Meeting Children

1
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]

2
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.

3
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

4
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.

5
Section 504
IDEA

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

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

6
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.

7
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.

8
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

9
Food Service Assistants

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

10
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

11
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
12
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

13
Dietary Considerations

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

14
Diabetic Meal Plans

• Food Guides

From ADA website http//www.diabetes.org/nutritio
n-and-recipes/nutrition/foodpyramid.jsp USDA
website http//mypyramid.gov/
15
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)

16
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

17
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.

18
Food Allergies

• Definition
• Symptoms
• Anaphylaxis

19
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)

20
Food Intolerance
Definition Food intolerance is an adverse
reaction to food that does not involve the immune
system. Examples

• Lactose Intolerance
• Gluten Intolerance

21
Treatment for Allergies

• Antihistamines/Bronchodilators
• Epinephrine
• Prevention and Strict Avoidance

22
Regulations
Accommodations with Approval of Food Service
Director
Accommodations Required

• Allergies with the potential of anaphylaxis
• Celiac disease

• Allergies with no anaphylaxis
• Food intolerances

23
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.

24
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.

25
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.

26
Which of these foods would you be able to eat?

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

27
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.

28
Baked Beans

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

29
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.

30
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

31
Phenylketonuria (PKU)

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

32
Galactosemia

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

33
Hereditary Fructose Intolerance

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

34
Maple Syrup Urine Disease

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

35
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

36
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

37
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

38
Thickened Beverages

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

39
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