Skip to content
Printer-friendly version

Accommodating Children with Special Dietary Needs


Nutrition Services Division Management Bulletin
Purpose: Policy, Beneficial Information
To: Child Nutrition Program Sponsors Number: USDA-CNP-03-2013
Attention: Food Program/Service Directors Date: April 2013
Subject: Guidelines for Accommodating Children with Special Dietary Needs in Child Nutrition Programs
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)
Supersedes: Management Bulletin 03-107 (April 2003)

This Management Bulletin (MB) provides guidance to Child Nutrition Program sponsors for accommodating children with 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. We have clarified further direction on the process, requirements, options, and resources for accommodating disabled and non-disabled children with special dietary needs below.

This MB applies to agencies and sponsors of School Nutrition Programs, the Child and Adult Care Food Program, and the Summer Food Service Program. For the purpose of this MB, these entities will be 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.

The U.S. Department of Agriculture (USDA) regulations from 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 (NSLP) and School Breakfast Program (SBP) for children whose disabilities restrict their diets.

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 the Medical Statement to Request Special Meals and/or Accommodations (hereinafter Medical Statement) form to identify the information required to implement a sound nutrition plan. The Medical Statement can be found on the CDE School Nutrition Program Forms Web page at http://www.cde.ca.gov/ls/nu/sn/fm.asp. It is also available on the CDE Child and Adult Care Food Program Forms Web page at http://www.cde.ca.gov/ls/nu/cc/fm.asp and the CDE Summer Food Service Program Forms Web page at http://www.cde.ca.gov/ls/nu/sf/fm.asp.

A written medical statement or Medical Statement form is required to 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. This will protect the Agency from liability and minimize misunderstandings between households and the Agencies.

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

Definition of a Recognized Medical Authority  

For a child that has 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 who is the appropriate recognized medical authority to diagnose a child without a disability, but with a special dietary need (non-disability).

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. Therefore, the CDE, Nutrition Services Division (NSD) will abide with the guidelines already in place with the USDA that state that a recognized medical authority is a licensed physician, physician assistant, or nurse practitioner. No other types of medical authorities are authorized to sign a medical statement to determine a child’s diet order. This course of action is in existence for 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 this day forward, a recognized medical authority is required to follow the USDA guidelines as defined above.

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, and 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 or non-disabilities 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 them.

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.

Guidelines for 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 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’s statement is provided for children whose disability restricts their diet.

Guidelines for a Non-Disability

As defined in 7 CFR Section15 (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.

The Agency has 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 accommodation must still be supported by a written medical statement or completed Medical Statement form and it must be signed by a recognized medical authority, including a licensed physician, physician assistant, or nurse practitioner.

The medical statement must clearly identify the child’s:

Funding Sources

Agencies may not charge children with disabilities or with certified special dietary needs who require food substitutions or accommodations more than they charge other children for program meals or snacks.

In most cases, children with disabilities are accommodated with little extra expense or involvement. However, the Agency is required to absorb the cost of additional expenses if food substitutions or modifications are needed for children with special needs.

An Agency’s general fund and other funding sources may be used to cover the additional costs. For more information on additional funding sources, refer to page(s) 11–14 in the USDA Accommodating Children with Special Dietary Needs in the School Nutrition Programs guidance manual that can be downloaded from the USDA Guidance and Resources Web page at http://www.fns.usda.gov/cnd/guidance.

Contact Information

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

Questions:   Nutrition Services Division | 800-952-5609
Download Free Readers

The USDA and the CDE are equal opportunity providers and employers.
Esto explica qué hacer si usted cree que se le ha tratado injustamente.