time
• Allow 3 to 5 days between each new food
• Observe infant closely for any reaction to new
  food items
• Serve appropriate textures in small amounts
• Do not add sugar, salt, fat,
• or spices to food

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Table food for older infants

• You can serve table food to older infants claim
  meal if
• You have checked with parents on items you can
  serve to the infant from the big kids menu
• The infant still gets all required components of
  the Infant Meal Pattern

• Big kids menu hamburger so you
• To serve/claim for Infants
• Cut it up
• write hamburger on the infant menu in the
  meat/meat alternate column
• You still need to serve infant formula/breast
  milk and vegetable/fruit

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Infant Formula

• Center must supply at least one creditable infant
  formula
• USDA is no longer keeping an approved infant
  formula list on their website
• Ensure formula is not an FDA exempt Infant
  Formula
• Look for the statement Infant Formula with Iron
• Use the nutrition facts label as a guide
• Must have 100 mg of iron or more per 100 calories
  of formula

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Parent Provided Food Formula

• A parent may choose to provide food and/or
  formula for their own child.
• Must be an iron-fortified infant formula
• Maintain documentation that the parent declined
  offered food and/or formula (CACFP enrollment
  form or the infant formula/feeding selection form)

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Food Provided by Parents

• Parents may provide breast milk, formula, and/or
  foods,
• However, the center/provider must
• -Supply at least one required component when
  two or more components are offered (not earlier
  than 4 months) , in order to claim the meal for
  reimbursement.

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Food Provided by Parents

• When mom comes to the site and nurses their
  child
• the meal is not reimbursable
• UNLESS
• the center or provider supplies an additional
  required component.

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When staff member nurses their own child

• the meal is reimbursable if they are working
• If on break you will treat as if they are a mom
  coming in to breastfeed their infant

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Is this infant meal reimbursable?
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Is this infant meal reimbursable?
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Infant Menu/Meal Count Records

• Weekly or Monthly Record
• One per individual per week
• OR
• Daily Record
• One per day for multiple infants of the same age
  group
• List what food and the amount of food offered at
  each meal immediately after feeding the child.
• Mark the meals on a point-of-service menu/meal
  sheet

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Individual Infant Menu/Meal Count
Pont of service (POS) write food offered at
time of service include count
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Infant menus must contain the following
information

• Food components offered.
• Names of infant.
• Infants age and date of birth.

• Meal type.
• Date of meal service.

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Common MenuDocumentation Errors

• Non-creditable foods
• Missing required components
• Breast fed infants are included in the meal
  counts (and no other component supplied by the
  site).

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Common MenuDocumentation Errors

• Not moving to next set of meal pattern
  requirements at start of their 4th and 8th
  months.
• Infants are moved to the Toddler Room and their
  meals are no longer recorded on individual daily
  infant meal records or are fed the child meal
  pattern.
• Children over age 1 are still in the infant room
  and fed infant meal pattern.

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Transitional Period

• After the 1st Birthday
• Between the 12th and 13th month
• Transition from IFIF to cows milk
• Offer as a mixture

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Happy 1st Birthday!

• After the 1st Birthday
• Use the 1 through 2 year old meal pattern
• Cows milk full fat for 1 to 2 yr. olds
• Medical statements required
• Infants not ready to be served the1-2 year old
  meal pattern

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Medical Statements

• Also required for serving
• Cows milk to children under 1 year
• Formula to children over 13 months
• An alternate meal pattern

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Creditable Foods for Infants

• Foods prepared at the center, with appropriate
  modifications
• Commercially prepared foods must be plain fruits,
  vegetables, and meats
• Infant cereal must be iron fortified

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Iron Fortified Infant Cereal

• Iron-fortified (45 mg. of iron for every 100 g.
  of dry cereal)
• Mix with breast milk or formula
• Feed with a spoon not from a bottle
• Many older infants dont like infant cereal for
  breakfast, but it is required to claim the meal
  mix in fruit and they like it

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Iron Fortified Infant Cereal

• Not creditable
• Cereal in jars
• Infant Cereal with fruit flakes
• Regular family breakfast cereals (hot or cold)

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Vegetables and Fruits

• Commercially Prepared
• Center Prepared

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Commercially Prepared Infant Food
Fruits and Vegetables Fruits and Vegetables
Creditable The fruit or vegetable is the first ingredient Contain multiple fruits or vegetables Water is not the first ingredient Non-Creditable Baby dinners Jarred cereal with fruit Desserts Water is the first ingredient
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Commercial Fruits and Vegetables

• Vegetable or fruit must be listed as first
  ingredient (no sugar)
• Plain vegetables and fruits are preferred

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Rice Cereal with Apples Beech-Nut Naturals First Advantage 4 oz. Cereals Ingredients apples, apple juice from concentrate (water and apple juice concentrate), water, dried egg yolks, rice flour, cinnamon, ascorbic acid (vitamin c), ferrous sulfate (source of iron), citric acid, zinc sulfate (source of zinc), niacinamide, calcium pantothenate, thiamine mononitrate (vitamin b1), riboflavin (vitamin b2), pyridoxine hydrochloride (vitamin b6), vitamin b12 and folic acid.
Not Creditable Cereals with fruit not creditable.
Not Creditable - Water 1st ingredient. - Has 2
food components, making it a dinner.
Pasta Vegetable Medley 4 oz. Vegetables Ingredien
ts water, tomato paste, pear concentrate,
carrots, dried egg yolks, enriched macaroni
product (durum wheat semolina, niacin, ferrous
sulfate, thiamine mononitrate, riboflavin and
folic acid), romano cheese (made from partially
skimmed cow's milk, cheese cultures, salt and
enzymes) and zinc sulfate.
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Center Prepared Fruits and Vegetables

• Texture must be appropriate
• usually cooked
• Avoid canned vegetables that are high in sodium
• Avoid canned or frozen fruits with added sugar
• Do not add sugar or salt

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Center Prepared Fruits and Vegetables

• Choking dangers
• Raw vegetables
• Corn kernels
• Hard fruits apples, etc.
• Whole fruits grapes, etc.
• Uncooked dried fruits

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Meat and Meat Alternates

• Eggs
• Egg yolks at 8 months
• Yolk must be hard cooked
• Avoid egg whites until after 1 year.

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Meat and Meat Alternates

• Cheese
• Introduced at 8 months or older
• Natural cheese rather than processed cheese

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Meat and Meat Alternates

• Avoid
• Peanut butter, seeds, nuts
• Fish and shell fish
• Processed meats
• (chicken nuggets)

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Commercially Prepared Infant Food
Meat Meat Alternates Meat Meat Alternates
Creditable Plain strained baby food meats - Including those with beef, chicken, turkey, lamb, veal, and ham. Non-Creditable Combination dinners. Meat sticks. Breaded/battered seafood and canned fish with bones. Yogurt. Nuts, seeds, and nut/seed butters.
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Vegetables Beef Beech-Nut Naturals Stage 2
  4 oz. Dinners Ingredients vegetables
(carrots, rehydrated potatoes, peas), water and
beef
Not Creditable - Has more than 1 food
component. - Considered a Dinner.
Chicken Lasagna Beech-Nut Naturals Stage 3  6
oz   Dinners Ingredients water, tomato
paste, finely ground chicken, carrots, pear puree
concentrate, enriched macaroni product (durum
wheat semolina, niacin, ferrous sulfate, thiamine
mononitrate, riboflavin and folic acid) and
romano cheese (made from partially skimmed cow's
milk, cheese cultures, salt and enzymes).  
Not Creditable - Water 1st ingredient - More
than 1 food component. Making it a
dinner.
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Grains/Breads

• (1st ingredient is whole or enriched grain)
• Strips of dry bread, toast, tortillas
• Plain crackers - saltines
• Teething biscuits
• English muffins
• Pita bread
• Animal crackers
• Graham crackers (without honey)

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Grains/Breads

• Avoid
• Snacks such as pretzels or chips
• Cookies or granola bars
• Crackers with seeds, nuts, etc.
• Whole kernels, such as rice.

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Non-Creditable Breads and Crackers for Infants

• Allergies (whole eggs)
• pancakes
• waffles
• muffins
• Calories
• brownies
• cakes
• doughnuts

• Choking
• hard pretzels
• breadsticks
• tortilla chips
• granola bars
• some ready to eat cereals

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Meal Times for Infants

• No specified meal time
• May offer meal at more than one sitting
• Claim if around normal meal time
• Breakfast not claimed at 11 a.m.
• Complete one meal before serving the next

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Meal Times for Infants

• On-Demand Infant Feeding
• Feed when hungry
• Only approved meal types can be claimed

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Division of Responsibility
Caregiver/Parent

• Whether breast or formula fed and make baby feel
  comfortable/secure
• Help baby feel calm alert
• Learn cues of baby
• Dont push or continue to feed if baby is not
  interested
• Introduce solid foods when baby is interested and
  able to eat, versus by their age

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Division of Responsibility
Baby

• How much
• How often
• What level of capability
• How fast

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Solid Foods

• Studies show solid foods do not help with sleep
  patterns
• Do not add solids to bottle
• Dont pressure pressure sets up feeding
  problems and children dont grow as well
• Look for clear feeding signals
• Leaning forward
• Opens mouth -

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Question

• If a parent wants an infant to have more than
  three meals during the day, who should furnish
  the formula for the meals that cannot be claimed?

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Answer

• If a parent wants an infant to have more than
  three meals during the day, who should furnish
  the formula for the meals that cannot be claimed?
• The parent because the center is not required to
  provide formula for more than three meals per
  infant per day.

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Question

• If a parent wants an infant to have only a
• limited number of bottles/formula, which
• is less than the infant wants, what are
• you to do?

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Answer

• If a parent wants an infant to have only a
• limited number of bottles/formula,
• which is less than the infant wants,
• what are you to do?
• Since infants are fed on demand and
• unless there is a medical statement,
• honor your responsibility to the infant.

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Question

• Is yogurt a creditable food for infants?

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Answer

• Is yogurt a creditable food for infants?
• No. Commercially prepared, plain yogurt can be
  served as an extra to infants 8 months and older,
  but it is not creditable as a meat/meat
  alternate. The same would go for mixed dinners.

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Question

• Are meals served to a child who just turned one
  year old reimbursable if they contain infant
  formula?

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Answer

• Are meals served to a child who just turned one
  year old reimbursable if they contain infant
  formula?
• Yes, for a period of one month. After the 13th
  month, a doctors statement will be needed for
  formula to continue in place of fluid milk.

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Question

• If a physician prescribes whole cows milk as a
  substitute for breast milk or formula for an
  infant under 12 months of age, are meals
  reimbursable?

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Answer

• If a physician prescribes whole cows milk as a
  substitute for breast milk or formula for an
  infant under 12 months of age, are meals
  reimbursable?
• Yes, with a medical statement, the meal pattern
  can be amended.

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State of Alaska CACFP web site

• http//education.alaska.gov/tls/cnp/CACFP1.html

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WIC Breastfeeding Information
http//www.hss.state.ak.us/dpa/programs/nutri/WIC/
default.htm
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Want more on infant feeding?

www.fns.usda.gov/tn/Resources/feeding_infants.html
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Ellyn Satters Feeding with Love and Good Sense
II DVD

• The Infant
• The Transitional Child
• The Toddler
• The Preschooler

www.ellynsatter.com Or www.ellynsatterinstitute.o
rg
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Special thank you to the Washington State CACFP
Nebraska State CACFP for some of the training
materials.