Alicia Casteel ( Alicia.Casteel@Arkansas ) Sheila Brown ( Sheila.Brown@Arkansas )

1. Meeting Children’s Special Food and Nutrition Needs in Child Nutrition Programs2006 Breakfast Lunch TrainingNational Food Service Management InstituteThe University of Mississippi Alicia Casteel (Alicia.Casteel@Arkansas.gov) Sheila Brown (Sheila.Brown@Arkansas.gov) (501) 324-9502 Fax: (501) 324-9505

2. Meeting Children’s Special Food and Nutrition Needs in Child Nutrition ProgramsLesson 1: Getting to Know the Regulations • 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. Learning Objectives

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 OtherSpecial 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. Disability Special education needed IEP completed Accommodations made Disability Special education not needed 504 plan completed Accommodations made IDEA Section 504

6. 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. USDA Regulations and Guidance Child with disability must have a licensed physician’s statement that includes:

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 Children’s Special Food and Nutrition Needs in Child Nutrition ProgramsLesson 2: Helping Students with Diabetes • 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 Learning Objectives

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/nutrition-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 Children’s Special Food and Nutrition Needs in Child Nutrition ProgramsLesson 3: Managing Food Allergies • Summarize key components regarding food allergies • Explain ways food service assistants can prevent exposing students with allergies to the allergen. Learning Objectives

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. Allergies with the potential of anaphylaxis Celiac disease Regulations Accommodations with Approval of Food Service Director Accommodations Required • 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 school’s emergency plan if anaphylaxis should occur in a student with a life threatening food allergy.

25. Meeting Children’s Special Food and Nutrition Needs in Child Nutrition ProgramsLesson 4: Understanding Inborn Errors of Metabolism • 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. Learning Objectives

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 Children’s 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 physician’s 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 Children’s 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 child’s intake for the remaining day, if needed • Will provide an explanation of an unusual blood level