Accommodating Children with Special Dietary Needs

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Accommodating Children with Special Dietary Needs. Review of USDA Guidance for School Food Service Staff Presented by: Ruth Taylor, MS, RD, LD Fulton Co. School Nutrition Program 2011 GSNA Conference. - PowerPoint PPT Presentation

Text of Accommodating Children with Special Dietary Needs

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Accommodating Children with Special Dietary Needs

Review of USDA Guidance for School Food Service StaffPresented by: Ruth Taylor, MS, RD, LDFulton Co. School Nutrition Program2011 GSNA Conference1In August 1991, USDA issued guidance entitled, Accommodating Children with Special Dietary Needs in the School Nutrition Programs. USDA worked closely with the Department of Education and the Department of Justice in the development of the guidance.

The goal was to provide operational guidance that reflected the requirements of statute and regulations:The Rehabilitation Act of 1973The Individuals with Disabilities Education ActAmericans with Disabilities Act7 CFR Part 15b7 CFR 210.10(g)While the statutory and regulatory provisions remain essentially unchanged, over the past 10 years, some of the reference material changed.

This revision of the guidance was intended to offer clarification and update information without making substantive changes.

Schools must make substitutions in foods in the reimbursable meal for students who are disabled and whose disability restricts their diet. basic intent of statute and regulations is to ensure that children with disabilities have access to program benefits

In the case of the Child Nutrition Programs, this means that substitutions to the reimbursable meal must be made for children who are unable to eat school meals because of their disabilities.

The word substitution is used because for the most part, accommodations under the school meal programs will involve replacing one food with another, although this will not always be the case.

What are Disabilities?Disability is defined in:Section 504 of the Rehabilitation Act of 1973Americans with Disabilities Act of 1990Part B of the Individuals with Disabilities Education Act (IDEA)IEP 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 defines a person with a disability as any person who:has a physical or mental impairment which substantially limits one or more major life activities,has a record of such an impairment or,is regarded as having such an impairment.Physical or mental impairment includes many diseases and conditions, a few of which may be: orthopedic, visual, speech, and hearing impairments; cerebral palsy; epilepsy; muscular dystrophy; multiple sclerosis;cancer; heart disease; metabolic diseases, such as diabetes or phenylketonuria (PKU); food anaphylaxis (severe food allergy); mental retardation; emotional illness; drug addiction and alcoholism; specific learning disabilities; HIV disease; and tuberculosis. Please reference the Act for a more detailed explanation.Major Life Activities covered by this definition include caring for ones self, eating, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.

Under Part B of the Individuals with Disabilities Education Act (IDEA) a child with a disability means a child evaluated in accordance with IDEA as having one or more of the recognized thirteen disability categories and who, by reason thereof, needs special education and related services. IDEA recognizes 13 disability categories which establish a childs need for special education and related services. These disabilities include: autism; deaf-blindness; deafness or other hearing impairments; mental retardation; orthopedic impairments; other health impairments due to chronic or acute health problems, such as asthma, diabetes, nephritis, sickle cell anemia, a heart condition, epilepsy, rheumatic fever, hemophilia, leukemia, lead poisoning, tuberculosis; emotional disturbance; specific learning disabilities; speech or language impairment; traumatic brain injury; and visual impairment; including blindness which adversely affects a childs educational performance; and multiple disabilities. Attention deficit disorder or attention deficit hyperactivity disorder may fall under one the the 13 categories. Please refer to the Act noted above for more information.

The Individualized Education Program (IEP) means a written statement for a child with a disability that is developed, reviewed and revised in accordance with the IDEA and its implementing regulations. NOTE: Some states supplement the IEP with a written statement specially designed to address a students nutritional needs. Other states employ a Health Care Plan to address the nutritional needs of their students. For ease of reference, the term IEP is used to reflect the IEP as well as any written statement designating the required nutrition services.

DisabilityAccommodation MUST be made

No extra charge

A disability determination can only be made by a licensed physician of which menu planning approach is used, substitutions must be made for children with disabilities whose disability restricts their diet. The need for the accommodation must be supported by a statement signed by a licensed physician.

Meals must be served free or at a reduced-price to children who qualify for these benefits regardless of whether they have a disability. These meals must be at no additional cost to these children.

The majority of osteopathic physicians are primary care physicians, licensed by the State to prescribe medication or to perform surgery. Osteopathic physicians are equal members with M.D.s.

This does not include Christian Science practitioners, chiropractors or other persons involved in providing care or treatment but who are not licensed as physicians by the state.Statement For Children With DisabilitiesWhat the disability is

How it restricts diet

Major life activity affected

Foods to be omitted

Foods to be substituted child with a disability must be provided substitutions in foods when that need is supported by a written statement signed by a licensed physician.

The statement must identify the five points which are shown in this slide.

In regards to the third bullet in the slide, major life activity, generally this separates persons with disabilities from persons with other special needs. Essentially, a disability is a condition that substantially limits one or more major life activity, such as: caring for ones self, eating, performing manual tasks, walking, hearing, speaking, breathing, learning, working.FOOD RELATED DISABILITIESDiabetes


Food Anaphylaxis disabilities are among the most prevalent food related disabilities that will require food substitutions of one kind or another.



Tube Feeding making texture modifications - and no substitution is being made, a physicians statement is not absolutely necessary. However, the State agency or school food authority may apply stricter guidelines.

To minimize the chance of misunderstandings, it is recommended that the school food service, at a minimum, maintain written instructions or guidance from a licensed physician regarding the texture modifications to be made.

School food service must follow instructions that have been prescribed by the licensed physician.Children Who Are Not Disabled But Have Other Special Dietary NeedsFood allergies or intolerancesNOT generally disabilities UNLESS anaphylactic

Accommodation MAY be made BUT is NOT Required

In many cases, allergies can be dealt with through Offer-Versus-Serve or by providing additional selections Generally, food allergies or intolerances are not a disability as defined under either Section 504 of the Rehabilitation Act or Part B of IDEA. The school food service may make food substitutions, at their discretion, for these children. Such determinations are made on a case-by-case basis.

However, when, in the licensed physicians assessment, food allergies may result in severe, life-threatening (anaphylactic) reactions, the childs condition would meet the definition of disability and the substitutions prescribed by the licensed physician must be made. Statement For Children Who Are Not DisabledThe substitutions must be supported by a statement signed by a recognized medical authority (physicians, physician assistants, nurse practitioner, or other professionals) specified by the State agency. For Children Who Are Not Disabled(continued)The statement must include:an identification of the medical or other special dietary condition which restricts the childs diet,

the food or foods to be omitted from the childs diet; and

the food or choice of foods to be substituted.

Recognized Medical Authority


Physician Assistant


Nurse Practitioner

Other Professionals Specified by the State Agency. documentation does not have to be provided by a licensed physician, though it may be.

Other refers to an authority other than the ones listed above that have been designated by the State agency. If you are uncertain about whether or not to accept documentation, you should check with the State agency.

NEVERRevise or Change a