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Accommodating Children with Special Dietary Needs


Nutrition Services Division Management Bulletin

Purpose: Policy, Beneficial Information

To: Child Nutrition Program Sponsors

Attention: Food Programs/Service Directors

Number: CNP-07-2014

Date: June 2014

Reference: FNS Instruction 783-2, Meal Substitutions for Medical or Other Special Dietary Reasons; Title 7, Code of Federal Regulations, sections 15.3(b) and 210.10(g); U.S. Department of Agriculture Policy Memorandum SP 36-2013, CACFP 10-2013, SFSP 12-2013: Guidance Related to the Americans With Disabilities Act Amendments Act

Supersedes: Management Bulletin USDA-CNP-03-2013

Subject: Guidelines for Accommodating Children with Special Dietary Needs in Child Nutrition Programs


This Management Bulletin (MB) provides clarification to Child Nutrition Program (CNP) sponsors regarding further direction on the process, requirements, options, and resources for accommodating children, with and without disabilities, who have special dietary needs. Federal legislation and regulations are in place to ensure that children with disabilities have the same opportunities as other children. This includes education and education-related benefits, such as school meals.

This MB contains updated information regarding the Americans with Disabilities Act Amendments Act of 2008 (ADAAA) and the appropriate use of the Individualized Education Plan (IEP). It is recommended that this MB be read in its entirety.

This MB applies to agencies and sponsors of School Nutrition Programs (SNP), the Child and Adult Care Food Program (CACFP), and the Summer Food Service Program (SFSP). For the purpose of this MB, these entities will be collectively referred to as Agencies.

Background Legislation and Regulation

The Rehabilitation Act of 1973, the Education of the Handicapped Act of 1975, and the Americans with Disabilities Act of 1990 state that persons with disabilities have the support of these laws that prohibit discrimination and require that children be provided with a free and appropriate public education.

U.S. Department of Agriculture (USDA) regulations under Title 7, Code of Federal Regulations (7 CFR), sections 15.3(b) and 210.10(g), require substitutions or modifications in the National School Lunch Program and School Breakfast Program for children whose disabilities restrict their diets.

Accommodating Children With a Disability

An individual with a disability is defined as any person who has a physical or mental impairment that substantially limits one or more major life activities or is regarded as having such an impairment. Major life activities include caring for one’s self, eating, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.

The ADAAA has amended the definition of the term “disability,” broadening it to cover additional individuals. The list of major life activities has also been expanded to add a new category called major bodily functions. These include: functions of the immune system, normal cell growth, along with digestive, bowel, bladder, neurological, brain, respiratory, circulatory, cardiovascular, endocrine, and reproductive functions.

The Agency must provide food substitutions to a child with a disability when the need for a substitution is supported by a written medical statement or completed Medical Statement form that is signed by a licensed physician.

Either medical statement must clearly identify the child’s:

The Agency is required to make dietary accommodations, including texture modifications (such as preparing chopped, ground, or pureed foods), when a physician provides a medical statement to the Agency for children whose disability restricts their diet.

Accommodating Children Without a Disability

As defined in 7 CFR Section 15(b), an individual who does not have a disability, but is unable to consume a particular food because of a medical or other special dietary condition, is considered to have a special dietary need.

Agencies have the option of making dietary accommodations for children who do not have a disability but are medically certified as having a medical or dietary need. It is important to note that the Agency can make accommodations for children with special dietary needs on a case-by-case basis. However, the Agency must ensure that the accommodation is supported by a written medical statement or completed Medical Statement form signed by a recognized medical authority; a licensed physician, a physician’s assistant, or a nurse practitioner.

The medical statement must clearly identify the child’s:

Written Medical Statement to Request Special Meals and/or Accommodations

The USDA requires that a written medical statement be completed to ensure that a child’s modified meal is reimbursable and that any meal modifications meet nutrition standards that are medically appropriate. The California Department of Education (CDE) developed a Medical Statement to Request Special Meals and/or Accommodations form to identify the information required to implement a sound nutrition plan for children with dietary restrictions. The Medical Statement form is available on the CDE SNP Forms Web page at http://www.cde.ca.gov/ls/nu/sn/fm.asp, the CDE CACFP Forms Web page at http://www.cde.ca.gov/ls/nu/cc/fm.asp, and the CDE SFSP Forms Web page at http://www.cde.ca.gov/ls/nu/sf/fm.asp.

A written medical statement or Medical Statement form must be signed by the appropriate recognized medical authority. It is important that Agencies reiterate to the child’s family that the written medical statement needs to contain the most current diet order from the child’s recognized medical authority. This will protect the Agency from liability and minimize misunderstandings with households.

Under no circumstance is an Agency to revise or change a recognized medical authority’s diet prescription or medical order.

Individualized Education Plan to Request Special Meals and/or Accommodations

An IEP is a plan or program developed in accordance with the Individuals with Disabilities Education Act to ensure that a child who has a disability receives specialized instruction and related services.

When specialized nutrition services are required, a written medical statement or completed Medical Statement form that is signed by a licensed physician must support the child’s IEP. An IEP does not supersede the licensed physician’s written medical statement. It supports the written medical statement to reiterate the child’s nutritional needs.

Definition of a Recognized Medical Authority  

For a child with a medical condition that has been determined to be a disability, the CDE will continue to comply with the USDA guidelines already in place that define a recognized medical authority as a licensed physician.   

The CDE has revised the definition of recognized medical authority when diagnosing a child, who does not have any disabilities, with a special dietary need.

The California Department of Consumer Affairs, Board of Registered Nursing, has determined that it is not in the scope of practice for a Registered Nurse (RN) to establish a medical diagnosis and/or prescribe dietary orders. The CDE’s Nutrition Services Division will abide with USDA guidelines already in place that define a recognized medical authority as a licensed physician, physician assistant, or nurse practitioner for children who are not disabled but have a special dietary need. No other medical authorities are authorized to sign a medical statement to determine a child’s meal order. This guideline assures the safety and well-being of all parties involved.

Agencies that currently have written medical statements on file that are signed by an RN will not need to update those statements. However, from the date this MB is issued, a recognized medical authority as defined above is required to sign all medical statements.

The New Meal Patterns and Children with Special Dietary Needs

Meals for children with recognized medical disabilities that restrict their diet are not affected by the new 2012 Food-Based Menu Plan (meal pattern) or dietary specifications. Meals will continue to be based on a written medical statement or completed Medical Statement form that is signed by a licensed physician. Optional accommodations for children with special dietary needs must be consistent with the new meal pattern and dietary specifications.

Food Allergies

Generally, children with food allergies or intolerances do not have a disability as defined under Section 504 of the Rehabilitation Act and the Individuals with Disabilities Education Act, Part B. The Agency may, but is not required to, make food accommodations for these children.

When food allergies result in a severe, life-threatening reaction, a child’s condition would rise to the level of a disability. The Agency is required to accommodate the prescribed diet ordered by a licensed physician.

Funding Sources

In most cases, children with disabilities are accommodated with little extra expense or involvement. Agencies may not charge children with disabilities or certified special dietary needs who require food substitutions or accommodations more than they charge other children for program meals or snacks.

An Agency’s General Fund and other funding sources may be used to cover the additional costs. For more information on additional funding sources, please refer to pages 11–14 in the USDA Accommodating Children with Special Dietary Needs in the School Nutrition Programs guidance manual. The manual is available to download from the USDA School Meal Guidance and Resources Web page at http://www.fns.usda.gov/school-meals/guidance-and-resources.

Contact Information

If you have any questions regarding this MB, please contact Lori Porter, Child Nutrition Consultant (CNC), Southern SNP Unit, by e-mail at lporter@cde.ca.gov or by phone at 916-322-1454, or Stephanie Enright, CNC, Northern SNP Unit, by e-mail at senright@cde.ca.gov or by phone at 916-323-0122.

Questions:   Nutrition Services Division | 800-952-5609
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