Accommodating Special

Dietary Needs

Jenny FullerKDE

USDA Regulations - Disability Require substitutions or modifications in

meals for children who are considered disabled 504 IDEA Certified by a licensed physician

Regulations - Disability

Definition of Disability According to Section 504, a “person with

a disability” means any person who:1. Has a physical or mental impairment

that substantially limits one or more major life activities

2. Has a record of such an impairment3. Is regarded as having such an

impairment

Definition of Disability

Definition of a Disability According to IDEA, a “person with a

disability” means1. Having one or more of the recognized

disability categories2. Disability adversely affects educational

performance3. Child needs special education and

related services

Definition of Disability

Major Life Activities Include:

Caring for one’s selfPerforming manual tasksWalking Seeing Hearing

SpeakingBreathingLearningWorkingSleepingEatingStanding

LiftingBendingReading ConcentratingThinkingCommunicating

Major Life Activities

Modifications for Children with Dietary Disabilities

Require substitutions and/or modifications for children whose disability restricts their diet Documentation from a licensed physician Health history from school nurse is not acceptable

Documentation must identify: 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

Modifications

Medical Statement - Disabilities

Must be completed in its entirety Provided before school food service can

make any meal modifications Ensures that the modified meal is

reimbursable and meets nutrition standards

Can use same record from year to year if nothing has changed

Medical Statement

ScenariosSCENARIO 1

A student’s mother brought in a medical statement signed by a licensed physician certifying a dietary disability. The medical statement is unclear and school food service in not sure they can provide the requested accommodations. What should the school do?

Scenarios

SCENARIO 1 ANSWER:

If school food service feels the medical statement is unclear or is an undue burden, then they are encouraged to convene a meeting including appropriate personnel such as: food service staff, administration, parents, school nursing staff and the physician to clarify the medical statement and determine appropriate accommodations for the student.

Scenarios

SCENARIO 2

A licensed physician’s statement only specifies the medical disability, not the required food substitutions. Can the school food service staff decide what food should be substituted?

Scenarios

SCENARIO 2 Answer

No! An appropriate school official must receive parent or guardian permission to obtain more information from the licensed physician concerning substitutions or modifications the student requires.

Scenarios

SCENARIO 3

A child in your school has a documented life threatening foodallergy that causes an anaphylactic reaction to peanuts. The mother requests that food service staff read all food labels for peanut ingredients to ensure a safe meal for her child. Does the food service need to accommodate this request?

Scenarios

SCENARIO 3 ANSWER

YES! A life threatening food allergy that causes an anaphylactic reaction is considered a dietary disability because it can affect a major life activity, breathing. Therefore, accommodations are mandated. The request for reading food labels should be included in the medical statement signed by the licensed physician.

Scenarios

Temporary Disabilities Must accommodate disabilities

regardless of duration Example: A child who had major oral

surgery

Temporary Disability

Texture Modifications Meals modified for texture will consist of

regular school menu items Unless specified by licensed physician

Texture Modification

Specific Brands Not required to provide a specific brand Provide only the medically appropriate

substitutions specified in medical statement

Specific Brands

Different Portion Sizes Must provide specified portions

Prescribed by licensed physician

Portion Sizes

A La Carte Foods & Beverages

Required accommodations only apply to reimbursable meals

If items included in IEP, school district must provide them; may have food service handle this responsibility

A La Carte

Meal Services Outside of USDA Meal Programs

Not required to provide meals when meal service is not available for general student body

Unless Child has IEP that requires a meal Child resides in a residential child care

institution (RCCI)

Meals Outside USDA Meal Programs

Carbohydrate Counts Responsible for providing carbohydrate

count to family for each food item served in one daily meal choice

NOT responsible for weighing or measuring food, or determining proper amount of carbohydrates needed or consumed

Responsibility of school nurse or other designated medical personnel

Carbohydrate Counts

Appropriate Eating Areas Ensure that students with disabilities

participate with nondisabled students to the maximum extent appropriate

Some instances, may be to child’s benefit to be served separately

All decisions must be based on what is appropriate to meet the needs

of the child

Eating Areas

Dietary Disability Recap Distinction between definition of ‘disability’ for

Section 504 & IDEA and for the purpose of food modifications/substitutions

Modifications may include: Food restrictions Carbohydrate counts Texture changes Increased or decreased calories

Medical statement must be signed by a licensed physician and kept on file

Modifications for a Disability & documentation do not have to meet the meal pattern

Recap - Disability

ScenariosSCENARIO 1

A student with celiac disease has a medical statement signed by a licensed physician that prescribes a gluten-free diet. Does the school food service need to accommodate this request?

Scenarios

SCENARIO 1 ANSWER

YES! The student’s physician has determined that the medical condition affects a major life activity and rises to the level of a disability. Therefore, school food service must accommodate the physician’s diet prescription.

Scenarios

SCENARIO 2

Occupational therapy staff is requesting that a disabled student eat their meals outside the cafeteria in order to work on feeding skills. Is this acceptable?

Scenarios

SCENARIO 2 ANSWER

Federal civil rights legislation requires that “in providing for or arranging for the provision of nonacademic services and extracurricular activities, including meals, school districts must ensure that students with disabilities participate with nondisabled students to the maximum extent appropriate to the needs of students with disabilities”. In rare instances, however, it may be to a child’s benefit to be served separately.

Scenarios

SCENARIO 2 cont’d

For instance, a child with severe motor disabilities may be able to receive individualized attention in handling eating utensils if a special education staff member is able to work with the student outside the cafeteria. In all cases, the decision to feed disabled children must always be based on what is appropriate to meet the needs of the children.

Scenarios

SCENARIO 3

A student has type 1 diabetes. The Individual Education Plan states that carbohydrate counting will be used as part of the medical treatment. Is food service staff required to count the carbohydrates this student eats?

Scenarios

SCENARIO 3 ANSWER

The school district is responsible for providing a carbohydrate count to the family of a diabetic child for each food item served in one daily reimbursable meal choice. Food service personnel are not responsible for weighing or measuring leftover food or determining the proper amount of carbohydrates needed or consumed. This is the responsibility of the school nurse or other designated medical personnel if requested.

Scenarios

USDA Regulations – Non Disability

Permit substitutions or modifications in meals for children without dietary disabilities, but with medical or other special dietary needs

School may choose to make these accommodations

Regulations

Modifications for Children Without Disabilities

Schools encouraged, but not required to make modifications

Documentation from a recognized medical authority

Documentation must identify: Medical or other special dietary condition

which restricts the child’s diet The food or foods to be omitted from the

child’s diet The food or choice of foods to be substituted

Modifications – Without Disability

Examples of Medical Conditions

Food intolerance Food allergies (not affecting a major life

activity) Elevated blood cholesterol Overweight (not morbidly obese)

Medical Conditions

Meal Modifications for Students Without a Disability

Children without food allergies that do not affect a major life activity are not considered to have a dietary disability

A meal that is modified must still meet the meal pattern requirements to be reimbursable

Meal Modifications –Without Disability

Offer vs. Serve Allows students to decline a certain

number off food items in the meal Can assist in accommodating students

with special dietary needs

Offer vs. Serve

ScenariosSCENARIO 1

If the school food service does decide to make food substitutions and/or modifications for students without a dietary disability, what documents are required?

Scenarios

SCENARIO 1 Answer

Each special dietary request must be supported by a statement, which explains the food substitution that is requested. It must be signed by a recognized medical authority. The medical statement must include: An identification of the medical or other dietary condition that 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.

Scenarios

SCENARIO 2

Are schools required to provide a modified meal to a child whose parents are strict vegetarians and want their child to be provided with vegetarian meals?

Scenarios

SCENARIO 2 ANSWER

NO! A school food service is not required to make accommodations based on food preferences of a family or child.

Scenarios

Non-Disability Recap Schools have the option of providing

accommodations Medical statement must be signed by a

recognized medical authority and kept on file

Offer vs. Serve may help to provide meal solutions to non-disability requests

Recap – Non-Disability

Lactose-Free Milk Creditable as the milk component for

meals Must be low-fat (1%) or fat-free (skim) May be substituted without written

statement May not charge more

Lactose-Free Milk

Non Dairy Milk Substitutions

May provide non dairy substitutes when requested by parent/guardian

Must be nutritionally equivalent to fluid milk

If make milk substitutions available, must be available for all children when request made

At the expense of the school food service program

Non Dairy Milk Substitutions

USDA Nutritional Standards for Non Dairy Milk Substitutions

Nutrients Per Cup (8 fluid ounces)Calcium: 276 mgProtein: 8 gVitamin A: 500 IUVitamin D: 100 IUMagnesium: 24 mgPhosphorus: 222 mgPotassium: 349 mgRiboflavin: 0.44 mgVitamin B12: 1.1 mcg

Non Dairy Milk Substitutions

Summary of Allowable Milk Substitutions (non disability)

Scenario Is This a Reimbursable Meal?

The school provides whole milk or reduced fat (2%) milk.

No. The USDA requires that schools serve only low-fat (1%) or fat-free (skim) milk.

The school provides lactose-free milk.

Yes, if the lactose free milk is low fat (1%) or fat free (Skim).

The school provides a nondairy milk substitute that does not meet the USDA nutrition standards.

No. All nondairy milk must meet the USDA nutrition standards.

The school provides juice or water instead of milk.

No. Juice or milk can never be offered as milk substitutes. All substitutions must be either lactose-free milk or a nondairy beverage that meets the nutrition standards.

Non Dairy Milk Substitutions

ScenariosSCENARIO 1

When a student has a non-disabling milk allergy, can juice or water be substituted for milk?

Scenarios

SCENARIO 1 ANSWER

No. Children with non-disabling milk allergies may only be offered a nondairy beverage that is nutritionally equivalent to fluid milk a specified by USDA. However, if the milk allergy is a dietary disability, a juice or water substitution prescribed by a licensed physician must be followed.

Scenarios

SCENARIO 2

If a student pays full price for theirlunch, but has a request from a parent to provide lactose-free milk, is the school food service responsible for providing that accommodation?

Scenarios

SCENARIO 2 Answer

The USDA requirements for accommodating special dietary needs apply to all children regardless of their eligibility for paid, free, or reduced-price meals. School food service is encouraged, but not required, to provide food substitutions or modifications for children without disabilities. Lactose-free milk is creditable as the milk component for reimbursable meals and can be provided without written request.

Scenarios

Requirements For All Special Dietary Accommodations

Documentation Required to have documentation on file

Regardless of disabled or nondisabled All changes to diet order must be in

writing Food service personnel should never

revise or change diet prescription Recommend schools develop a plan for

ensuring current information on file

Documentation

Requirements For All Special Dietary Accommodations

Price of Meals Cannot charge more for modified meals Accommodating special dietary needs

apply regardless of eligibility for paid, free, or reduced-price meals

Price of Meals

Requirements For All Special Dietary Accommodations

Reimbursement Claimed at same reimbursement rate as

standard meals For children with and without disabilities

No additional reimbursement is available

Additional costs for food is an allowable food service program cost

Reimbursement

Best Practices for Accommodating Special Dietary Needs

Provide clear guidelines for students, families and school staff

Ensure consistent practices Document compliance with federal and state

requirements Educate families regarding school policies

and procedures Monitor to ensure meal modifications are

appropriate and meet individual and meet individual dietary needs

Best Practices

Frequently Asked Questions:

1. What must a licensed physician’s statement for children with a dietary disability identify?

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

Frequently Asked Questions

2. Are schools required to provide a modified meal to a student without a dietary disability?

No. School food service is encouraged, but not required to provide food substitutions or modifications for children without dietary disabilities. The school food service is responsible for determining if and for what cases modifications will be made. Keep in mind that substitutions and/or modifications must be based on a statement provided by a recognized medical authority.

Frequently Asked Questions

3. What is the difference between a licensed physician and a recognized medical authority?

A licensed physician is a doctor of medicine (MD) or osteopathy (DO). A recognized medical authority is a professional recognized by the state of Kentucky who is a physician (MD or DO), physician assistant, or advanced practice registered nurse (APRN).

Frequently Asked Questions

4. Is the school food service able to charge more for a meal that requires modification?

No. Schools may not charge children with dietary disabilities or with certified special dietary needs who require food substitutions or modifications more than they charge any other children for program meals or snacks.

Frequently Asked Questions

Additional Resources USDA – Accommodating Children with Special Dietary Needs

http://origin.www.fns.usda.gov/cnd/Guidance/special_dietary_needs.pdf

NFSMI Handbook for Children with Special Food and Nutrition Needs http://

nfsmi-web01.nfsmi.olemiss.edu/documentlibraryfiles/PDF/20111103084132.pdf

Q&As: Milk Substitutions: http://

www.fns.usda.gov/cnd/Governance/Policy-Memos/2009/SP_35-2009_os.pdf

Resources

Questions?

Questions