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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