cacfp infant meals: guidelines for the first...

Revised: Aug 2013

CACFP Infant Meals:

Guidelines for the First Year

CACFP Infant meals: A Guide to Feeding the First Year Table of Contents

Required Forms for CACFP

Resources………………………………………………………………………………….. 1

Parent Preference Letter…………………………………………………………………….. 2

5-Day CACFP Infant Menu Template & Sample…………………………………………… 3-5

Infant Meal Count Record by Individual Child Template and Sample……………………… 6-9

Infant Development & Nutrition

Hunger and Satiety (Fullness) Cues…………………………………………………………..10

Sequence of Infant Development and Feeding Skills in Normal, Healthy Full-Term Infants... 11

Feeding the Baby the First Year…………………………………………………………........12

CACFP Meal Pattern & Bread and Cracker and Infant Cereal 8-11 Months……………......... 13-14

How the Infant Meal Pattern Corresponds with Food Textures and Feeding Styles……......... 15

0-3 Months

List of Required Formulas for Use in CACFP……………………………………………… 16-17

Preparation Checklist for Standard Liquid Concentrated Iron-fortified Infant Formula…… 18

Preparation Checklist for Standard Powdered Iron-fortified Infant Formula……………… 19

4-7 Months

Introduction of Foods – Basic Principles for Feeding Solid Foods…………………………. 20-22

You Can Help Prevent Choking…………………………………………………………….. 23

Using Commercially Prepared Baby Food………………………………………………… 24

8-11 Months

Using Home - Prepared Baby Foods……………………………………………………….. 25

Infant Foods - Creditable not Creditable Foods……………………………………………. 26-32

Feeding Infant – (excerpt from What’s in a Meal)………………………………………….. 33-36

USDA & ODE Infant Memos……………………………………………………………38-49

Activity

Resources

CACFP Required Forms for Infants

Website address for the required CACFP forms:

http://www.ode.state.oh.us/GD/Templates/Pages/ODE/ODEDetail.aspx?page=3&TopicRelationID=486&

ContentID=538&Content=117325

Team Nutrition (USDA) Feeding Infants: A Guide for Use in the Child Nutrition Program:

Downloadable Manual - - http://www.fns.usda.gov/tn/resources/feeding_infants.html

The guide presents information on infant development, nutrition for infants, breastfeeding and formula

feeding, preventing tooth decay, feeding solid foods, drinking from a cup, choking prevention, sanitary

food preparation and safe food handling, commercially prepared and home-prepared baby food, and

some of the Infant Meal Pattern requirements.

1

http://www.ode.state.oh.us/GD/Templates/Pages/ODE/ODEDetail.aspx?page=3&TopicRelationID=486&ContentID=538&Content=117325

http://www.ode.state.oh.us/GD/Templates/Pages/ODE/ODEDetail.aspx?page=3&TopicRelationID=486&ContentID=538&Content=117325

CACFP INFANT MEALS – PARENT PREFERENCE LETTER

TO: Parents and Guardians of Infants under one year of age FROM:

Name of Center or Provider

TOPIC: Who will provide food for your infant’s meals?

Due to participation on the Child and Adult Care Food Program (CACFP), all children enrolled at this child care center or family child care (FCC) home receive meals free of charge. The CACFP is a child nutrition program of the United States Department of Agriculture. Child care centers and family child care homes are reimbursed a meal rate to help with the cost of serving nutritious meals to enrolled children. These centers and FCC homes can be reimbursed daily for up to two meals and one snack served to each enrolled child, including infants. Emergency Shelters can be reimbursed for up to three meals. The meals must meet CACFP meal pattern requirements for children and infants.

To meet CACFP requirements, the center or FCC home is required to offer formula and other required infant food to all enrolled infants. The iron fortified infant formula we will provide for infants until they turn one year of age is:

Center or provider to insert the NAME OF FORMULA that they will provide

A parent or guardian may decline the formula offered by the center or home and supply the infant’s formula themselves. However, when an infant turns one year of age, the center or FCC home will begin to provide milk and the other required food items to meet the meal pattern requirements for toddler age children.

To assist us in your infant formula and food preferences, please complete preferences below by checking one item each in the formula and solid food section.

PARENT OR GUARDIAN: PLEASE CHECK YOUR PREFERENCES FOR FORMULA AND FOOD

Formula or Breast Milk: (check one)

I want the center or FCC home provider to provide formula for my infant

I will bring iron fortified infant formula for my infant

I will bring expressed breast milk for my infant

I will come to the center or FCC home to breast feed my infant

Solid Food: (check one)

I want the center or FCC home to provide solid food for my infant when he/she is developmentally ready for it

I will bring solid food for my infant when he/she is developmentally ready for it

*Note: If your feeding preferences change, the center or provider will ask you to complete a new form.

INFANT’S NAME:

INFANT’S BIRTHDATE:

PARENT/GUARDIAN SIGNATURE:

DATE:

The U.S Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at [email protected]. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish).

USDA is an equal opportunity provider and employer.

Rev. 8/1/2013 2

mailto:[email protected]

CACFP INFANT MENU (5-DAY)

Site Name Date: Date: Date: Date: Date:

Age Portion Size/Component Mon Tue Wed Thu Fri

Bre

akfa

st

Birth – 3 Months

4-6 fl. oz. formula1 or breastmilk2, 3

4 – 7 months

4-8 fl. oz. formula1 or breastmilk2, 3 0-3 Tbsp. infant cereal1, 4

8 – 11 months


2-4 Tbsp. infant cereal1

1-4 Tbsp. fruit or vegetable or both

Lunc

h/Su

pper

Birth – 3 months


4 – 7 months


0-3 Tbsp. infant cereal1, 4

0-3 Tbsp. fruit or vegetable or both4

8 – 11 months


2-4 Tbsp. infant cereal1 and/or 1-4 Tbsp. meat, fish, poultry, egg yolk or cooked dry beans or peas, or 1/2-2oz. cheese, or 1-4 oz. (volume) cottage cheese; or 1-4 oz. (weight) cheese food, or cheese spread

1-4 Tbsp. fruit or vegetable or both

Snac

k

Birth – 7 months


8 – 11 months

2-4 fl. oz. formula1 or breastmilk2, 3 or fruit juice5

0-1/2 slice of bread4, 6 or 0-2 crackers4, 6

1 Infant formula and dry infant cereal must be iron-fortified. 2 Formula or breastmilk, or portions of both, may be served; however it is recommended that breastmilk be served in place of formula from birth through 11 months.

3 For some breastfed infants who regularly consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum amount of breastmilk may be offered, with additional breastmilk offered if the infant is still hungry. 4 A serving of this component is required only when the infant is developmentally ready to accept it. 5 Fruit juice must be full-strength. 6 A serving of this component must be made from whole-grain or enriched meal or flour. 8/2004

Forms/Ohio CACFP 7 Day Infant Menu 3

CACFP INFANT MENU (5-DAY) Site Name: This institution is an equal opportunity provider.

Date: Date: Date: Date: Date: B

reak

fast

Age Portion Size/Component Mon Tue Wed Thu Fri Birth – 3 Months

4-6 fl. oz. formula1 or breastmilk2, 3 IFIF IFIF IFIF IFIF IFIF

4 – 7 Months


0-3 Tbsp. infant cereal1, 4 IFIC-Rice IFIC-Oatmeal IFIC-Rice IFIC-Oatmeal IFIC-Rice

8 – 11 Months


2-4 Tbsp. infant cereal1 IFIC-Rice IFIC-Oatmeal IFIC-Rice IFIC-Oatmeal IFIC-Rice

1-4 Tbsp. fruit or vegetable or both Mashed Bananas Applesauce Peaches- finely chopped Plums Pears

AM

Sna

ck Birth – 7

Months 4-6 fl. oz. formula1 or breastmilk2, 3 IFIF IFIF IFIF IFIF IFIF

8 – 11 Months

2-4 fl. oz. formula1 or breastmilk2, 3, or fruit juice5

IFIF Pears IFIF Grape Juice IFIF

0-1/2 slice of bread4 ,6 or 0-2 crackers4, 6

Toast Saltine Crackers Animal Crackers Wheat Crackers Toast

Lunc

h

Birth – 3 Months


4 - 7 Months


0-3 Tbsp. infant cereal1, 4 IFIC-Rice IFIC-Oatmeal IFIC-Rice IFIC-Oatmeal IFIC-Rice

0-3 Tbsp. fruit or vegetable or both4 Peas Peaches Green beans Apple sauce Mashed Potato

8 – 11 Months


2-4 Tbsp. infant cereal1; and/or 1-4 Tbsp. meat, fish, poultry, egg yolk, cooked dry beans or peas; or 1/2-2 oz. cheese, or 1-4 oz. (volume) cottage cheese; or 1-4 oz. (weight) cheese food or cheese spread

Beef

(ground/finely

chopped)

Cottage Cheese

Turkey

(Ground/finely

chopped)

Chicken

Ground/finely

chopped

Colby cheese –

finely chopped

1-4 Tbsp. fruit or vegetable or both Peas Peaches Green beans Apple sauce Peas

1 Infant formula and dry infant cereal must be iron-fortified. 2 Breastmilk or formula, or portions of both, may be served; however it is recommended that breastmilk be served in place of formula from birth through 11 months 3 For some breastfed infants who regularly consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum amount of breastmilk may be offered, with additional breastmilk offered if the infant is still hungry.

4 A serving of this component is required only when the infant is developmentally ready to accept it. 5 Fruit juice must be full-strength. 6 A serving of this component must be made from whole-grain or enriched meal or flour. 12/20/2011 4

CACFP INFANT MENU (5-DAY)

Site Name: This institution is an equal opportunity provider.

Date: Date: Date: Date: Date: PM

Sna

ck

Age Portion Size/Component Mon Tue Wed Thu Fri Birth – 7 Months


8 – 11 Months


Apple (finely

chopped)

IFIF White Grape Juice IFIF Banana


Melba Toast Teething Biscuit Graham Crackers Toast Wheat Crackers

Supp

er

Birth – 3 Months


4 - 7 Months


0-3 Tbsp. infant cereal1, 4 IFIC-Oatmeal IFIC-Rice IFIC-Oatmeal IFIC-Rice IFIC-Oatmeal

0-3 Tbsp. fruit or vegetable or both4 Bananas Sweet Potatoes Bananas Sweet Potatoes Bananas

8 – 11 Months


2-4 Tbsp. infant cereal1; and/or 1-4 Tbsp. meat, fish, poultry, egg yolk, cooked dry beans or peas; or 1/2-2 oz. cheese, or 1-4 oz. (volume) cottage cheese; or 1-4 oz. (weight) cheese food or cheese spread

Chicken

Ground/finely

chopped

IFIC- Rice Cereal

Cottage Cheese

IFIC- Rice Cereal

Turkey

Finely chopped

1-4 Tbsp. fruit or vegetable or both Mashed Potato Carrots Green Beans Carrots Green Beans

Even

ing

Snac

k Birth – 7 Months


8 – 11 Months


IFIF IFIF IFIF IFIF IFIF


Melba Toast Teething Biscuit Graham Crackers Toast Wheat Crackers

1 Infant formula and dry infant cereal must be iron-fortified. 2 Breastmilk or formula, or portions of both, may be served; however it is recommended that breastmilk be served in place of formula from birth through 11 months 3 For some breastfed infants who regularly consume less than the minimum amount of breastmilk per feeding, a serving of less than the minimum amount of breastmilk may be offered, with additional breastmilk offered if the infant is still hungry.

4 A serving of this component is required only when the infant is developmentally ready to accept it. 5 Fruit juice must be full-strength. 6 A serving of this component must be made from whole-grain or enriched meal or flour. 12/20/2011

5

INFANT(< 12 months) MEAL COUNT RECORD BY INDIVIDUAL CHILD Ohio CACFP policy is that infant (under one year of age) meal counts be recorded by individual child’s name. Meals/snacks must meet the infant meal pattern requirements to claim reimbursement. This is a meal count form not an attendance form. Infants 0 -7 months of age who are not developmentally ready for other foods: center may claim for meals/snacks containing only parent provided bottled breast milk or IFIF provided by parent or center. Infants 4 – 11 months of age who are developmentally ready for other foods: center may claim if they provide the minimum quantity of at least one other required meal components of the meal pattern. Column Formula by Center or Food by Center. Check appropriated column (s) if the center provided the formula or food item(s) for each child Record and “X” under the meal type (breakfast, lunch, pm snack) if a claimable meal/snack was served to the infant MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Month: Year:

Form

ula

by C

ente

r

Food

by

Cen

ter

Bre

akfa

st

Lunc

h

PM S

nack

Bre

akfa

st

Lunc

h

PM S

nack

Bre

akfa

st

Lunc

h

PM S

nack

Bre

akfa

st

Lunc

h

PM S

nack

Bre

akfa

st

Lunc

h

PM S

nack

Week of:

Classroom:

Teacher:

CHILD’S NAME

Age (in months)

Birth Date

DAILY CLAIMABLE MEAL COUNT TOTALS

MEAL COUNT TOTALS FOR PAGE (WEEK)

BREAKFAST

LUNCH PM SNACK

6

INFANT (< 12 months) MEAL COUNT RECORD BY INDIVIDUAL CHILD Ohio CACFP policy is that infant (under one year of age) meal counts be recorded by individual child’s name. Meals/snacks must meet the infant meal pattern requirements to claim reimbursement. This is a meal count form not an attendance form. Infants 0 -7 months of age who are not developmentally ready for other foods: center may claim for meals/snacks containing only parent provided bottled breast milk or IFIF provided by parent or center. Infants 4 – 11 months of age who are developmentally ready for other foods: center may claim if they provide the minimum quantity of at least one other required meal components of the meal pattern. Column Formula by Center or Food by Center. Check appropriated column (s) if the center provided the formula or food item(s) for each child Record and “X” under the meal type (breakfast, am snack, lunch, pm snack, supper, evening snack) if a claimable meal/snack was served to the infant If center is approved to claim more than 2 meals and1 snack or 2 snacks and 1 meal per child per day, then center must circle the meal or snack that they will not be claiming if total for child is over 2 meals

and 1 snack or 2 snacks and 1 meal. MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

MO.:_____September ___ YR: __2012__ WEEK OF: ____Sept. 2-8______ CLASSROOM:__Little Lambs________ TEACHER:____Jenny Baker___________

Form

ula

by C

ente

r

Food

by

Cen

ter

Bre

akfa

st

AM

Sna

ck

Lunc

h

PM

Sna

ck

Sup

per

Eve

ning

Sna

ck

Bre

akfa

st

AM

Sna

ck

Lunc

h

PM

Sna

ck

Sup

per

Eve

ning

Sna

ck

Bre

akfa

st

AM

Sna

ck

Lunc

h

PM

Sna

ck

Sup

per

Eve

ning

Sna

ck

Bre

akfa

st

AM

Sna

ck

Lunc

h

PM

Sna

ck

Sup

per

Eve

ning

Sna

ck

Bre

akfa

st

AM

Sna

ck

Lunc

h

PM

Sna

ck

Sup

per

Eve

ning

Sna

ck

CHILD’S NAME

Birth Date

Lily Coleman 6/12/12 Y X X X X X X X X X X X X X X

Billy Jackson 5/28/12 Y X X X X X X X X X X X X X X X

Rosa Taylor 10/3/12 Y X X X X X X X X X X X X X X X

DAILY CLAIMABLE MEAL COUNT TOTALS 2 3 3 1 2 2 2 2 3 3 1 1 3 3 1 2 3 3 1

PAGE TOTALS BREAKFAST 9

AM SNACK 0

LUNCH 14

PM SNACK 14

SUPPER 4

EVENING SNACK 0

7

P:\CACFP & Family Day Care Sites\Presentations\Infant Packet\New Infant Packet pages - Dec11\08_Meal_Count_Record_-_1[1].doc

CLASSROOM MONTH YEAR TEACHERMEAL COUNT RECORD

BREAKFAST AM SNACK LUNCH PM SNACK SUPPER EVENING SNACK Date

Children

Program Adults

Children

Program Adults

Children

Program Adults

Children

Program Adults

Children

Program Adults

Children

Program Adults

Total

8

C:\Users\jean.myer\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BO4BKEHA\Completed 08_Meal_Count_Record_-_11 (2).doc

CLASSROOM Infants Under 12 months MONTH January YEAR 2012 TEACHER Jenny Baker MEAL COUNT RECORD

BREAKFAST AM SNACK LUNCH PM SNACK SUPPER EVENING SNACK Date

Children

Program Adults

Children

Program Adults

Children

Program Adults

Children

Program Adults

Children

Program Adults

Children

Program Adults

1 C L O S E D C L O S E D 2 2 0 3 3 1 0 3 2 0 2 2 0 0

4 2 0 3 3 1 0

5 1 0 3 3 1 0

6 2 0 3 3 1 0

7 C L O S E D C L O S E D 8 C L O S E D C L O S E D 9 2 0 3 3 1 0

10 1 0 2 2 0 0

11 2 0 3 3 1 0

12 3 0 3 3 1 0

13 1 0 3 3 1 0


17 2 0 2 2 0 0

18 1 0 3 3 0 0

19 2 0 3 3 0 0

20 3 0 3 3 1 0


24 3 0 2 2 1 0

25 2 0 3 3 0 0

26 1 0 3 3 0 0

27 3 0 3 3 1 0


31 2 0 2 0 1 0

Total 42 0 61 59 15 0

9

Reference: Infant Nutrition and Feeding: A Guide for Use in the WIC and CSF Programs, USDA, March

2009

10

Feeding Infants

Birth through 5months

4 months through 6 months




Figure 1 Sequence of Infant Development and Feeding Skills

in Normal, Healthy Full-Term Infants*DEVELOPMENTAL SKILLS

*Developmental stages may vary with individual babies. See the Bibliography, page 93, for references used to develop this chart.

• Suck/swallow reflex• Tongue thrust reflex• Rooting reflex• Gag reflex

• Draws in upper or lowerlip as spoon is removedfrom mouth

• Up-and-down munching movement

• Can transfer food fromfront to back of tongueto swallow

• Tongue thrust and rootingreflexes begin to disap-pear

• Gag reflex diminishes• Opens mouth when sees

spoon approaching

• Begins to control the po-sition of food in themouth

• Up-and-down munchingmovement

• Positions food betweenjaws for chewing

• Moves food from side-to-side in mouth

• Begins to curve lipsaround rim of cup

• Begins to chew in rotary pattern (diagonal move-ment of the jaw as food is moved to the side or center of the mouth)

• Rotary chewing (diagonalmovement of the jaw asfood is moved to theside or center of themouth)

• Poor control of head,neck, trunk

• Brings hands to moutharound 3 months

• Sits with suppor t

• Good head control

• Uses whole hand tograsp objects (palmergrasp)

• Begins to sit alone unsupported

• Follows food with eyes• Begins to use thumb and

index finger to pick upobjects (pincer grasp)

• Sits alone easily

• Transfers objects fromhand to mouth

• Begins to put spoon inmouth

• Begins to hold cup• Good eye-hand-mouth

coordination

• Swallows liquids butpushes most solid ob-jects from the mouth

• Takes in a spoonful ofpureed or strained foodand swallows it withoutchoking

• Drinks small amountsfrom cup when held byanother person, withspilling

• Begins to eat mashedfoods

• Eats from a spoon easily• Drinks from a cup with

some spilling• Begins to feed self with

hands

• Begins to eat ground or finely chopped foodand small pieces of softfood

• Begins to experimentwith spoon but prefersto feed self with hands

• Drinks from a cup with less spilling

• Eats chopped food andsmall pieces of soft,cooked table food

• Begins self-spoon feed-ing with help

Baby’s Approx. Age Mouth Patterns Hand and Body Skills Feeding Skills or Abilities

11

A Guide for Use in the Child Nutr ition Programs

Birth through 3 Months


8 months through11 months

• Only suck and swallow

• Draw in upper or lower lip asspoon is removed from mouth

• Move tongue up and down

• Sit up with suppor t

• Swallow semisolid foods without choking

• Open the mouth when theysee food

• Drink from a cup with help, with spilling

• Move tongue from side to side

• Begin spoon feeding themselves with help

• Begin to chew and have someteeth

• Begin to hold food and use their fingers to feed themselves

• Drink from a cup with help, with less spilling

LIQUIDS ONLY

• Breastmilk

• Infant formula with iron

ADD SEMISOLID FOODS

• Infant cereal with iron

• Strained vegetables*

• Strained fruit*

*may be started later in the agerange

ADD MODIFIED TABLE FOODS

• Mashed or diced soft fr uit

• Mashed or soft cooked vegeta-bles

• Mashed egg yolk

• Strained meat/poultry

• Mashed cooked beans or peas

• Cottage cheese, yogurt, orcheese strips

• Pieces of soft bread

• Crackers

• Breastmilk, iron-fortified formula,or fruit juice in a cup

Figure 2 Feeding the Baby For the First Year

BABIES AGE: WHEN BABIES CAN: SERVE:

Babies grow quickly during the first year oflife and make many changes in the types offoods and textures of foods they are able to

eat. As babies grow and develop, watch forthe following signs which will tell you whenthey are ready for a new food.

12

Bread and Crackers, and Infant Cereal- snack only 8-11 months

Bread and Cracker-Type Products that are Reimbursable

Breads (white, wheat, whole wheat, French, Italian, and similar breads, all without nuts, seeds, or hard pieces of whole grain kernels)

Biscuits

Bagels (made without nuts, seeds, or hard pieces of whole grain kernels)

English muffins

Pita bread (white, wheat, whole wheat)

Rolls (white, wheat, whole wheat, potato, all without nuts, seeds, or hard pieces or whole grain kernels)

Soft tortillas (wheat or corn)

Crackers-saltines or snack crackers made without nuts, seeds, or hard pieces of whole grain kernels; matzo crackers, animal crackers, graham crackers made without honey.

Zwieback

Teething biscuits

14


Figure 8How the Infant Meal Pattern Corresponds

with Food Textures and Feeding Styles

Birth 1 2 3 4 5 6 7 8 9 10 11 12Age ofBaby byMonth

Agegroupingin InfantMealPattern

Sequenceof Intro-ducingFoods inInfantMealPattern

Texture of SolidFood

FeedingStyle

Birth through 3 months 4 months through 7 months 8 months through 11 months

Breastmilk Infant Cereal Meat or Meat Alternates or Formula Vegetables and/or Fruit Crackers and/or Bread

Fruit Juice (only in a cup)

Strained/Pureed (thin consistency for cereal)

Mashed

Ground/Finely Chopped

Chopped

Breastfeeding or Bottle Feeding

Spoon Feeding

Cup Feeding

Self Feeding/Finger Foods

15

Feeding Infants

Figure 4bPreparation Checklist for Standard Liquid Concentrated Iron-fortified Infant Formula (using glass or hard plastic bottles)

If more than one bottleis prepared, put a cleannipple right side up oneach bottle and coverwith a nipple cap. Labeleach bottle with thebaby’s name and thedate and time that itwas prepared.

1 Wash your hands, arms,and under your nails, verywell with soap and warmwater. Rinse thoroughly.Clean and sanitize yourworkspace.

2 Wash bottles and nipples,using bottle and nipplebrushes, and caps, rings,and preparation utensilsin hot soapy water beforeusing. Rinse thoroughly.

Squeeze clean waterthrough nipple holes tobe sure they are open.

3

4 Put the bottles, nipples,caps, and rings in a potand cover with water. Putthe pot over heat, bringto a boil, and boil for 5minutes. Remove withsanitized tongs, allow theitems to cool, and air dry.

5 For formula, bring water to a very bubbly boil.Keep boiling it for a minute or two, then let it cool.Use this water to mix the formula. Use water from

a source approved by the local healthdepartment. If tap water is used for

boiling, collect onlycold tap water allowed to run for 2 minutes first.

6 Wash the top of the canwith soap and water andrinse well to remove dirt.Wash the can openerwith soap and hot water.

SHAKE CAN WELL andthen open the can.

8

9

10

11

12

Attach nipple and ringto the bottle and SHAKEWELL. Feed preparedformula immediately. Ifformula is left in thecan, cover and refriger-ate can until needed.Use within 48 hours.

Throw out unused formu-la left in bottle after feed-ing or which has been un-refrigerated for 1 hour ormore. Store unopenedcans in a cool, dry indoorpantry shelf. Use beforethe expiration date.

Pour needed amount offormula into a clean bot-tle using ounce markingsto measure formula andadd an equal amount ofcooled boiled water.Thus, if 4 oz. of formula ispoured into the bottle, 4ounces of water shouldalso be added.

7

Baby Jane

8/12/98

2:30 p.m.

Baby Tony

8/11/98

4:30 p.m.

Baby Gabe

8/14/98

4:30 p.m. Baby Tony

8/2/98

8:30 a.m.

Baby Jose

8/12/98

10:30 a.m.Baby Jane

8/12/98

2:30 p.m.

Baby Eva

8/19/98

12:00 p.m.

BOIL COOL

Refrigerate until feedingtime. Use within 48hours. Do not leave for-mula at room tempera-ture. To warm bottle,hold under runningwarm water. Do not

microwave bottles.

18


Wash your hands, arms, and underyour nails, very well with soap andwarm water. Rinse thoroughly.Clean and sanitize your workspace.

Figure 4cPreparation Checklist for Standard Powdered Iron-fortified

Infant Formula (using glass or hard plastic bottles)

Wash bottles and nipples, usingbottle and nipple brushes, andcaps, rings, and preparation utensilsin hot soapy water before using.Rinse thoroughly.

Squeeze clean water through nip-ple holes to be sure they are open.

Put the bottles, nipples, caps, andrings in a pot and cover with water.Put the pot over heat, bring to aboil, and boil for 5 minutes.Remove with sanitized tongs, allowthe items to cool, and air dry.

For formula, bring water to a very bubblyboil. Keep it boiling for a minute or two,then let it cool. Use this water to mix theformula. Use water from a source ap-

proved by the local health department. If tap water is usedfor boiling, collect only cold tapwater allowed to run for 2 minutes first.

Remove plastic lid; wash lid withsoap and clean water and dry it.Write date on outside of plastic lid.Wash the top of the can with soapand water, rinse well, and dry.Wash the can opener with soapand hot water. Open the can andremove scoop. Make sure that thescoop is totally dry before scoop-ing out powdered formula. Onlyuse the scoop that comes with theformula can.

If more than one bottle is pre-pared, put a clean nipple rightside up on each bottle and coverwith a nipple cap. Label eachbottle with the baby’s name andthe date and time that it wasprepared.

To be used again, the scoopshould be washed with soap andhot water, rinsed thoroughly, andallowed to air dry. When makingformula again, the scoop shouldbe totally dry before using it toscoop powder out of the can.Store unopened cans in a cool,dry indoor pantry shelf. Use be-fore the expiration date.

Attach nipple and ring to the bot-tle and SHAKE WELL. Feed pre-pared formula immediately.

Make sure that no water or otherliquid gets into the can of powder.Cover opened can tightly andstore in a cool dry place (not inthe refrigerator). Use within 4weeks after opening to assurefreshness.

For each 2 ounces of cooled boiledwater added to a clean bottle, care-fully add 1 level scoop of powdered

formula. Thus, if 8 ounces ofwater is poured into the bottle,4 level scoops of formulashould be added.

Refrigerate until feeding time.Use within 48 hours. Do not leave

formula at room temperature.To warm bottle, hold underrunning warm water. Do notmicrowave bottles.

Throw out unused formula left inbottle after feeding or which hasbeen unrefrigerated for 1 hour ormore.

1

2

3

4

5

6

7

8

9

10

11

12

13

Baby Jane

8/12/98

2:30 p.m.

Baby Tony

8/11/98

4:30 p.m.

Baby Gabe

8/14/98

4:30 p.m. Baby Tony

8/2/98

8:30 a.m.

Baby Jose

8/12/98

10:30 a.m.Baby Jane

8/12/98

2:30 p.m.

Baby Eva

8/19/98

12:00 p.m.

BOILCOOL

19

Feeding Infants

Introducing Solid Foods:Starting out

• Talk with the parents before introducing solidfoods. Only introduce solid foods when babiesare developmentally ready for them.

• Coordinate with each baby’s parents so that thesame new foods and textures are introduced atthe same time as at home.

• Do not serve solid foods to a baby younger than 4months of age without a doctor’s written instruc-tions.

How to Feed When Baby is Ready forSolid Foods• Sit directly in front of the bab y to encourage the

baby. Offer the spoon. Wait for the baby’s mouthto open before attempting to feed. If babies arenot ready to eat from a spoon the y are not readyto eat solid foods.

• In feeding solid foods, use a small spoon andplace a tiny amount of food between a youngbaby’s lips. At first much of it may slide out of themouth, but gradually the baby will learn to movethe food to the back of the mouth for swallowing.

• Do not force the baby to finish the ser ving.Babies are the best judge of ho w much food theyneed. Let them decide how much they eat. Feeduntil the baby indicates fullness by:– not opening the mouth,– pulling away from the spoon,– turning away,– pushing food or spoon back out of the mouth, or– throwing the food on the floor.

• Be calm and fr iendly but not overwhelming.Follow the baby’s lead on when to feed, what tofeed, and how much to feed.

• Do not put cereal or any other solid food in a bottleor infant feeder. Use a spoon for feeding instead.An infant feeder is a hard plastic container with aspout at one end and a plunger at the other endwhich is used to push a liquid mixture of solid f ood

into a baby’s mouth. Babies fed food in a bottle orinfant feeder are forced to eat the food, can choke,and may not learn to eat foods properly.

• Any special equipment needed for feedingchildren with disabilities should be used.Consult with the parents on how to feed ba-bies with special needs.

• Make the texture of the food appropriate for thebaby’s stage of development. Providing new textures encourages the baby’s further development.

Feeding Safety• Test the temperature of foods before feeding them

to make sure they are not too hot.• When feeding solid foods, seat babies in high-

chairs appropriate for their age and development.Fasten the baby into the highchair with safetystraps before feeding. Keep the highchair awayfrom a table, counter, wall, or other surface sothat the baby cannot push off from it.

• Babies being fed and older babies learning tofeed themselves should be closely super vised byan adult seated at the same tab le or next to thebaby’s highchair. Make sure that the baby doesnot eat while talking, cr ying, or laughing. Also,the adult can watch for “squirreling” (keeping several pieces of food in the mouth without swallowing) which can cause choking.

• To prevent choking, make sure that babies (andchildren) are not eating while they are talking, crying, laughing, crawling, walking, running, playing, lying down, or riding in a vehicle.

• Use a small spoon, made of unbreakab le materialthat will not splinter, that easily fits into the mouth(do not use plastic utensils). Place food in aclean small plastic unbreakable bowl or dish withedges that are not shar p.

• Keep hot liquids or foods out of reach of babiesand children, not on the edge of a counter ortable, or on a tablecloth that could be pulled

Figure 6Basic Principles for Feeding Solid Foods

20


down. Make sure that staff do not consume hotliquids near babies or children. Babies and children can be burned from hot liquids or foodstipped over.

Watching for Reactions• Reinforce the introduction of new foods by serving

the same foods as the parents are feeding. Waitat least 1 week between introducing new foods towatch for reactions (diarrhea, rashes, vomiting,coughing, wheezing, general irritability, hives,stomach pain).

• If a baby seems to be having a severe reaction toa food (e.g., hives, difficulty breathing, or shock),contact the rescue squad or Emergency MedicalService and the baby’s parents immediately.

• If a baby does not like the taste of a new food atfirst, you can try offering it again 3 or 4 w eeks later after discussing this with the parents .

Drinking Water• A baby’s doctor may recommend feeding a small

amount of sterile water in a cup when solid f oodsare introduced. Consult with the baby’s parentsabout the feeding of water. Sterile water is waterthat is brought to a very bubbly boil, boiled for 1 to2 minutes, and then allowed to cool.

Do Not Feed Babies These Foods:• Cow’s Milk—it is not as nutritious and may cause

anemia in babies. Breastmilk or infant formula arebest for the first year of life.

• Hard pieces of raw vegetable or raw fruit—theycan cause choking and be difficult to digest.

• Egg white, whole eggs, shellfish (shrimp, lobster,crab, oysters, clams, scallops, crawfish), andchocolate and cocoa. These foods may cause allergic reactions in babies.

• Shark, swordfish, king mackerel, or tilefish—thesefish may contain high levels of harmful mercury.

• Citrus (e.g., orange, tangerine, grapefruit), pine-apple, or tomato juices or foods before 6 monthsof age. These foods may cause allergic reactionsin babies.

• Home-prepared beets, carrots, collard greens,spinach, and turnips before 6 months of age.

• Peanut butter and other nut and seed butters(e.g., soy nut, almond, cashew, or sunflower seedbutter) and nuts and seeds. These foods cancause choking and may cause allergic reactionsin some babies.

• Commercially prepared baby food desserts orcommercial cakes, cookies, candies, and sweetpastries. These foods tend to be high in sugarand may contain less of the key nutrients that babies need.

• Sugar, maple syrup, corn syrup, molasses, glucose, or other syrups added to food or beverages.

• Foods, beverages, or powders containing artificialsweeteners. Babies should not be fed low-caloriefoods or drinks.

• Foods that could cause choking, see page 66.

Never Feed Babies These Foods:• Honey–Honey and products containing honey,

including sources used in cooking or baking (suchas in honey graham crackers), should never befed to babies. Honey is sometimes contaminatedwith Clostridium botulinum spores which maycause a type of illness called inf ant botulism.

• Raw milk–Raw cow’s or goat’s milk could be contaminated with harmful substances which canmake a baby very sick. Only pasteurized milkproducts should be used once milk is introducedat 12 months of age.

• Raw or undercooked eggs, meat, poultry, or fish– These foods when raw or undercooked cancontain harmful bacteria, parasites, and otherharmful substances that can make a baby verysick.

• Home-canned foods–These foods may contain harmful bacteria if improperly canned.

Figure 6 (continued)Basic Principles for Feeding Solid Foods

21

58 Feeding Infants

DO

Burp the baby at natural pausesduring the feeding and at the endof each feeding.

Put only breastmilk or formula inthe bottle. Do not put cereal, oth-er food, juices, or other dr inks inthe bottle.

Give the bottle to the baby atfeeding time, not nap time, and do not let the baby go to sleepwith the bottle.

Hold the baby while feeding instead of propping the bottle inthe baby’s mouth. Do not let thebaby walk or crawl around withthe bottle.

DO

Wash the baby’s hands beforefeeding.

Use a small spoon or let the bab yuse his or her fingers.

Place food on the tip of the spoonand put food on the middle of thebaby’s tongue.

Remove food from the jar beforefeeding. Do not feed the babyfood from the jar.

Give only one new food at a time,and wait at least 1 week beforegiving another new food.

Figure 7 Good Habits Start Early

During a baby’s first year, good nutrition and good eating habits will help the baby togrow up happy and healthy.

WHY

To reduce spitting up from swallowed air.

To prevent overfeeding, choking,tooth decay, and to allow thebaby to develop good eatinghabits.

To prevent choking, ear infections, and tooth decay fromthe milk which remains on theteeth.

To prevent choking, to providecuddling for the baby, and to prevent babies from sharing their bottles with others.

WHY

To clean any dirt or germs offthe hands to keep the baby’sfood clean.

To help the baby learn propereating habits.

To make it easy for the baby toswallow.

To prevent the saliva from thebaby’s mouth from spoiling theremainder of the food in the jar.

To give the baby time to getused to each new flavor and texture, and to see if the bab y is allergic to the new food.

When You Feed a Baby Solid Foods:

When You Bottle Feed a Baby:

22


Figure 9You Can Help Prevent Choking

Watch Babies and Children During Mealsand Snacks to Make Sure They:

• Sit quietly for all feedings.• Eat slowly.• Chew food well before swallowing.• Eat small portions and only one bite at a time .

Fix Table Foods So They Are Easy toChew:

• Grind up tough foods.• Cut soft food into small pieces or thin slices .• Cut soft round foods, like cooked carrots, into

short strips rather than round pieces.• Remove all bones from fish, chicken, and

meat before cooking.• Cook food until it is soft.• Remove seeds and pits from fr uit.

Foods That Can Cause Choking andShould Not be Fed to Babies and YoungChildren:

Firm, smooth, or slippery foods that slide downthe throat before chewing, such as:• hot dogs, sausages, or toddler hot dogs (even

when cut in round slices)• peanuts and other nuts• hard candy, jelly beans• whole beans• whole grapes, berries, cherries, melon balls,

or cherry and grape tomatoes• whole pieces of canned fruit

Small, dry, or hard foods that are difficult to chewand easy to swallow whole, such as:• popcorn• peanuts, nuts and seeds (like sunflower or

pumpkin seeds)• plain wheat germ • whole grain kernels (like rice, wheat berries)• small pieces of raw carrots or other raw or

partially cooked hard vegetables or fruits• pretzels• cooked or raw whole kernel corn• potato and corn chips

Sticky or tough foods that do not break apart eas-ily and are hard to remove from the airway, suchas:• peanut butter or other nut or seed butters• raisins and other dr ied fruit• tough meat or large chunks of meat• marshmallows • chewing gum• caramels or other chewy candy.

Babies and young children are at the highestrisk of choking on food and remain at highrisk until they can chew better. Choking kills

more young children than any other homeaccident. How can you make eating safer foryoung children?

23


When you buy baby foods:

• Look at the “use-by” date on baby food jars. If the date has passed, do notbuy or use the food.

• Buy baby food jars that are clean on the outside and do not ha ve a brokenvacuum seal. The seal is broken if the button on the center of the top ispopped out.

• Single-ingredient baby foods, like single vegetables, fruits, and meats providemore nutrition ounce for ounce than baby food combination dinners and babyfood desserts. Plain meats and plain vegetables or fruit can be mixed togetherif the baby likes the taste. Fruit can be served instead of a baby food dessert.

• Read the ingredient list on the baby food label. This way you can tell if foodscontain vegetable, fruit, or meat as the first ing redient and if they have addedsalt, butter, oil or cream, sugar, corn syrup, or other ingredients.

When you serve baby food in jars:

• Look at the “use-by” date on the baby food jar. If the date has passed, do notuse the food.

• Wash the lid and jar of bab y food before opening.• Make sure the jar lid is sealed and has not been brok en before opening it. If

the seal has not been broken, you should hear a “pop” noise when you openthe lid of the jar.

• Do not tap the jar lid or bang it to open it—this could break glass chips into thefood.

• Remove enough food from the jar for one feeding. Look closely at the food tomake sure there are no abnor mal pieces in it. Place the food in a dish forfeeding. This way the baby’s saliva on the spoon will not spoil the lefto verfood in the jar. If additional food is needed, use a clean spoon.

• If needed, warm the baby food on a stove or in a food warmer. Stir thefood and test its temperature before feeding. Do not leave baby food injars to heat in a microwave—the food can get very hot and could burnthe baby’s mouth.

• Throw away any leftover food in the dish. Do not put it back in the jar.

When you store baby food in jars:

• After opening a jar, replace the lid and place it in the refr igerator. Label the jarwith the child’s name and the date and time that it w as opened. Use the foodwithin 2 days, except for baby food meats and egg yolks which should beused within 24 hours. Throw out foods not used within those times .

• Regularly check to make sure that your refrigerator temperature is coldenough (40° Fahrenheit or lower) to keep the food safe.

• Look at the “use-by” date on the jar when stor ing unopened jars. If the datehas passed, throw out the food and recycle the jar.

• Store unopened jars in a cool dr y place like a kitchen cabinet or pantr y (not inthe refrigerator, car, garage, or outdoors).

• Rotate the stored jars so that y ou use the food previously purchased prior tonewly purchased food.

Keep the baby’s food clean to keep it safe. Remember to wash your hands before handling any food (See Figure 10 on Hand Washing Tips).

Figure 11Using Commercially Prepared Baby Food

24


Before preparing food:• Wash all bowls, utensils, pots and pans, equipment

(such as a blender, food mill, food processor, babyfood grinder, cutting board), the sink, and counters inhot, soapy water, rinse, and sanitize. Allow to air dry.

When you prepare baby food:• Begin with good quality food. Use fresh food if

possible. Check ingredients on the ingredient labelof commercially canned or frozen foods. Preparefoods for a baby immediately before use and avoidusing leftover food.

• Wash fruits and vegetables well and remove partsnot to be eaten (peels, seeds, pits) before cooking.

• Do not feed home-prepared spinach, beets,turnips, carrots, or collard greens to babies un-der 6 months old.

• Remove bones, fat, and gristle from meats, poultry, and fish. Meats, poultry, fish, dried beansor peas, and egg yolks should be well cooked.Baking, boiling, broiling, poaching, and steamingare good cooking methods. Call USDA’s Meat andPoultry Hotline at 1-800-535-4555 for informationon safe food handling, including what tempera-tures to bring meat, poultry, and fish to dur ingcooking.

• Cook foods until they are soft and tender. Foodcan be pureed to the r ight texture using a blenderor food processor, a fine mesh strainer, baby foodgrinder, or food mill. For older babies, foods canbe mashed with a fork or chopped finely. Watercan be added to give pureed food a thinner consistency.

• Do not add salt, butter, margarine, lard, oil, cream,sugar, syrups, gravy, sauces, or fat drippings to thebaby’s food. Never add honey to the baby’sfood.

• Do not use home-canned food, food from dented, rusted, bulging or leaking cans or jars,or from cans or jars without labels.

When you store home-prepared baby food:• Immediately after cooking, refr igerate or freeze

freshly cooked food to be stored. Label the foodwith the date and time it w as prepared. Do not letthe food sit at room temperature—harmful germscan grow in the food at that temperature. Throwout foods left at room temperature for 2 hours ormore including serving time.

• Make sure to place foods to be stored in the refr ig-erator in a clean container with a tightly fitting lid.Regularly check to make sure that the refr igeratortemperature is cold enough (40

oFahrenheit or

below) to keep food safe.

• Use refrigerated foods within 2 days (except formeats, poultry, fish, and egg yolks—use themwithin 24 hours). Throw out foods not used withinthose times.

• To freeze baby food, either pour cooked food intosections of a clean ice cube tr ay or place 1 to 2 tablespoons of pureed food in spots on a cleancookie sheet. Cover the food with plastic wrap orfoil. When frozen, place the food pieces into acovered freezer container or tightly closed plasticbag in the freezer. Label and date the containersor bags. Use frozen foods within 1 month.

• Regularly check to make sure that the freezer temperature is cold enough (0

oFahrenheit or

below) to keep food safe.

When you serve home-prepared baby food:• Serve freshly cooked food to a baby right after

preparing it. Allow the food to cool to lukewarm. Stirthe food and test its temperature before feeding.

• Throw away any leftover food in the baby’s dish.Do not put it back in the refr igerator or freezer.

When you reheat home-prepared babyfood:• Completely reheat refrigerated or frozen home-

prepared baby food to at least 165o

Fahrenheit before feeding. Allow food to cool to lukewarm.Stir the food and test its temperature to make sureit is not too hot or cold bef ore serving to baby.

• Thaw frozen foods in the refr igerator, under coldrunning water, or when reheating the food. Neverdefrost baby foods by setting them out at roomtemperature or in a bowl of standing water. Germscan grow in food sitting at room temperature.

• Throw out leftover food remaining in the dish thatthe baby does not eat.

• Do not refreeze baby food that has thawed. Labelfood with the date and time it w as removed fromthe freezer. Store thawed food in the refr igeratorand use it within 2 days or throw it out (except formeats, poultry, or fish which should be thro wn outafter 24 hours).

Keep the baby’s food clean to keep it safe. Remember to wash your hands before handlingany food (See Figure 10 on Hand Washing Tips).

Figure 12Using Home-Prepared Baby Foods

25

USDA & ODE Infant Memos

FY2000 USDA CACFP Memo #11- Issues Related to Feeding Infants in the Child and Adult Care Food Program – questions and answers

FY2003 USDA CACFP Memorandum #03-02-Baby Fruits or Vegetables with DHA

FY2003 USDA CACFP Memorandum #03-13 - Reimbursement of Infant Meals in Child Nutrition Programs

FY2005 USDA CACFP Memo #05-04 Clarification on Acceptable Infant Formulas

FY2005 USDA Memo #05-07 Meal Pattern Requirements for Infants 8 through 11 Months in Child Nutrition Programs

FY2002 USDA CACFP Memorandum #17- Infant Meals in Child and Adult Care Food Program

FY2003 ODE Memorandum - Reimbursement of Infant Meals in Child Nutrition Programs

37

Reply to attn of:

Subject:

To:

United States Department of Agriculture

Food and Nutrition Service

Midwest Region

77 W. Jackson Blvd., 20th Floor Chicago, IL 60604-3511

MWCN 202: CC2 May 9, 2000

FY00 Child and Adult Care Food Program Policy Memorandum #11

Issues Related to Feeding Infants in the Child and Adult Care Food Program (CACFP) State Directors Child Nutrition Programs

We know that dietary needs during an infant’s first year of life are individually prescribed and more complicated than those for toddlers and older children. Recent changes in the requirements for infant meal service have raised questions regarding reimbursable meals and snacks for infants in CACFP.

The interim rule, Amendments to the Infant Meal Pattern, published in the Federal Register on November 15, 1999 (64 FR 61770), announced important changes in meal services to infants in CACFP. The rule eliminates whole cow’s milk from the infant meal pattern by requiring that all meals and snacks served to infants, up to one year of age, include breast milk or iron fortified infant formula. The rule also allows reimbursement for meals served to infants, from birth through seven months, that exclusively contain breast milk.

Since publication of the interim rule, we have received a number of questions related to feeding infants in the CACFP. Some questions were addressed in the January 13, 2000, memorandum, Effective Date for Implementation of Interim Regulation Amending the Infant Meal Patterns for the National School Lunch Program, School Breakfast Program and Child and Adult Care Food Program (#4-00). Attached are additional questions and answers issued by the National office that we hope you will find helpful. For purposes of this memorandum, the term “infant” will refer to babies under 12 months of age, and the term “child” or “children” will refer to those over 12 months of age. Also included in this memorandum are some technical corrections to the infant meal pattern in the CACFP final rule, Overclaim Authority, published on December 27, 1999 (64 FR 72257). If you have any questions regarding this memorandum, please contact Julie Mikkelson at 312-886-5514.

THERESA E. BOWMAN Regional Director Special Nutrition Programs Attachment

(1) When an infant receives both breast milk and formula, is the meal eligible for reimbursement?

38

Yes, a meal served to an infant under 12 months of age and under which contains some amount of breast milk (and some amount of formula ) is reimbursable as long as the total number of ounces offered to the infant meets, or exceeds, the minimum amount for the milk component as specified in the CACFP infant meal pattern. (2) Are meals served to children, 12 months and older, reimbursable if they contain infant formula? Yes, for a period of one month, when a child is weaning from infant formula to whole cow’s milk (i.e., transitioning), meals that contain infant formula may be reimbursable. When a child is weaned from formula (or breast milk) to cow's milk, it is a common practice to provide the infant with both foods at the same meal service, to gradually ease the infant to accept some of the new food. However, unlike breast milk, infant formula is not an alternative type of milk which can be substituted to meet the fluid milk requirement for the CACFP meal pattern for children over the age of one year. (See FNS Instruction 783-7, rev. 1, Milk Requirement—Child Nutrition Programs.) Thus, for a child 13 months of age and older who is not in this transitional stage, a statement from a recognized medical authority is needed for a meal containing infant formula to be eligible for reimbursement (See FNS Instruction 783-2, rev 2, Meal Substitutions for Medical or Other Special Dietary Reasons). (3) If a physician prescribes whole cow’s milk as a substitute for breast milk for an infant under 12 months of age, is the meal reimbursable? Yes, a meal or snack containing whole fluid cow's milk and served to an infant under 12 months of age is eligible for reimbursement if the substitution is authorized, in writing, by a recognized medical authority. Similarly, if a recognized medical authority prescribes a formula such as low-iron fortified formula, which is not currently listed as a creditable formula for CACFP, the meal is eligible for reimbursement. We have always recognized the unique dietary needs of infants and that decisions concerning diet, during this first year of life, are for the infant's health care provider and parents or guardians to make together. Therefore, to support the request, a medical statement which explains the food substitution or modification is needed. The statement must be submitted and kept on file by the facility or institution. (4) A mother would like her 5-month old infant to receive breast milk which she provides and solid foods, which are listed as options in the meal pattern. Because the infant is developmentally ready for solid foods, whose responsibility is it to provide them? If an infant is developmentally ready for one or more solid food items and the parent or guardian requests that the infant be served solid foods, the center or provider is responsible for purchasing and serving them to the infant. The CACFP infant meal pattern takes into consideration that infants develop at different paces. Some food items such as fruit and cereal are listed as options in the infant meal pattern to account for an infant’s “readiness” to accept these foods (i.e., some infants are developmentally ready for solid foods earlier than others). This occurs in the breakfast and lunch/supper meal service for infants 4-7 months of age, and for the snack meal service for infants 8-11 months of age. A child care center or provider must serve a complete meal to every infant or child enrolled in the meal service. Therefore, if a child is developmentally ready for these solid foods, and the parent or guardian requests that the infant is served solid foods, the components are no longer considered as options and should be served to the infant to provide her with the optimal nutrition she needs to develop and grow. (5) Is a meal reimbursable if the parent or guardian provides the majority of the meal components for infants older than three months? In addition to medical or special dietary needs, parents may choose to provide one or several of the meal components under the CACFP infant meal pattern for infants older than three months, as long as this is in compliance with local

39

health codes. Because we recognize that parents or guardians are often most in touch with their child’s individual dietary preferences, we believe the CACFP infant meal pattern can accommodate these preferences. In such a case, the center or provider would still be required to provide at least one of the components in at least the minimum quantities specified in the meal pattern in order for the meal to be reimbursable. Centers and sponsoring organizations also need to ensure that the parent or guardian is truly choosing to provide the preferred component(s), and that the center or provider has not solicited (requested or required) the parent or guardian to provide the components in order to complete the meal and reduce cost to the center or provider. (6) If a mother comes to the day care home or center to nurse her infant, is the meal reimbursable? No. Although we strongly support all efforts for mothers to breastfeed their infants, we believe that the caregiver must provide some type of service in order to be reimbursed for a meal. CACFP reimburses child care facilities for the cost of preparing and serving nutritious meals and snacks to infants and children receiving day care. In the case of breastfed infants, CACFP reimburses the facility for the cost of preparing the bottle and feeding the infant. When a parent nurses her own child, the services for which the center or the provider would receive reimbursement are not being performed. However, the meal would be reimbursable for infants over 3 months of age who are developmentally ready for solid foods, if at least one other component is furnished by the center or provider. For example, if a mother comes to the day care home for lunch meal service to breastfeed her 5 month old infant and the provider supplies a serving of vegetables (listed as an option in the infant meal pattern for lunch for infants aged 4-7 months), the meal is reimbursable. (7) If a day care home provider breastfeeds her own infant, is the meal eligible for reimbursement? Yes, a day care provider who nurses her own infant may claim reimbursement for the meal as long as she is eligible to claim reimbursement for meals and snacks served to her own child. In this case, the meal is reimbursable because the mother (provider) is actively engaged with the child. Thus, unlike a mother who comes into a center or home to breastfeed an infant, the provider is being reimbursed for her services—the time and effort she expends breastfeeding her own infant. As with any other claim for meals served to the provider’s own child, the infant must be eligible for free and reduced price meals, enrolled in the day care program, and participating in the program during the time of the meal service. At least one other nonresident child must also be enrolled in the day care program and be present during the meal service. (8) Cottage cheese is a meat alternate in the lunch and supper meal pattern for infants aged 8 through 11 months. How much cottage cheese must be offered to fulfill the meat/meat alternate meal pattern requirement? Cottage cheese, cheese food, and cheese spread are acceptable meat alternates in the CACFP infant meal pattern. An error in the meal pattern tables in sections 210.10(m)(2)(iii)(C), 210.10a(h)(3), and 226.20(b)(4) incorrectly measures the amount of cheese in tablespoons. The correct amount which may be offered as a meat alternate to infants, aged 8 through 11 months, is 1 to 4 ounces. (9) Is yogurt an allowable meat alternate in the infant meal pattern?

The Office of Analysis, Nutrition and Evaluation plans to issue a memorandum on the use of yogurt in the CACFP infant meal pattern in the future.

40

Reply to attn of:

Subject:

To:



Midwest Region


CC2 January 6, 2003 FY 2003 School and Community Nutrition Programs Policy Memorandum # 03-06 FY 2003 Summer Food Service Program Policy Memorandum # 03-02 FY 2003 Child and Adult Care Food Program Policy Memorandum # 03-02 Baby Fruits or Vegetables with DHA State Directors Child Nutrition Programs In response to a number of inquiries, we wish to clarify that certain baby food products containing DHA cannot be served to infants as part of a reimbursable meal in the child nutrition programs. DHA is an omega-3 fatty acid known as docosahexaenoic that may be added to commercially prepared fruits or vegetables. The source of DHA in some lines of baby food products, such as Beech-Nut First Advantage Sweet Potato Souffle or Tropical Blend, is egg yolk. These DHA-added products combine fruits or vegetables with dried egg yolk, heavy cream, rice flour, vanilla extract, and other ingredients. They are not labeled or marketed as desserts, but they contain similar ingredients that may not be appropriate for an infant younger than 8 months of age. Introducing these “dessert-like” ingredients to an infant’s diet at an earlier age could result in a food sensitivity or a food allergy. Although DHA-added products cannot contribute to the infant meal pattern, they may be served as additional foods to infants 8 months of age or older. Since they contain several ingredients, additives, or extenders that could cause allergic reactions, we recommend that the center, provider, or the school check with the infant’s parent or guardian, before serving them. Please contact our office if you have questions. JOHN KWIT for THERESA E. BOWMAN Regional Director Special Nutrition Programs

41

Reply to attn of:

Subject:

To:



Midwest Region


USDA IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER

MWCN: CC 2 May 13, 2003 FY 03 School and Community Nutrition Programs Policy Memorandum # 03-16 FY 03 Child and Adult Care Food Program Policy Memorandum # 03-13 Reimbursement of Infant Meals in the Child Nutrition Programs State Directors Child Nutrition Programs Midwest Region The child nutrition programs reimburse child care centers, family day care homes, emergency shelters, schools, and residential child care institutions for the costs of serving nutritious meals-- including the costs of preparation and clean up of meals--to infants. We are revising program policy to recognize the non-food related cost of serving infants by allowing reimbursement for meals containing only infant formula, whether supplied by the caregiver or by the parent. Please advise your agencies that reimbursable meals for infants may contain either breastmilk or iron-fortified infant formula, or both, supplied by the caregiver or by the parent. However, to receive reimbursement, the caregiver must always offer the infant a complete, developmentally appropriate meal. Because we are recognizing the labor involved in serving meals to infants, the meal must be served and fed to the infant by the caregiver. If you have additional questions about the reimbursement of infant meals, please contact our office.

THERESA E. BOWMAN Regional Director Special Nutrition Programs

42

Reply toattn of:

Subject:

To:



Midwest Region

CC 2 December 2, 2004 FY 05 Child and Adult Care Food Program Policy Memorandum # 05-04 FY 05 School and Community Nutrition Programs Policy Memorandum #05-07 Clarification on Acceptable Infant Formulas

State Directors Child Nutrition Programs This memorandum is in response to questions raised by the Connecticut State agency: 1. Must a formula served (in the CACFP) be listed exactly as it says on the Child and

Adult Care Food Program Approved List? 2. Must a provider have a medical statement on file for an infant formula to be part of a

reimbursable meal?

The answer is a qualified no. The current list of the Iron-Fortified Infant Formulas That Do Not Require a Medical Statement is NOT an inclusive list, because new infant formula products are continually being developed.

According to the Child and Adult Care Food Program (CACFP) regulation, 7 CFR 226.20(b)(2), “either breast milk or iron-fortified infant formula, or portions of both, must be served for the entire first year.” Any product labeled as an iron-fortified infant formula, legally must meet the Food and Drug Administration (FDA)’s definition, 21 CFR 107.10(b)(4) (i), as a product “which contains 1 milligram or more of iron in a quantity of product that supplies 100 kilocalories when prepared in accordance with label directions for infant consumption.” The number of milligrams of iron per 100 kilocalories of formula can be found on the nutrition label of infant formulas.

If a formula is not on the current list of the Iron-Fortified Infant Formulas That Do Not Require a Medical Statement, a child care provider or institution may use the following criteria to determine whether or not a formula is reimbursable under the CACFP without the need of a medical statement:

43



a)

b) Examine the nutrition label to make sure that the formula is iron-fortified. The statement "Infant Formula with Iron" or a similar statement must be on the label.

c) Be aware of the fact that all infant formulas marketed in the United States must meet

the nutrient specifications listed in FDA Regulation, 21 CFR 107 http://www.cfsan.fda.gov/~lrd/cfr107.html#spD and in the Section 412 of the Food, Drug, and Cosmetic Act http://www.fda.gov/opacom/laws/fdcact/fdcact4.htm#sec412. If a formula is purchased outside of the United States, it is likely that the formula is not regulated by FDA; therefore, it may not be creditable under the CACFP.

The nutritive values of each formula are listed on the product's nutrition label. Infant formula manufacturers may have their own proprietary formulations, but they must contain at least the minimum levels of all nutrients specified in FDA regulations without going over the maximum levels, when maximum levels are specified.

d) Also be aware of the fact that manufacturers of infant formula are required by FDA regulation to follow current Good Manufacturing Practices, including quality control procedures to assure that the infant formula provides nutrients in accordance with Section 412 of the Food, Drug, and Cosmetic Act, and to assure that the infant formula is manufactured in a manner designed to prevent adulteration.

A child care provider can serve a formula if the exact product is on the current list of the

Iron-Fortified Infant Formulas without the need of obtaining a medical statement.

In the memorandum from Connecticut, the issue of whether the two specific brands of infant formulas are creditable was questioned. Similac Advance is an iron-fortified infant formula that is currently included in the list of Iron-Fortified Infant Formulas That Do Not Require a Medical Statement. Similac Alimentum Advanced, is an infant formula that is on the FDA Exempt Infant Formula list; therefore, it is not creditable unless supported by a statement from a licensed physician or a recognized medical authority specified by the State agency, as appropriate, that indicates the need for this special formula.

Ensure that the formula is not listed as an FDA Exempt Infant Formula. An exempt infant formula is an infant formula labeled for use by infants who have inborn errors of metabolism or low birth weight, or who otherwise have unusual medical or dietary problems (21 CFR 107.3). Formulas classified as Exempt Infant Formulas by FDA require a medical statement in order to be served to infants under the CACFP as part of a reimbursable meal. A medical statement must be signed by a licensed physician if an infant is considered disabled according to USDA’s regulation, or a recognized medical authority specified by the State agency if an infant has medical or other special dietary needs. To check whether or not an infant formula is an FDA Exempt Infant Formula, visit FDA's website at http://www.cfsan.fda.gov/~dms/infexmp.html.

44



If a child care provider or institution is not sure of whether or not an infant formula is creditable under the CACFP, they should contact their State agency who can contact FNS for assistance, as needed

3. Can you provide guidance about a formula supplied by the parent that is not iron-fortified? Would service of this product require a medical statement in order to be creditable for a reimbursable meal for an infant?

As stated above, according to 7 CFR 226.20(b)(2), “either breast milk or iron-fortified

formula, or portions of both, must be served for the entire first year.” In addition, Page 24 of Feeding Infants: A Guide for Use in the Child Nutrition Programs, Paragraph 2, states that low-iron formulas do not meet the meal pattern and may be served as a dietary substitution only if an infant is unable to consume iron-fortified infant formula because of medical or other special dietary needs. The substitution can only be made when supported by a statement from a licensed physician or a recognized medical authority that indicates the recommended infant formula. These rules apply to formula provided by the CACFP facility and to formula provided by the parent.

While our responses to these questions pertain to meals served to infants in the CACFP, it should be noted that they also apply to meals containing infant formula under the National School Lunch Program or the School Breakfast Program.

DICK GILBERT Acting Regional Director Special Nutrition Programs

45

Reply toattn of:

Subject:

To:



Midwest Region



December 28, 2004 CC 2 / NT 04 FY 05 Child and Adult Care Food Program Policy Memorandum # 05-07 FY 05 School and Community Nutrition Programs Policy Memorandum #05-12 Meal Pattern Requirements for Infants 8 Through 11 Months in the Child Nutrition Programs

State Directors Child Nutrition Programs The Food and Nutrition Service (FNS) has recently received questions about the appropriate number of components that fulfill the meal pattern for lunches and suppers served to infants 8 through 11 months of age. This memorandum clarifies that, for this age group of infants, a reimbursable lunch or supper has three components. A reimbursable lunch or supper must include:

(1) Fluid Milk:

6 to 8 fluid ounces of breastmilk, or iron-fortified infant formula, or both

(2) Cereal, or “Meat/Meat Alternate,” or both:

2 to 4 tablespoons of iron-fortified dry infant cereal

or 1 to 4 tablespoons of meat, or 1 to 4 tablespoons of fish, or 1 to 4 tablespoons of poultry, or 1 to 4 tablespoons of egg yolk, or 1 to 4 tablespoons of cooked dry beans, or 1 to 4 tablespoons of cooked dry peas, or ½ to 2 ounces (weight) of cheese, or 1 to 4 ounces (volume) of cottage cheese, or 1 to 4 ounces (weight) of cheese food

or appropriate quantities (as listed above) of cereal and meat/meat alternate

46

(3) Fruit or Vegetable:

1 to 4 tablespoons of fruit, or vegetable, or both

We hope this information makes it easier to understand the infant meal pattern requirements that are written in sections 226.20(b)(5)(iii)(B) and 210.10(o)(5)(iii)(B), and the accompanying tables in sections 226.20(b)(6) and 210.10(o)(6). If you have additional questions about the reimbursement of infant meals, please contact our office.

DICK GILBERT Acting Regional Director Special Nutrition Programs

47

Reply to attn of:

Subject:

To:



Midwest Region



MWCN 203: CC2 May 31, 2002 FY 2002 CACFP POLICY Memorandum #17, Obligations of Child Care Centers and Day Care Homes to Offer Infant Meals in the Child and Adult Care Food Program (CACFP) State Directors Child Nutrition Programs This memorandum clarifies that child care centers and family day care homes participating in CACFP must offer program meals to all eligible children who are enrolled for care in their facilities. We are providing this explanation to ensure that all children, including infants, who are enrolled for child care have access to CACFP meals. A facility may not avoid this obligation by stating that the infants are not “enrolled” in CACFP, or by citing some logistical or cost barrier to offering an infant meal. Decisions on offering program meals must be based on whether the child is enrolled for care, not whether the child is enrolled for CACFP. Section 226.2 of the CACFP regulations defines an enrolled child as “a child whose parent or guardian has submitted to an institution a signed document which indicates that the child is enrolled for child care.” As long as the infant is in care during the meal service period, the facility must offer the infant a meal that complies with program requirements. As with all children in CACFP facilities, an infant’s parent or guardian may decline what is offered, and supply the infant’s meals instead. The key factor is that the infant must be provided access to CACFP meals. We are aware that there are some States that may not currently use this policy. Please ensure that your CACFP institutions and facilities come into compliance within a reasonable amount of time. If you have any questions, please contact John Kwit at (312) 886-5514. Sincerely. Rich Rotunno for THERESA E. BOWMAN Regional Director Special Nutrition Programs

48

25 S. Front Street, Mail Stop 301 Columbus, Ohio 43215-4183

Telephone 614-466-2945 · FAX 614-752-7613 www.ode.state.oh.us

Office of Child Nutrition Services Robin Ziegler Interim Director

MEMORANDUM To: Child Nutrition Program Sponsors From: Robin Ziegler, Interim Director, and Office of Child Nutrition Services Date: July 1, 2003 Subject: Reimbursement of Infant Meals in Child Nutrition Programs The United States Department of Agriculture (USDA) has revised program policy to allow for the reimbursement for meals containing only infant formula, whether supplied by the caregiver or by the parent. This new policy is effective immediately and has been revised in order to recognize the nonfood related cost of serving infants in child care centers, family child care homes, emergency shelters, schools and residential child care institutions. Because USDA is recognizing the labor involved in serving meals to infants, the meal must be served and fed to the infant by the caregiver to be claimed as reimbursable. Therefore, reimbursable meals for infants (under 1 year of age) may contain either breast milk or iron-fortified infant formula, or both, supplied by the caregiver or by the parent. However to receive reimbursement, the caregiver must always provide the infant a complete, developmentally appropriate meal as outlined in the infant meal pattern and highlighted below:

Infants 0 through 3 months of age – Caregivers may claim reimbursement for meals or snacks containing only parent provided breast milk or iron fortified infant formula served by the caregiver.

Infants 4 through 7 months of age who are NOT developmentally ready for other foods – Caregivers

may claim reimbursement for meals or snacks containing only parent provided breast milk or iron fortified infant formula served by the caregiver.

Infants 4 through 7 months who ARE developmentally ready for other foods and infants 8 through 11

months of age – Caregivers may claim reimbursement if they provide the minimum quantity of at least one of the other meal components specified in the meal pattern.

Note: If a mother comes to the care facility/home and breastfeeds her own child, that meal is not

reimbursable if no other meal component as specified in the meal pattern is provided by the caregiver.

In addition, Child and Adult Care Food Program (CACFP) regulations specify that when infants from birth through 11 months are enrolled in a facility or home that participates in the CACFP, “infant meals shall be offered.” Thus, CACFP centers or homes serving infants (under 1 year of age) are required offer parents or guardians the option of providing their own formula and/or food through the completion of the Infant Meals – Parent Preference Letter. Attached is the most current letter for centers and home to begin using with new enrollees. If you have questions, please call (614)466-2945. Attachment

Susan Tave Zelman Superintendent of Public Instruction

49

CACFP ACTIVITY

INFANT MEALS (under 1 year of age)

Directions: Circle if the following is a creditable or non-creditable food item or menu. For non-creditable answers, list an explanation. 1. Creditable or Non-Creditable Breakfast: Farina or Cherrios for infants 4 – 11 months

Explanation:

2. Creditable or Non-Creditable Lunch or Supper: Fish sticks for infants 8 – 11 months Explanation:

3. Creditable or Non-Creditable Lunch or Supper: Scrambled egg as a meat alternate for 8 -11 months Explanation:

4. Creditable or Non-Creditable Lunch or Supper: Strained turkey, mashed potatoes and iron fortified infant formula for 8 – 11 months Explanation:

5. Creditable or Non-Creditable Lunch or Supper: Hotdogs, applesauce, and iron fortified infant formula for 8 -11 months Explanation:

6. Creditable or Non-Creditable Lunch or Supper: Cheese slice, mashed bananas, whole milk for 8 – 11 months Explanation:

7. Creditable or Non-Creditable Snack: Apple juice, pureed pears for 8 – 11 months Explanation:

8. Creditable or Non-Creditable Snack: Yogurt and iron fortified infant formula Explanation:

(More on backside)

50

Directions: Circle true or false for each question. 1. True or False The Parent Preference Letter only needs to be kept on file when the

infant begins to eat solid food. 2. True or False A separate infant menu must be used and kept on file for infants under

one year of age. 3. True or False Not matter who provides the formula (parent or center), the center may

claim the meal if the infant is not yet developmentally ready to eat solid foods.

4. True or False Once an infant begins to eat solid food, the center must provide all

required food components for the meal/snack in order to claim the meal/snack.

5. True or False Infant meal counts can be recorded by total head count or by individual

child’s name. 6. True or False If a mother comes into the child care center and breastfeeds her own

child and no other component is supplied by the center, the center can claim that as a reimbursable meal.

7. True or False Infants must be fed at the time listed on the sponsor’s site application in

order for it to be a reimbursable meal. 8. True or False If a parent mixes cereal and formula in a bottle and brings it to the

center, the center can claim this as a creditable formula if a doctor’s statement is on file.

9. True or False Combination jars foods (turkey and vegetable) are considered creditable. 10. True or False It is optional to offer program meals to infants enrolled for care because

of the cost barrier to serve them. 51

cacfp infant meals: guidelines for the first...

Documents