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Transcript
Meeting Children’s Special
Food and Nutrition Needs in
Child Nutrition Programs
2006 Breakfast Lunch Training
National Food Service Management Institute
The University of Mississippi
Alicia Casteel ([email protected])
Sheila Brown ([email protected])
(501) 324-9502
Fax: (501) 324-9505
1
Meeting Children’s 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.
2
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
3
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.
4
IDEA
Section 504
• Disability
• Special education
needed
• IEP completed
• Accommodations
made
• Disability
• Special education
not needed
• 504 plan
completed
• Accommodations
made
5
USDA Regulations and
Guidance
Child with disability must have a licensed
physician’s 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.
6
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.
7
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
8
Food Service Assistants
•
•
•
•
•
•
Keep confidentiality
Provide substitutions and modifications
Exercise care
Document
Do not overcharge
Be consistent
9
Meeting Children’s 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
10
Cheese Pizza
Baked chicken
Chef Salad
Turkey Sandwich on
Whole Wheat
Dinner Roll
French Fries
Carrot Sticks
Apple
Grape Juice
Brown Rice
Cookie
Whole Milk
Skim Milk
Chocolate Milk
11
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
12
Dietary Considerations
• Carbohydrates (grains and
starches)
• Protein
• Fat
• Meals and snacks
13
Diabetic Meal Plans
• Food Guides
From ADA website: http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp &
USDA website: http://mypyramid.gov/
14
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)
15
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
16
Meeting Children’s 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.
17
Food Allergies
• Definition
• Symptoms
• Anaphylaxis
18
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)
19
Food Intolerance
Definition: Food intolerance is an
adverse reaction to food that does not
involve the immune system.
Examples
• Lactose Intolerance
• Gluten Intolerance
20
Treatment for Allergies
• Antihistamines/Bronchodilators
• Epinephrine
• Prevention and Strict Avoidance
21
Regulations
Accommodations
Required
• Allergies with the
potential of
anaphylaxis
• Celiac disease
Accommodations with
Approval of Food
Service Director
• Allergies with no
anaphylaxis
• Food intolerances
22
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.
23
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 school’s emergency plan if
anaphylaxis should occur in a student with a life
threatening food allergy.
24
Meeting Children’s 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.
25
Which of these foods would
you be able to eat?
Low-fat Vanilla Yogurt
Baked Beans
Multi-grain Crackers
26
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.
27
Baked Beans
INGREDIENTS: water, prepared
white beans, sugar, mustard, salt
corn starch, onion powder, caramel
color, tapioca maltodextrin,
autolyzed yeast extract, natural
flavors.
28
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.
29
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
30
Phenylketonuria (PKU)
• Cannot process the amino acid
phenylalanine
• Dietary treatment:
– low-protein diet (to prevent
increase in phenylalanine)
– special formula to provide
protein
31
Galactosemia
• Cannot process the sugar galactose
• Dietary treatment: no milk or dairy
products
32
Hereditary Fructose Intolerance
• Cannot process the sugar fructose
• Dietary treatment:
– no fructose (high-fructose corn
syrup, honey, fruit)
– no sucrose (table sugar)
33
Maple Syrup Urine Disease
• Cannot process the branched chain
amino acids leucine, isoleucine,
valine
• Dietary treatment:
– low-protein diet
– special formula to provide
protein
34
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
35
Meeting Children’s Special Food and
Nutrition Needs in Child Nutrition
Programs
Texture 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 physician’s
36
instructions
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
37
Thickened Beverages
• Requested by the speech or
occupational therapist or the
physician
• Powdered thickeners and prethickened beverages are available
• Use resources
38
Meeting Children’s Special Food and
Nutrition Needs in Child Nutrition
Programs
Other considerations: How to Handle
Mistakes
• Report mistakes to the parents
immediately
– Child may need emergency care
– Parent can adjust the child’s intake for
the remaining day, if needed
– Will provide an explanation of an
unusual blood level
39