Dietary Considerations Action Plan
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04CH_Groark_Nutrition.pdf
Menu Planning
After studying this chapter you will be able to:
▸▸ Recognize standards that guide meal planning.
▸▸ Identify resources to use when planning menus.
▸▸ Discuss considerations for working with families and food brought from home.
▸▸ Incorporate special dietary needs into meal planning.
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© Dag Sundberg/Getty Images
Program Goals for Healthy Living Chapter 4
4.1 Program Goals for Healthy Living The meals provided in a child care or educational setting offer not only the chance to nourish children, but also to teach them about nutrition and healthy living. The regulations that guide meal planning are very precise and may seem daunting. Remember that the regulations are designed to meet the end goal of providing good nutrition. A great way to meet that goal is to keep the themes of balance and moderation in mind while planning meals. The role that education and care providers play is a very important one in the development of a child.
Good nutrition for children involves meeting their needs for appropriate growth, develop- ment, and function. The meals they are served should help them grow and keep them healthy. Caregivers should avoid giving children too many nutrients, and instead should ensure that menus feature a balance of macro- and micronutrients as discussed in chapter 1.
The Dietary Guidelines
The Dietary Guidelines for Americans provides a framework with which individuals and groups, including those in school and child care settings, can make sound decisions about nutrition. Refer to chapter 2 for a more in-depth look at the 2010 Dietary Guidelines. The MyPlate guide to eating communicates the messages of the Dietary Guidelines in a user-friendly manner that is not only an excellent guide for making food choices but also a valuable tool for educating and encouraging children about good nutrition (U.S. Department of Agriculture [USDA], 2011).
Obesity rates have tripled over the past half century as the current food and activity environment has evolved to promote an imbalance of calories, which leads to weight gain (Ogden, Kit, Carroll, & Park, 2011). Recall from chapter 2 that increased body weight over time is associated with increased risk of
heart disease, Type 2 diabetes, and some types of cancers. Increasing nutrient-dense fruits, vegetables, and whole grains in our diet helps our bodies feel full and decreases the impulse to overeat. Making half the plate fruits and vegetables, which naturally contain little to no fat, helps control the portions of starch and protein, which although excellent food groups, have too many calories when eaten in large portions. Including seafood and reducing solid fats helps promote the consumption of heart-healthy fats and limit intake of cholesterol. Reducing intake of beverages with added sugar, such as sodas, fruit drinks, and sports drinks, and increasing the consumption of nutrient-dense low-fat or nonfat milk helps promote a better balance of calories and provides building blocks for growing bodies.
Another approach that can help put the concepts of the Dietary Guidelines into practice is using foods that have been minimally processed. Keeping food as close to whole as possible will help retain good nutrients rather than lose some of those nutrients to processing. Whole grains include oatmeal, graham flour, brown or wild rice, and popcorn. When label reading, ensure that the first grain ingredient is whole. Recall that refining grains reduces fiber, protein, and some vitamins and minerals. Foods that have undergone processing also often contain higher amounts of salt, which is one of the nutrients the Dietary Guidelines recommends decreasing.
Whether planning meals on a small or large scale, striving for balance, moderation, and whole foods can help caregivers put together healthy and nutritious menus for everyone, including growing bodies.
The Dietary Guidelines help promote balanced eating that encourages a healthy weight for individuals.
Program Goals for Healthy Living Chapter 4
Focus on Fruits and Vegetables
The Centers for Disease Control and Prevention (CDC) shares the message that diets with high fruit and veg- etable intake are associated with decreased risk of chronic diseases, such as heart disease, stroke, hyper- tension, diabetes, and some cancers (CDC, 2010). It is reported that less than 10% of Americans consume adequate fruits and vegetables, and in children fruit juice, not whole fruit, comprises the majority of fruit intake (CDC, 2010). Additionally the most commonly consumed vegetable is starchy potatoes, in the form of French fries (CDC, 2010). When choosing vegeta- bles, emphasize non-starchy varieties, which include leafy greens and cruciferous vegetables. Though potatoes may be a vegetable, physiologically they raise the blood sugar due to the high carbohydrate content. Corn and peas are other com- mon starchy vegetables. People with diabetes must consider starchy vegetables as part of their starch consumption, along with grains, rice, cereals, etc. (National Institute of Diabetes and Digestive and Kidney Diseases, 2007). It would be wise for the general population to do the same, because starchy vegetables tend to be more calorically dense. In regard to menu planning to meet federal regulations, a potato will still count toward vegetable servings, but it would be a good idea to avoid offering potatoes along with a starch entrée, such as pasta.
The following tips can help caregivers incorporate more fruits and vegetables into the food inventory:
Choose fresh vegetables when they are in season. Produce that is in season will have the best nutrient profiles, as well as be cost-effective. Refer to Fruits and Veggies: More Matters Campaign for a great seasonal buying guide (http://www.fruitsandveggiesmorematters. org/?page_id=789).
Take part in the national Farm to School initia- tive. The Farm to School Program (http://www.fns. usda.gov/cnd/f2s/) has its roots in the initiating of the National School Lunch Program (NSLP). It is a wonder- ful resource for schools looking to establish a connec- tion with local farmers to promote health, nutrition, or environmental goals. Getting goods locally facili- tates getting food in season, which is very economi- cal. It also reduces the amount of time between the farm and the table, which not only helps goods last longer and therefore is more cost-effective, but also maximizes the nutrient quality of the produce, which can lose important vitamins and minerals over time. Additionally, supporting local farmers helps promote environmental and economical sustainability within a region.
Start a school garden. This provides a source of fruits and vegetables directly for the school or program. It also provides countless opportunities for education regarding sustainability, sci- ence, health, and physical activity. Another benefit: Gardening is an excellent form of exercise! (CDC, 2010). Examples of organizations doing this include The Edible Schoolyard in Berkeley, CA, California Head Start and the California School Garden Network, and CHANGE (Cultivating Health and Nutrition through Gardening Education) in Washington State (CDC, 2010).
▲ Gardening is an excellent opportunity to educate children about fruits, vegetables, sustain- ability, nutrition, and science. © Jupiterimages/Thinkstock
It is reported that less than 10% of Americans consume adequate amounts of fruits and vegetables, and in children fruit juice, not whole fruit, comprises the majority of fruit intake (CDC, 2010).
Program Goals for Healthy Living Chapter 4
Participate in the USDA Fresh Fruit and Vegetable Program (FFVP). In an effort to expand the availability of fruits and vegetables for meals and snacks at school, the USDA’s FFVP can help integrate fresh foods into the classroom (http://www.fns.usda.gov/cnd/FFVP/toolkit.htm).
Use the USDA Food Buying Guide. This guide determines the optimal amount of fruits or vegetables to purchase to minimize waste (http://www.nfsmi.org/documentlibraryfiles/ PDF/20090803041151.pdf).
Once there are more fruits and vegetables in the kitchen, use the following tips to increase fruit and vegetable intake at the table:
• Offer them choice! Offer two or more choices for fruits or vegetables at a meal so that children can select which they would like to eat.
• Make it pop! Make the produce appealing. Vary textures, colors, shapes, etc., to appeal to the senses of taste, touch, and vision.
• Give them more bang for their buck! Add vegetables to pastas and pizzas. Puree veg- etables such as sweet potatoes, turnips, parsnips to thicken soups.
• Balance less nutrient-dense foods! Add fruit and vegetables to baked goods.
• Keep it whole! Offer whole fruit versus juice.
• Chop it and top it! Use fruit for toppings for cereal, pancakes, yogurt, and salads.
• Let them eat fruit! Serve fruit as the dessert.
• Spice things up! Substitute salsa for salad dressings or high-calorie dips.
• Keep it fun! Use fun, descriptive names for menu items (USDA, 2008; USDA, n.d.)
Additional Resources
In the classroom, refer to these resources to educate and excite children about the health benefits of fruits and vegetables.
• The Fruits and Veggies: More Matters Campaign offers resources for engaging children in shop- ping for and cooking fruits and vegetables as well as links to other programs and initiatives (http://www.fruitsandveggiesmorematters.org/?page_id=1475).
• Participate in the PACK (Pack Assorted Colors for Kids) program, a five-day education program aimed to increase childrens’ consumption of fruits and vegetables. The program has resources for educators, which can be found at http://www.pbhfoundation.org/pub_sec/edu/kids_act/ packweek/PACK_materials.php. PACK provides a school food service guide, tips for choosing a variety of colors, posters, activity guide, and activity and coloring sheets.
• Rather than sell chocolate, candies, or baked goods for fundraisers, sell fruit! The Fresh Fruit Fundraising Program works with a farm in Washington State to provide apples and pears for fundraising (http://www.fruitsandveggiesmorematters.org/?page_id=15814).
• MyPlate offers print materials and a “10 Tips Nutrition Education Series,” which educators might find helpful when working with children on the topic of fruits and vegetables (http://www. choosemyplate.gov/healthy-eating-tips/ten-tips.html).
• The National Food Service Management Institute’s Cooks for Kids series offers training for those working with children on how to include them in cooking, how to prepare selected recipes, and how to promote sustainable cooking (http://www.nfsmi.org/Templates/TemplateDivision. aspx?qs=cElEPTQz).
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Program Goals for Healthy Living Chapter 4
Consider the Impact of Competitive Foods
Recent information has shown that the majority of schools studied were able to meet guide- lines for protein, vitamins, and minerals, but were exceeding the recommendations for fat, saturated fat, and sodium (Crepinsek et al., 2009). Also, it has been shown that children participating in the NSLP and the School Breakfast Program (SBP) get more nutrients because they eat more foods from key food groups than do nonparticipants, including low-fat milk, vegetables, and fruit (including 100% fruit juice) (Condon, Crepinsek & Fox, 2009).
It is important to consider the goals of the education or child care program and if it will offer competitive foods (foods that are sold at school that are not part of the NSLP or SBP and are therefore not held to federal nutrition standards). These foods are often found in vending machines, snack bars, canteens, and school stores (U.S. General Accounting Office, 2004). The USDA divides competitive foods into two categories:
• Foods of Minimal Nutritional Value (FMNV) include carbonated beverages, chewing gum, candy, and water ices. These foods may not be sold during meal times in the food service area.
• Competitive foods not included in the above description are not restricted in their place of purchase (U.S. General Accounting Office, 2004). Examples may include lem- onade, fruit punches, iced tea, and sports drinks. These may be sold during lunch time, even though they compete with the more nutrient-dense beverages such as milk and 100% fruit juice.
Research has shown that competitive foods have a negative impact on the nutritional intake of schoolchildren (Briefel et al. 2009; Templeton, Marlette, & Panamangalore, 2005). If competitive foods are offered, 40% of children will purchase these generally low-nutrient and high calorie options (Fox et al., 2009). The sale of competitive foods has increased in schools, particularly middle school and high school, and 83% of schools offer nondairy beverages in the a la carte line (U.S. General Accounting Office, 2004). In one study, sugar-sweetened bev- erages contributed 29 calories per day in middle-school stu- dents and 46 calories per day in high-school students (Briefel et al., 2009). To illustrate the impact this can make, an extra 29 calories per day for 1 year would lead to 3 pounds of fat gain, and an extra 46 calories per day for 1 year would lead to nearly 5 pounds of fat gain. On the other hand, when schools offered no sugar-sweetened beverages a la carte, they were able to lower the calorie consumption in their students by 52 calories per day. It has also been demonstrated that when com- petitive foods are purchased, students’ overall nutrient intake is decreased because the foods selected by students at lunch provide fewer nutrient-dense calories, less calcium, and less vitamin A (Templeton et al., 2005).
Beyond federal regulations that limit the purchase of these foods during mealtimes in food service areas, further regulations vary by state. Although schools often justify the availability of com- petitive foods on the basis of their ability to generate revenue
▲ Whether available in school vend- ing machines or the lunchroom, beverages such as soda, iced teas, sports drinks, and drinks with less than 100% fruit juice are competitive foods that negatively impact chil- dren's nutrition. © age fotostock/SuperStock
Requirements Chapter 4
for educational purposes (U.S. General Accounting Office, 2004), it is important to carefully evaluate the value of these foods in a school or child care environment. Is it enough to offer school meals with proper nutrition with an appropriate caloric intake if competitive foods will increase overall calories and decrease valuable micronutrients? How do those responsible for the care and education of children teach them about good nutrition and healthy food choices when competitive foods contradict those messages? These are important questions to con- sider when a school or program is choosing the foods to provide the children under its care and supervision.
4.2 Requirements The evolution of national programs for feeding children in schools began in the early half of the twentieth century. There is a long history of local groups being involved in the feeding of needy children through schools, and the Great Depression had a significant impact on the health and well-being of the country. Farms were having difficulty finding a market for their goods, and people were struggling to get enough food to feed themselves and their children. Thus it was only natural for schools to use the farm produce to feed their students. However, the availability of farm produce began to dwindle during World War II, because the resources were largely used by the military. In fact, the screening of potential soldiers highlighted the health problems associated with poor childhood nutrition because many were found unfit
for military service. The need for a nationally regu- lated program to safeguard national security led to authorization of the National School Lunch Act of 1946 to prevent and combat childhood malnutrition (Gunderson, 2011).
Two agencies handle the majority of regulations for feeding children in a child care or education setting. The Child and Adult Care Food Program (CACFP) provides reimbursement for eligible people at par- ticipating child (and adult) day care settings (USDA, 2011b). The equivalent for school settings is the NSLP (USDA, 2011c).
The programs that can participate with CACFP include public or nonprofit child care centers, before/ after-school programs, Head Start Programs, emer-
gency shelters, and adult day care centers. A private center may be eligible to participate in the CACFP if 25% of its enrolled children are income-eligible. For the NSLP, public or nonprofit private schools may participate. Refer to the income eligibility guidelines of the federal gov- ernment for more information (http://www.fns.usda.gov/cnd/Governance/notices/iegs/IEGs. htm) (Food and Nutrition Service, 2011).
For both CACFP and NSLP, a participating center or school agrees to provide free or reduced- price nutritious meals to eligible children up to the age of 12 (or adults). For CACFP programs, for instance, the number of reimbursable meals and snacks depends on the kind of organi- zation that has applied. Child care centers can be reimbursed for two meals and one snack, or one meal and two snacks. Shelters can claim three meals per day. Before-school or after- school programs may be reimbursed for one meal and one snack per day.
▲ The CACFP sets forth regulations for nutrition standards for child care settings. © iStockphoto/Thinkstock
Requirements Chapter 4
Nutrient Requirements of National School Lunch Programs
The USDA provides cash reimbursement for each meal served. Fully paid lunches receive the lowest reimbursement and free lunches receive the highest reimbursement. The USDA also provides entitlement foods, commodities valued at a certain amount per meal served. This amount varies yearly. Examples of entitlement foods available include fruits, vegetables, meats, cheese, beans, fruit juices, vegetable oils or shortening, peanut products, and grain products (Food and Nutrition Service, 2009).
The current standards were set forth by the USDA in the 1995 School Meals Initiative for Healthy Children, which has since been revised according to the updates in the Dietary Guidelines for Americans. These regulations must be met by any school that receives federal reimburse- ment for the school lunch program. The requirements consist of individual nutrient requirements, methods for meal planning, and food that is required to be on the tray (Stallings et al., 2009).
There are eight specific requirements for nutrients: cal- ories, protein, fat, calcium, iron, vitamin A, vitamin C, and calories that come from fat and saturated fat (USDA, 2008). For more information about these key nutrients, refer back to chapter 2. School lunches must provide one-third and breakfast must provide one-quarter of the Recommended Dietary Allowances of major nutrients (calories, protein, vitamins A and C, minerals iron and calcium). Also in accordance with the Dietary Guidelines for Americans, fat can provide no more than 30% of the calories in the meal, with saturated fat being limited to 10% of total calories. These nutrition goals must be met when an average school week menu is analyzed by an agency at the state level (USDA, 2008).
In 2009, the Institute of Medicine (IOM) recommended additional nutrient requirements to reflect the updates made by the Dietary Guidelines. The IOM proposed 24 nutrient targets. One major nutrient to which the IOM called attention is sodium. The IOM made recommendations for reducing the amount of sodium in school foods and proposed these recommendations be realized by 2020 (Stallings et al., 2009). At this time, those rec- ommendations have not been made into regulation.
Two approaches to menu planning are typically used with participation in the NSLP: Food-based menu planning and nutrient-based menu planning.
Food-based Menu Planning
Food-based menu planning is the more traditionally used approach (see Table 4.1). It specifies amounts of food group components for particular age categories. Food components are meat/meat alternatives, vegetables/fruits, grains/breads, and milk. At lunch, five food items from four food components must be provided, one of each food component, except vegeta- bles/fruits which must be two. The portion size varies by age group, however the distribution of foods must be the same. There is traditional food-based (Table 4.1) and enhanced food- based (Table 4.2) menu planning:
▲ Schools that receive federal reimburse- ment must follow the guidelines as set by the National School and/or School Breakfast Program. © iStockphoto/Thinkstock
There are eight specific requirements for nutrients: calories, protein, fat, calcium, iron, vitamin A, vitamin C, and calories that come from fat and saturated fat.
Requirements Chapter 4
Table 4.1: Traditional Food-Based Menu Planning Approach: Meal Pattern for Lunches
MINIMUM QUANTITIES
RECOM- MENDED
QUANTITIES
Food components and food items
Group I, Ages 1–2 preschool
Group II, Ages 3–4 preschool
Group III, Ages 5–8 grades K–3
Group IV, Ages 9 and older grades 4–12
Group V ages 12 and older grades 7–12
Milk (as a beverage) 6 fluid ounces 6 fluid ounces 8 fluid ounces 8 fluid ounces 8 fluid ounces
Meat or meat alternate (quantity of the edible portion as served):
Lean meat, poultry, or fish
Cheese
Large egg
Cooked dry beans or peas
Peanut butter or other nut or seed butters
Yogurt, plain or flavored, unsweetened or sweetened
The following may be used to meet no more than 50% of the requirement and must be used in combination with any of the above:
Peanuts, soy nuts, tree nuts, or seeds, as listed in program guidance, or an equivalent quantity of any combination of the above meat/meat alternate (1 ounce of nuts/seeds equals 1 ounce of cooked lean meat, poultry, or fish)
1 ounce
1 ounce
½
¼ cup
2 tablespoons
4 ounces or ½ cup
½ ounce
= 50%
1½ ounces
1½ ounces
¾
3 ⁄8 cup
3 tablespoons
6 ounces or ¾ cup
¾ ounce
= 50%
1½ ounces
1½ ounces
¾
3 ⁄8 cup
3 tablespoons
6 ounces or ¾ cup
¾ ounce
= 50%
2 ounces
2 ounces
1
½ cup
4 tablespoons
8 ounces or 1 cup
1 ounce
= 50%
3 ounces
3 ounces
1½
¾ cup
6 tablespoons
12 ounces or 1½ cups
1½ ounces
= 50%
Vegetable or fruit: 2 or more servings of vegetables, fruits or both
½ cup ½ cup ½ cup ¾ cup ¾ cup
Grains/breads (servings per week): Must be enriched or whole grain. A serving is a slice of bread or an equivalent serving of biscuits, rolls, etc., or ½ cup of cooked rice, macaroni, noodles, other pasta products or cereal grains
5 servings per week1 — minimum of ½ serving per day
8 servings per week1 — minimum of 1 serving per day
8 servings per week1 — minimum of 1 serving per day
8 servings per week1 — minimum of 1 serving per day
10 servings per week1 — minimum of 1 serving per day
1 For the purposes of this table, a week equals five days. (USDA, 2008).
Requirements Chapter 4
In the enhanced food-based approach, the age groups are different (see Table 4.2). Rather than kindergarten through third grade and fourth grade through twelfth grade with an optional seventh through twelfth grade, there is kindergarten through sixth grade and sev- enth through twelfth grade with an optional kindergarten through third grade. This system is intended to provide more calories from low-fat foods to better meet the Dietary Guidelines (USDA, 2008).
Table 4.2: Enhanced Food-Based Menu Planning Approach: Meal Pattern for Lunches
MINIMUM REQUIREMENTS
OPTION FOR
Food components and food items
Ages 1–2
Preschool
Grades K–6
Grades 7–12
Grades K–3
Milk (as a beverage) 6 fluid ounces 6 fluid ounces 8 fluid ounces 8 fluid ounces 8 fluid ounces
Meat or meat alternate (quantity of the edible portion as served):
Lean meat, poultry, or fish
Cheese
Large egg
Cooked dry beans or peas
Peanut butter or other nut or seed butters
Yogurt, plain or flavored, unsweetened or sweetened
The following may be used to meet no more than 50% of the requirement and must be used in combination with any of the above:
Peanuts, soy nuts, tree nuts, or seeds, as listed in program guidance, or an equivalent quantity of any combination of the above meat/meat alternate (1 ounce of nuts/seeds equals 1 ounce of cooked lean meat, poultry, or fish)
1 ounce
1 ounce
½
¼ cup
2 tablespoons
4 ounces or ½ cup
½ ounce = 50%
1½ ounces
1½ ounces
¾
3 ⁄8 cup
3 tablespoons
6 ounces or ¾ cup
¾ ounce = 50%
2 ounces
2 ounces
1
½ cup
4 tablespoons
8 ounces or 1 cup
¾ ounce = 50%
2 ounces
2 ounces
1
½ cup
4 tablespoons
8 ounces or 1 cup
1 ounce = 50%
1½ ounces
1½ ounces
¾
3⁄8 cup
3 tablespoons
6 ounces or ¾ cups
1½ ounces = 50%
Vegetable or fruit: 2 or more servings of vegetables, fruits or both
½ cup ½ cup ¾ cup plus an extra ½ cup over a week1
1 cup ¾ cup
Grains/breads (servings per week): Must be enriched or whole grain. A serving is a slice of bread or an equivalent serving of biscuits, rolls, etc., or ½ cup of cooked rice, macaroni, noodles, other pasta products or cereal grains
5 servings per week1 — minimum of ½ serving per day
8 servings per week1 — minimum of 1 serving per day
12 servings per week1 — minimum of 1 serving per day2
15 servings per week1 — minimum of 1 serving per day2
10 servings per week1 — minimum of 1 serving per day2
1 For the purposes of this table, a week equals five days. 2 Up to one grains/breads serving per day may be a dessert. (USDA, 2008)
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For both versions of food-based planning, additional considerations include:
• Meat/meat alternatives
– This food component can only be part of the main dish plus one additional food item.
– Dry beans or peas can be either the meat/meat alternative or the vegetable within one meal; they may not count as both.
– One serving of meat/poultry/fish does not include the bone.
– One serving of chicken or turkey can include skin.
– Meat alternatives, such as vegetable protein products or enriched macaroni prod- ucts with fortified protein, can be used in accordance with the USDA directions.
– The maximum amount of nuts and/or seeds in one meal is 1 ounce.
• Grains/breads
– A portion smaller than ¼ serving cannot count toward the grain requirement.
– If not whole grain, refined grains must be enriched or fortified in accordance with USDA standards.
• Vegetables/fruits
– At least two different vegetables and/or fruits must be offered at lunch.
– 100% fruit or vegetable juice can only be used for half the lunch requirement (no more than 1 serving). Less than 100% fruit or vegetable juice cannot be counted toward the requirements.
– As stated previously with meat/meat alternatives, dry beans or peas can be either the meat/meat alternative or the vegetable within one meal; they may not count as both.
– A serving of frozen fruit includes the juice/liquid that forms when thawing.
– Unless otherwise specified in the USDA Food Buying Guide, the juice or syrup in which the fruit is packed may be included as part of the serving.
– A portion smaller than 1/8 cup is not significant enough to count toward the meal requirement or as one of the two different vegetables or fruits (USDA, 2008).
Nutrient-based Menu Planning
Nutrient-based menu planning uses computer software programs (approved by the USDA) to analyze menus while planning. Nutrient requirements must be met when the menus are averaged over a one-week period. The system of categorizing for ages is different. There is a grade system and an age system. For a K–12 school, there is only one breakfast grade group (K–12), and at least two of the grade groups must be used for lunch (K–6 and 7–12). There is an optional grade group of 7–12 for breakfast and K–3 for lunch. There are separate preschool requirements, all of which are demonstrated in the tables that follow (see Tables 4.3–4.6) (USDA, 2008).
Requirements Chapter 4
Table 4.3: Nutrient-based Menu Requirements for Lunch
Nutrient
Preschool
Grades K–6
Grades 7–12
Optional Grades K–3
Energy Allowances (calories)
517 664 825 633
Protein (grams) 7 10 16 9
Calcium (milligrams) 267 286 400 267
Iron (milligrams) 3.3 3.5 4.5 3.3
Vitamin A (retinol equivalents)
150 224 300 200
Vitamin C (milligrams)
14 15 18 15
Total Fat Fat should contribute no more than 30% of total calories.
Saturated Fat Saturated fat should contribute no more than 10% of total calories.
(USDA, 2008)
Table 4.4: Nutrient-based Menu Requirements for Breakfast
Nutrient
Preschool
Grades K–12
Optional Grades 7–12
Energy Allowances (calories)
388 554 618
Protein (grams) 5 10 12
Calcium (milligrams) 200 257 300
Iron (milligrams) 2.5 3 3.4
Vitamin A (retinol equivalents)
113 197 225
Vitamin C (milligrams)
11 13 14
Total Fat Fat should contribute no more than 30% of total calories.
Saturated Fat Saturated fat should contribute no more than 10% of total calories.
(USDA, 2008)
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Alternatively, the menus can be categorized by ages rather than grades (see Table 4.5). This could be helpful in a school setting where there are not traditional grades. The age groups are 3–6, 7–10, 11–13, and 14 and older.
Table 4.5: Nutrient-based Menu by Age-group for Lunch
Nutrient
3-6 Years
7-10 Years
11-13 Years
14 Years and older
Energy Allowances (calories)
558 667 783 846
Protein (grams) 7.3 9.3 15 16.7
Calcium (milligrams) 267 267 400 400
Iron (milligrams) 3.3 3.3 4.5 4.5
Vitamin A (retinol equivalents)
158 233 300 300
Vitamin C (milligrams)
14.6 15 16.7 19.2
Total Fat Fat should contribute no more than 30% of total calories.
Saturated Fat Saturated fat should contribute no more than 10% of total calories.
(USDA, 2008)
Table 4.6: Nutrient-based Menu by Age-group for Breakfast
Nutrient
3-6 Years 7-10 Years 11-13 Years 14 Years and older
Energy Allowances (calories)
419 500 588 625
Protein (grams) 5.5 7 11.25 12.5
Calcium (milligrams) 200 200 300 300
Iron (milligrams) 2.5 2.5 3.4 3.4
Vitamin A (retinol equivalents)
119 175 225 225
Vitamin C (milligrams)
11 11.25 12.5 14.4
Total Fat Fat should contribute no more than 30% of total calories.
Saturated Fat Saturated fat should contribute no more than 10% of total calories.
(USDA, 2008)
Requirements Chapter 4
When using the nutrient-based menu planning system, the requirements for reimbursement are that a meal contains a minimum of three menu items, contains the planned number of items in the planned portion sizes to fulfill the week’s nutrient standards (otherwise, the average of the week will not meet requirements as planned), and must fulfill the appropriate requirements based on age or grade group. With the food-based system, the week equals five days. For nutrient-based menu planning, a week equals three consecutive days. Whereas the food-based system has minimum sizes for portions that may be counted toward a food item, with the nutrient-based menu planning, every food item, even condiments, is entered into the system and can contribute toward the nutrient content of the meals provided (USDA, 2008).
See Table 4.7 for samples of lunch derived from both the food-based and the nutrient-based approaches.
Table 4.7: Sample Lunch Menus from Food-based and Nutrient-based Approach
Traditional Food-based Enhanced Food-based Nutrient-based
Tuna salad on bun (2 ounces meat/meat alternative + 2 grains)
OR vegetable lasagna with Italian bread and margarine
(2 ounces meat/meat alternative + ¾ cup vegetable/fruit)
Sub sandwich with reduced-fat mayonnaise with lettuce, tomato, pickle, ketchup (2 ounces meat/meat alternative + 3 grains + ¾ cup vegetable/fruit)
OR vegetable lasagna with garlic bread
(2 ounces meat/meat alternative + 3 grains + ¼ cup vegetable/fruit)
Fish sandwich on multi-grain bread with ketchup, tartar sauce, pickles
OR vegetable lasagna with whole- wheat Italian bread and margarine
Lettuce and tomato, carrot sticks, fresh grapes (¾ cup vegetable or fruit)
Tossed salad with dressing
(½ cup vegetable/fruit)
Fresh apple
(½ cup vegetable/fruit)
Oatmeal raisin cookie (¼ grain)
Tossed salad with Italian dressing
OR potato salad
Sweet potato-prune bread square
OR fresh orange
1% plain milk (8 ounces) 1% plain milk (8 ounces) 1% plain milk (8 ounces)
(USDA, 2008)
Promoting optimal health and nutrition is a team effort that may involve many members of an organization. Various personnel within food service and child care and education may be involved at many levels of implementation of the plan, and the development of program goals for good health. The written menu should be planned by a registered dietitian or qualified nutrition professional (American Academy of Pediatrics [AAP], 2011). Most schools and cen- ters do not employ full-time registered dietitians. In these scenarios, registered dietitians are hired as part-time consultants when menu planning is needed.
Requirements Chapter 4
Nutrient Requirements for a Child Care Food Program
The CACFP uses meal patterns that are very similar to the regulations of NSLP. Meal plan- ning requires identifying food components, food items, and minimums for meals. CACFP also includes snacks. The style of menu planning with CACFP more closely resembles the food- based approach of the NSLP (Food and Nutrition Service, n.d.).
Table 4.8: CACFP Menu: Birth through 3 months
Breakfast Lunch or Dinner Snack
4–6 fluid ounces breast milk or formula
4–6 fluid ounces breast milk or formula
4–6 fluid ounces breast milk or formula
(USDA, 2011)
Table 4.9: CACFP Menu: 4 through 7 months
Breakfast Lunch or Dinner Snack
4–8 fluid ounces breast milk or formula 0–3 tablespoons infant cereal
4–8 fluid ounces breast milk or formula 0–3 tablespoons infant cereal 0–3 tablespoons fruit and/or vegetable
4–8 fluid ounces breast milk or formula
(USDA, 2011)
Table 4.10: CACFP Menu: 8 through 11 months
Breakfast Lunch or Dinner Snack
6–8 fluid ounces breast milk or formula 2–4 tablespoons infant cereal
And 1–4 tablespoons fruit and/or vegetable
6–8 fluid ounces breast milk or formula 2–4 tablespoons infant cereal and/or
1–4 tablespoons meat, fish, poultry, egg yolk, cooked dry beans or peas
Or ½–2 ounces of cheese
Or 1–4 ounces cottage cheese, cheese food, or cheese spread
And 1–4 tablespoons fruit and/or vegetable
2–4 fluid ounces breast milk or formula or 100% fruit juice 0–½ slice bread or 0–2 crackers
(USDA, 2011)
Requirements Chapter 4
Table 4.11: CACFP Menu: 1 through 2 years, 3 through 5 years, and 6 through 12 years
Breakfast: Offer one food item from each of the components below
1–2 Years
3–5 Years
6–12 Years
Fluid milk 4 ounces 6 ounces 8 ounces
Vegetable or fruit (or 100% juice)
¼ cup (2 fluid ounces) ½ cup (4 fluid ounces) ½ cup (4 fluid ounces)
Grains/breads:
Bread, enriched or whole grain
Cereal, enriched or whole grain
Cold dry cereal or hot cooked cereal
Cooked pasta or noodle products
Cornbread, biscuit, roll, or muffin
½ slice
¼ cup
¼ cup
½ serving
½ slice
1∕3 cup
¼ cup
½ serving
1 slice
¾ cup
½ cup
1 serving
Lunch: Offer one food item from each of the food components below except vegetables or fruit, where two must be offered.
1–2 Years
3–5 Years
6–12 Years
Fluid Milk 4 ounces 6 ounces 8 ounces
Meat or meat alternative:
Cooked, boneless, lean meat, poultry, or fish
Cheese
Egg
Cooked dry beans or peas
Peanut or other nut/seed butters
Nuts and or seeds
Yogurt (plain or sweetened)
1 ounce
1 ounce
½ large
¼ cup
2 tablespoons
½ ounce
4 ounces
1½ ounces
1½ ounces
¾ large 3∕8 cup
3 tablespoons
¾ ounce
6 ounces
2 ounces
2 ounces
1 large
½ cup
4 tablespoons
1 ounce
8 ounces
Vegetable or fruit (or 100% juice) 2 servings of ¼ cup (2 ounces)
2 servings of ½ cup (4 ounces)
2 servings of ¾ cup (6 ounces)
Grains/breads:
Bread, enriched or whole grain
Cereal, enriched or whole grain
Cold dry cereal or hot cooked cereal
Cooked pasta or noodle products
Cornbread, biscuit, roll, or muffin
½ slice
¼ cup
¼ cup
¼ cup
½ serving
½ slice
¼ cup
¼ cup
¼ cup
½ serving
1 slice
½ cup
½ cup
½ cup
1 serving
Requirements Chapter 4
Snack: Must offer two of the four components below
1–2 Years
3–5 Years
6–12 Years
Fluid Milk 4 ounces 4 ounces 8 ounces
Meat or meat alternative:
Cooked, boneless, lean meat, poultry, or fish
Cheese
Egg
Cooked dry beans or peas
Peanut or other nut/seed butters
Nuts and or seeds
Yogurt (plain or sweetened)
½ ounce
½ ounce
½ large 1∕8 cup
1 tablespoon
½ ounce
2 ounces
½ ounce
½ ounce
½ large 1∕8 cup
1 tablespoon
½ ounce
2 ounces
1 ounce
1 ounce
½ large
¼ cup
2 tablespoons
1 ounce
4 ounces
Vegetable or fruit (or 100% juice) ½ cup (4 ounces) ½ cup (4 ounces) ¾ cup (6 ounces)
Grains/breads:
Bread, enriched or whole grain
Cereal, enriched or whole grain
Cold dry cereal or hot cooked cereal
Cooked pasta or noodle products
½ slice
¼ cup
¼ cup
¼ cup
½ slice 1∕3 cup
¼ cup
¼ cup
1 slice
¾ cup
½ cup
½ cup
(USDA, 2011b)
A sample breakfast might be ¾ cup 1% milk with ½ slice toasted raisin bread, 1 teaspoon margarine, and ½ cup sliced bananas. A snack may be 2 ounces flavored low-fat yogurt with ½ cup fresh pear dices and water. Lunch may include a peanut butter sandwich (1½ tablespoon of peanut butter on ½ ounce of bread) with ½ cup of broccoli cheese soup, ¼ cup thawed frozen pineapple cubes with the juice from thawing, and ¾ cup of low-fat milk (USDA, 2002).
Types of Menus Commonly Used in Food Service Operations
After a menu planning system has been selected—be it the CACFP, NSLP food-based, or NSLP nutrient-based—the menus have to be designed and put into action. Three types of menus are commonly used: single use, static, and cycle. A single-use menu is not repeated in its entirety. It tends to be used for a particular day, perhaps as a catered event or to break up the monotony of a regular menu. A static menu offers the same menu on a daily basis and is commonly used in restaurants. The options do not change from day to day. A cycle menu offers a rotating menu with different items daily for a week to a month, or even longer. This menu format is frequently used by noncommercial organizations, including hospitals and edu- cation settings (Spears & Gregoire, 2004).
Of these three types, child care and educational settings most often use cycle menus because this allows for variety in menu items while streamlining cost, procurement, production, and operations (Spears & Gregoire, 2004). Additionally, cycle menus are a great cost-effective way of taking advantage of the seasonality of food. Since the cycle menus are often rotated on a weekly, monthly, or bimonthly basis, they can optimize the foods that are available during specific times of the year and minimize costs.
Resources for Menu Planning Chapter 4
4.3 Resources for Menu Planning The necessary tools for menu planning fall into two major categories. There are tools that help food meet nutrient standards and then there are those that help stay within a budget. Many of the upcoming resources listed in this chapter provide tips on both of these areas, which are very closely tied to each other.
Tools for Menu Planning
As has been previously mentioned in this chapter, the 2010 Dietary Guidelines and MyPlate provide the nutrition foundation for menu planning. In terms of tools to implement these nutrition principles when menu planning, there are a wealth of resources available, which can be found in the following Additional Resources box.
Strive for balance. Balance flavors; avoid flavors that are too similar, such as all mild or all spicy. Balance calorie-density, such as high-fat foods with low-fat foods. Offer salty items with more bland options.
Emphasize variety. Keep things interesting by avoiding similar items in a short period of time, such as consecutive days or within the same week. An example of this might be cheese pizza and spaghetti marinara. Vary the types of entrees from day to day, such as soups, cas- seroles, sandwiches, and grilled protein (meat, poultry, or fish). Offer a surprise food every now and then to introduce new flavor combinations, such as broccoli slaw instead of coleslaw. Prepare the same ingredient in different ways: raw, steamed, and mashed, etc.
Add contrast. Give children different textures within the same meal, such as crunchy carrot sticks with soft lasagna. Contrast types of foods. For instance, a pasta entrée with a side of potato offers too much starch at one time. Instead, consider offering a crunchy fresh salad with non-starchy vegetables such as lettuce, carrots, and cucumbers. Another way to contrast food is shapes. Provide a number of shapes to keep children interested. Instead of carrot sticks with green beans, which may look similar in shape, consider offering crinkle- cut carrots.
Think about color. Remember that offering a variety of color is an easy way to hit lots of micronutrients at once. It also keeps a meal interesting. A meal that is all the same color, such as baked chicken with white bread, cauliflower, and banana slices, will look quite plain. Instead, consider baked chicken with diced tomato garnish with whole-grain roll, broccoli, and blueberries. Think of different colors within salads or fruit cocktails as edible garnishes to brighten the plate. Spices can also be a way to add eye-catching color to a meal.
Consider eye appeal. This brings us to the last suggestion, to make the meal appealing. It is often said we start to eat with our eyes, and children will definitely be more interested in a meal that is visually exciting.
Budgeting for Menus
The beginning of any budget is deciding how much income there is to use. Identify the sources of money for a school or child care food budget. Reimbursement from NSLP or CACFP is a common source of income. Other sources of funding can include the local or state education departments, Head Start, or Early Intervention. Private groups receive fees or
Resources for Menu Planning Chapter 4
Additional Resources
The CACFP provides a menu planning guide entitled “Menu Magic for Children: Menu planning guide for childcare homes”: http://www.fns.usda.gov/tn/resources/menumagic.html
The USDA has standardized recipes “USDA Recipes for Schools”: http://www.fns.usda.gov/tn/ Resources/usda_recipes.html
Another excellent resource is the NSFMI, whose website provides a variety of written and visual educational materials for individuals and groups involved in childhood food service: http://www.nfsmi.org/
The National Resource Center for Health and Safety in Child Care published “Caring for our Children: National health and safety performance standards; Guidelines for Early Care and Education Programs” (2011): http://nrckids.org/CFOC3/PDFVersion/list.html
The Idaho State Department of Education published “Healthy Cycle Menus Booklet for the National School Breakfast and Lunch Program” (2010). While its menus are designed to meet the Idaho Nutrition Standards specifically, it provides wonderful sample menus: http://healthymeals.nal. usda.gov/hsmrs/Idaho/NSLP%20Healthy%20menus%20Booklet%20Final.pdf
The IOM produced the report “School Meals: Building blocks for healthy children” (2009). It offers standards to updating the nutrient guidelines for meeting school meal requirements: http:// www.iom.edu/Reports/2009/School-Meals-Building-Blocks-for-Healthy-Children.aspx
The Food and Nutrition Information Center publishes a resource list for those involved in school food service: http://www.nal.usda.gov/fnic/pubs/foodservice.pdf
The USDA provides an online information center called The Healthy Meals Resource System: http://healthymeals.nal.usda.gov/nal_display/index.php?info_center=14&tax_level=1
The Iowa Department of Education offers the Healthy Kids Act Toolkit, with numerous resources for parents, school staff, and students: http://educateiowa.gov/index.php?option=com_ content&view=article&id=1983:healthy-kids-act-toolkit&catid=440:nutrition-program- learning-tools&Itemid=446
The USDA’s “Feeding Infants: A guide for use in child nutrition programs” is available online: http://www.fns.usda.gov/tn/resources/feeding_infants.html
The Head Start program’s Early Childhood Learning and Knowledge Center provides a compre- hensive site of nutrition resources: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/Health/ Nutrition
Registered dietitians are the experts on nutrition science. The Academy of Nutrition and Dietetics has a “Find an RD” service that can be found at http://www.eatright.org/programs/rdfinder/
Another set of tips comes from the USDA to help in menu planning to put together nutritious meals that meet requirements (USDA, 2002; USDA, 2008).
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Including Families and Foods from Home Chapter 4
tuition, some of which can go to the food budget. It is good to estimate between 6 and 19% of the total food service budget to be used for food ser- vice staffing, equipment, and inventory (Childcare, Inc., 2001).
To optimize purchases, the USDA’s Food Buying Guide for Child Nutrition Programs, along with the Food Buying Guide Calculator for Child Nutrition Programs, can help determine how much food is necessary to fulfill the menu that has been planned. Commodity or entitlement foods from the USDA can also contribute to the food inventory. Examples of these foods include fruits, vegetables, meats, cheese, beans, fruit juices, vegetable oils or shortening, peanut products, and grain products. Remember that planning a menu with seasonal produce in mind will help control costs. In addi- tion to helping meet nutrient regulations, orga- nized record keeping can allow for more efficient, informed production to limit waste and reduce overall costs (USDA, 2008). Common techniques for budget shopping can be applied to purchasing food inventory, such as buying in bulk for lower prices, reevaluating vendors to ensure the lowest contracts, and using an organized purchasing sys- tem to ensure there are no unnecessary purchases or wasted products.
A resource that may be helpful for those extensively involved in menu planning and execution is the “Financial Management Instructor’s Guide” developed by the NFSMI in 2005. Also from the NFSMI is “Financial Management for Food Service Directors,” a self-directed CD-ROM that includes a budget builder activity. Also refer to NFSMI’s website (http://www.nfsmi.org) for extensive training and resources at every level of menu planning, budgeting, and child care and education.
4.4 Including Families and Foods from Home The food safety considerations regarding food brought from home are addressed in chapter 3. An additional consideration is the nutritional quality of the food brought from home. The AAP (2011) recommends that centers provide families with written materials that describe how the facility strives to meet the nutritional requirements of the children under its care. The AAP also suggests that this material includes information on how families can help the facility meet requirements.
The center should provide foods to fill gaps that are present in meals brought from home. If this becomes a frequent recurrence with a family, the facility may refer them to expert ser- vices, either from a registered dietitian, the child’s pediatrician, or the local community orga- nizations with trained dietitians/nutritionists, such as Special Supplemental Nutrition Program
▲ Planning a menu around what is in season is a cost-saving tip that can help streamline food bud- gets. © Martin Poole/Thinkstock
Including Families and Foods from Home Chapter 4
for Women, Infants, and Children (WIC) or Supplemental Nutrition Assistance Program (SNAP) (AAP, 2011).
Early care and education centers need written policies regarding foods brought from home. This sort of policy might include the following information:
• Labeling food with name, date, and contents
• Storage times and temperature
• Policy on not sharing snack and meal food brought from home
• Policy on food brought in to share with students
• Policy on providing age-appropriate food to fill nutritional gaps of foods brought from home
• Person(s) responsible for monitoring the above and referring to services as needed (Indiana Institute on Disability and Community, n.d.)
Regarding food brought in to share with students for celebrations, centers might find it helpful to provide families with suggestions for healthful food options for special occa- sions. Instead of sweets, families can be encouraged to send whole, sliced, halved, cubed, or wedged fruits such as apples, blueberries, blackberries, cantaloupes, grapes, manda- rin oranges, pineapple, pears, peaches, raspberries, strawberries, or watermelon. Low-fat lemon yogurt can be a great option for a fruit dip. Freeze-dried fruit can be a fun option for snacks. It retains the shape of the original fruit but has a fun texture that children enjoy. Since these are prepackaged, they can be a good option if the school has a policy against foods prepared in another kitchen, as was discussed in chapter 3. Of course, fresh veg- etables also can be an option. Raw vegetable trays are commonly available at grocery stores and are great treats for parties and celebrations. Popcorn can be a fun whole grain that many children enjoy, keeping in mind that it should not be offered to very young children because it is a choking hazard. Low-sodium pretzels or low-sugar cereals are a fun alterna- tive to less nutrient-dense carbohydrates such as chips or cookies. The Iowa Department of Education has a nice handout that can be sent home to families to help guide them toward more nutritious options for sending to school. This can be found at http://educateiowa. gov/index.php?option=com_docman&task=doc_download&gid=9169&Itemid=1507 (Iowa Department of Education, n.d.).
H E A LT H I N A C T I O N :
Fun and Healthy Party Alternatives
• Instead of ice cream, fill ice cream cones with low-fat yogurt and fruit.
• Instead of nachos and cheese, try fruit nachos (cinnamon-sugar pita chips topped with low-fat vanilla yogurt and fresh berries) or baked tortilla chips with salsa. Salsa can also be a great dip for vegetables, not just tortilla chips.
• Instead of a pizza party, try fruit pizzas: Unseasoned prepared pizza dough baked and spread with low-fat yogurt or cottage cheese and sprinkled with sliced fruit.
With a little creativity, less healthful foods can be the inspiration for fun healthy options that every- one can feel good serving and eating.
Special Diets Chapter 4
4.5 Special Diets It is important to be aware of special dietary needs when caring for children in a child care or educational setting so that all children receive safe, nutritious food. Some children have spe- cial dietary needs that require individual attention. Furthermore, some of these children may have a disability that is protected under the Individuals with Disabilities Education Act, the American with Disabilities Act, and Section 504 of the Rehabilitation Act of 1973 (American Diabetes Association, 2011). A person with a disability is defined as an individual who has an impairment (physical or mental) that significantly restricts at least one major life activity. Examples of physical or mental impairment include diabetes, food allergy that can lead to anaphylaxis, mental retardation, cancer, or sensory impairments (visual, speech, or hearing). Major life activities are defined as the ability to eat, see, hear, speak, breathe, walk, care for one’s self, perform manual tasks, work or learn (USDA, 2001).
Some common disabilities that could require attention and possible menu substitutions include diabetes, anaphylactic food allergies, inborn errors of metabolism, or children with physical impairments that require texture modification. Schools or programs that receive fed- eral funding are expected to accommodate the needs of persons with disabilities, including dietary needs (American Diabetes Association, 2011). Dietary restrictions that are medically necessary but not due to what is considered a disability are managed at the discretion of the food service department of the school (USDA, 2001). An excellent resource for schools in managing special dietary considerations is the USDA’s “Accommodating Children with Special Dietary Needs in the School Nutrition Programs: Guidance for school food service staff” (USDA, 2001).
Documentation from a licensed physician is needed for a child who has a disability and needs modified school meals. The documentation must include the disability, statement of why the child’s diet is limited, the major life activity that is limited by the disability, the foods that need to be restricted or avoided, and the food that can substitute for these foods (USDA, 2001). A food allergy that does not cause anaphylaxis is not considered a disability. For more on this life-threatening medical event, read ahead to the next section and refer back to chapter 2.
Food Allergies
Food allergies occur when the immune system identifies a food protein as a foreign substance that needs to be attacked. The symptoms of food allergies can include hives, vomiting, diar- rhea, difficulty breathing, swelling, and life-threatening ana- phylaxis. The most common food allergens are peanuts, tree nuts, milk, egg, wheat, soy, finfish, and shellfish. Food allergies are diagnosed and followed by a health care provider. Allergies to milk, soy, egg, and wheat may be outgrown, so follow up by the family with the health care provider to assess continued
▲ Health care providers are valuable resources when working with children with special nutritional needs. Licensed physicians can provide statements for children with disabilities that require special diets. A registered dietitian may be working to design and help commu- nicate these diets. © Michael Blann/Thinkstock
Special Diets Chapter 4
allergies should be conducted. The information from that follow-up should be shared by the family with the education and care providers.
Food intolerances are different from allergies in that they are not triggered by the body’s immune system. An example is lactose intolerance, which is a deficiency of the enzyme lac- tase. It causes gastrointestinal distress because the carbohydrate lactose cannot be broken down. Lactose is present in milk, yogurt, and soft cheeses such as ricotta or cottage cheese. Hard cheeses that can be sliced have a low lactose content and are often well-tolerated. Yogurts with active cultures are often tolerated because the bacteria in the yogurt break down the lactose, essentially predigesting it. Some people with lactose intolerance may use lactase pills or modified products, such as Lactaid®. On the other hand, a milk allergy is caused by the protein in milk, casein. This protein exists in all the above products and cannot be assumed to be safe in a different form. While the causes, reactions, and potential to be out- grown of food allergies and intolerances can vary, the concepts of good food labeling, label reading, and strict avoidance of potential triggers are universal.
The most recent legislation regarding food allergies, the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), requires much clearer identification of the presence of food allergens (The Food Allergy and Anaphylaxis Network [FAAN], 2011). Any of the major food allergens and their possible food derivatives must be clearly labeled in plain language. It can be helpful to devise a care plan for food allergies. The FAAN (2011) provides a number of resources that can help childhood educators, such as an online course for educators about food allergies, a food allergy action plan, school guidelines, and a teacher checklist. Statewide guidelines for managing food allergies in schools can be found at the FAAN (2011). The FAAN recommends the following tips for food allergy safety in the cafeteria:
• Be aware of foods/ingredients that must be avoided and what to substitute: The child’s parents will be the first resource on this. Another excellent resource is the school nurse.
• Read labels: Educate food service staff regarding ingredients and key words to look for on food labels. Remember that prepackaged foods’ recipes may change; do not take for granted that the food is always safe.
• Be prepared in the kitchen: Set aside space that is safe for handling food intended to be allergen-free to avoid cross-contamination.
• Know the student: Work with the families and children on how to be identifiable to the food service staff for monitoring.
• Exercise cleaning procedures: Make the cleaning of the cafeteria and kitchen before and after meals part of standard operating procedures to limit risk of cross- contamination (FAAN, 2011).
Education of key personnel is important to ensuring the safety of children with food aller- gies. Be aware of how a child might verbalize symptoms of food allergies. Parts of the mouth (tongue, lips, back of the throat) may be described as burning, hot, itchy, tingling, thick, heavy, tight, fuzzy, etc. Early recognition of an allergic reaction is critical to preventing further medical harm. A written food allergy action plan should be developed and practiced prior to an exposure to ensure the safety of the plan (FAAN, n.d.). The child should be educated to practice food safety by not sharing/trading food with other children and by not eating foods not known to be safe (FAAN, n.d.).
Special Diets Chapter 4
Type 1 Diabetes
Type 1 diabetes results when the insulin-producing beta cells of the pancreas are destroyed by the immune system. As a result, the body is no longer able to properly use carbohydrates without assistance. Once carbohydrates have been digested, our bodies turn them into glu- cose. Without insulin, glucose cannot get into cells, and when this happens, glucose accu- mulates in the blood and leads to high blood sugars. To manage diabetes, exogenous insulin is given. The key in Type 1 diabetes is to be aware of sources of carbohydrates and then appropriately dose insulin. Recall from chapter 2 the distinguishing characteristics of Type 1 and Type 2 diabetes. Type 2 diabetes is insulin resistant, which often can be reversed by an improvement in lifestyle habits. The pancreas is intact, and the elevated blood sugars are caused by the body trying to adapt to high presence of carbohydrates in the blood by becom- ing less sensitive to insulin. Type 2 diabetes requires improved diet and exercise. Very often, Type 2 diabetics need to lose weight. Type I diabetes is primarily treated with insulin. Over time, people with Type 1 diabetes are at risk for vascular complications that are made worse by weight problems. Thus, in the long run, it is important to emphasize a healthy lifestyle for both types of diabetes. Neither type of diabetes has dietary restrictions, so much as a need to know their food sources and a balance of food groups.
Diabetes is considered a disability and therefore is protected under the Rehabilitation Act of 1973, the Americans with Disabilities Act, and the Individuals with Disabilities Education Act. The accommodations necessary for these children in their education setting should be written out as part of their Individualized Education Plan (IEP). Among the many responsibilities of the school is the provision of information regarding the nutritional content (serving size, calories, carbohydrate, and fat) of the food provided by the school (American Diabetes Association, 2011). Because diabetes does not affect what a child can eat to nourish themselves safely, food substitutions are not necessary. The nutritional content of the food must be clear so that the child with Type 1 diabetes can receive the right amount of insulin to maintain normal blood sugars. A child with Type 2 diabetes may or may not be using insulin, but is likely to have been given goal amounts of carbohydrates per meal. Thus these children may need to know how much carbohydrate is in the lunch foods offered, even though they do not use medication.
Additional Resources
The American Diabetes Association provides a number of resources for school and child care professionals seeking information on how to best manage diabetes safely in their setting:
• Helping the Student with Diabetes Succeed: A guide for school personnel
• Diabetes Care Tasks at School: What key personnel need to know
• Your School & Your Rights: Protecting Children with Diabetes Against Discrimination in Schools and Day Care Centers
• Children with Diabetes: Information for school and child care providers
• The American Diabetes Association’s Safe at School campaign
• Complete Guide to Diabetes
(ADA, 2011).
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Special Diets Chapter 4
Cultural Preferences
It is important to recognize and honor the diversity of the American population. Along with diversity comes a variety of cultural food preferences that should be respected and encour-
aged. Cultural competence is a demonstration on the part of child care teachers and administrators of knowledge, behaviors, and policies that promote effective communication with people of different backgrounds. It is relevant to working with cowork- ers, children, and families. Culturally appropriate child care practices were outlined in chapter 1.
A great resource for beginning to understand the different food choices and influences that can come along with culture is provided by MyPyramid. Variations of the MyPyramid include Native American, Asian, and a Japanese spinning top (Painter, Rah, & Lee, 2002). Twelve countries have developed their own campaigns to promote nutritional guidelines, including China, Canada, Australia, Great Britain, Philippines, Korea, Germany, Mexico, Puerto Rico, Portugal, Sweden, and the United States (Painter, Rah, & Lee, 2002).
In addition to food choices, children of various cultures may also be accustomed to different feeding practices, particularly infant feeding and breast-feeding. Many cultures will breast- feed longer than is commonly practiced in the United States. A good resource for breast- feeding support is La Leche League International (www.llli.org).
Should anything be of concern, working with the families closely and without judgment is critical to ensuring the child’s safety and a continued positive relationship between all caregiv- ers involved.
Tips for encouraging cultural competency and aware- ness when working with young children include:
• Offer ethnically diverse food items in menus.
• Conduct taste tests in the classroom to try other cuisines, perhaps using cultural holidays as edu- cational opportunities.
• Bridge the familiar and unfamiliar, using a com- mon ingredient as a starting point for various cultural cuisines.
• Attempt to offer menu information in the native languages of children in the class or group.
• Broaden children’s experiences by reading children’s books on other countries’ customs and foods.
• Provide hands-on learning opportunities such as grocery stores and cooking demonstrations.
• Resources for encouraging cultural awareness include:
▲ The food traditions of other cultures offer a wonderful opportunity to celebrate and honor diversity. © Stockbyte/Thinkstock
Careful and respectful observation of cultural preferences will help cre- ate a welcoming educational or care environment, and teach other chil- dren how to accept and celebrate cultural differences.
Special Diets Chapter 4
– Food Guidelines by Country, provided by the Food and Agriculture Organization of the United Nations (http://www.fao.org/ag/humannutrition/nutritioneducation/ fbdg/en/).
– The Food and Nutrition Information Center resource list for educators, Cultural and Ethnic Food and Nutrition Education Materials (http://www.nal.usda.gov/fnic/pubs/ ethnic.pdf).
– Illinois State University web resource “World Food Habits” (http://www.foodhabits. info/).
– Cultural Food Practices guide assembled by a practice group of the Academy of Nutrition and Dietetics, editors Cynthia Goody and Lorena Drago, that provides information regarding the food practices of 15 different cultures.
Food is very personal for families, especially when they bring their traditions with them from another culture. It is important for educators and caregivers to communicate with parents and students to meet the emotional and nutritional needs of students.
Religious Preferences
Preferences based on religion require just as much sensitivity as cultural preferences. The school or child care center must encourage communication between families and education authorities to provide safe, good food that is consistent with both the child’s needs and per- sonal traditions. Three examples of religious dietary preferences are as follows:
• Islam: Halal is the set of Islamic laws that govern food practices, cosmetics, personal care, and pharmaceuticals. The following foods are prohibited: pork and its products, animal products that result from improper slaughtering, and carnivorous animals including birds of prey (Islamic Food and Nutrition Council of America, 2011).
• Judaism: Kosher refers to acceptable food practices that are part of Jewish laws and traditions. Common foods in the United States that are prohibited include pork, shell- fish, and fish without scales, such as catfish. Dairy and meat must not be consumed at the same meal. Other restrictions include certain birds and other mammals. Some food manufacturing processes, including improper slaughtering, are also restricted.
• Seventh Day Adventist: Practitioners of the Seventh Day Adventist religion follow a vegetarian diet and also avoid caffeine and alcohol. The vegetarian resources that will be discussed in the next section can be helpful for followers of this diet.
Vegetarian and Vegan Diets
Eating a vegetarian, plant-based diet is a choice made by many families and can be a healthy way to nourish a child. There are different types of plant-based diets. Attention must be paid to those nutrients that are predominantly found in animal foods (iron, calcium, vitamin D, zinc, B12, vitamin A, omega-3 fatty acids) to make sure these are not left out of the diet, by adding complementary proteins.
Types of vegetarianism practiced include:
• Semivegetarian: Primarily plant-based but includes eggs, and on occasion meat, fish, and poultry.
• Lacto-ovo-vegetarian: Primarily plant-based but includes eggs and milk (avoids fish, poultry, and meats).
Special Diets Chapter 4
• Ovo-vegetarian: Primarily plant-based but includes eggs (avoids, fish, poultry, meats, and milk).
• Lacto-vegetarian: Primarily plant-based but includes milk (avoids fish, poultry, meats, and eggs).
• Vegan: All plant-based. Does not eat any food that contains an ingredient that comes from an animal. This includes ingredients such as gelatin in Jell-O, cream in creamy salad dressings, eggs and milk in baked goods or pasta, etc.
Plant foods high in iron (e.g., iron-fortified grains, broccoli, spinach, soybeans) and high in vitamin C should be included in diets free of meat. Zinc not only is commonly found in animal foods, but is best absorbed when eaten together with animal protein. Thus, it is even more important to ensure the regular consumption of foods high in zinc (such as soybeans, legumes, nuts, fortified grains). Many Americans rely on dairy for their main source of calcium. For ovo- vegetarians or vegans, fortified soy milk, broccoli, dark leafy greens are examples of good plant-based sources of calcium. Vitamin D from milk, fortified soy milk and products, and/or supplements is important to include. Vitamin B12 is only found naturally in animal foods. B12 can be found in cow’s milk, fortified soy milk and products, eggs, and supplements. Vitamin A is only found in animal foods; however beta-carotene, a precursor to vitamin A, is found abundantly in plant foods. Beta-carotene is an orange pigment, so look for foods such as car- rots, sweet potatoes, cantaloupe, mangoes, apricots, and pumpkin. The essential omega-3 fatty acid is found in seafood. For those who do not eat fish, look for plant sources such as walnuts, flaxseed, soybeans, and canola oil.
Helpful resources for vegetarian diets suggested by the USDA include:
• The Vegetarian Resource Group (http://www. vrg.org/nutrition/adapyramid.htm)
• The Vegetarian Diets page from the Dietitians of Canada (http://www.dietitians.ca/ Your-Health/Nutrition-A-Z/Vegetarian-Diets. aspx?categoryID=54)
It is recommended that the family share certain information with the child care or education setting, including food choices and growth patterns (AAP, 2011). Of course, the childcare or education setting can ask for such information in an open and non- judgmental manner.
Calorie Concerns (Under/Overweight Children)
Recall from chapter 2 that malnutrition is a state of nutritional imbalance that describes both undernutrition and overnutrition. A child who is demonstrating growth failure may require supplemental nutrition under the guidance of a health care provider. In infants, specialized or concentrated formulas should only be used under the supervision of a health care professional because an infant’s immature kidneys cannot handle overconcentration of protein and electro- lytes. Calorie-boosting recipes and/or high-calorie supplements may be used with toddlers and older children. Educators and caregivers may be asked to take part in the strategies being used to boost growth. They may be asked to communicate feeding histories, such as writing down
▲ Vegetarian diets can be a perfectly healthy and delicious way to nourish a growing child. © Digital Vision/Thinkstock
Summary Chapter 4
what is eaten at meals and snacks. Additionally, they may be called upon to continue behav- ioral strategies at school that are being implemented at home. An example of this may be to offer food before beverage for the child who fills up on beverages first. Another example may be to help with self-monitoring and motivation techniques, such as behavioral sticker charts.
Obesity is also a form of malnutrition, and it is often associated with micronutrient deficien- cies because even though these children eat enough calories and protein, they do not eat enough nutrient-dense foods. As has been previously discussed in chapter 2, the health con- sequences of excess weight gain are tremendous, including associations with heart disease, diabetes, sleep apnea, and certain cancers. Several factors lead to an imbalance of calories. When this occurs, not enough energy is expended in comparison to how much is consumed.
Any deviation from a normal eating plan to manage a child’s weight, whether an underweight or an overweight child, should be overseen by a health care expert. It is recommended that written instructions be communicated by the health care provider, including:
• Child’s full name
• Date instructions were written
• Special needs of the child
• Any corresponding dietary restrictions or instructions
• Any specialized tools/utensils for feeding
• Restricted foods and/or substitutions
• Any other special considerations
• Plan of action if exposure to restricted food occurs (AAP, 2011)
As with all children, and particularly those with special dietary considerations, good communi- cation and planning between educators, child care providers, family, and health care experts ensures optimal and safe nutrition for growing, thriving children. Communication can be verbal between parent and caregiver or in written form, including a letter from the parent or the child’s health care provider. A health care provider may write a letter explaining the child’s needs or send a copy of a clinic note. Alternatively, schools or care settings might have their own forms for dietary therapy that the parent can bring to the health care provider to fill out. Whatever the form of communication, the goal is to clearly share information when a plan is being implemented or changed and to exchange insight into what and how the child is eating.
Summary • Planning how to feed children requires a balance of knowledge, skill, resources, col-
laboration, and communication.
• When planning meals, the theme of balance reappears, balancing calories, balancing textures, balancing colors, and even balancing budgets.
• Providing proper nutrition requires careful planning to meet nutritional requirements to optimally promote physical and cognitive growth and development.
• The Dietary Guidelines provide a backbone for nutrition planning that is easily commu- nicated by MyPlate.
• Those working in early childhood care and education have the opportunity to pull together resources and menus that can reinforce the program’s health messages to children for valuable lessons that will last a lifetime.
Case Study Chapter 4
Chapter Review 1. Describe the meaning of each of the key terms.
2. Discuss three ways to increase fruits and vegetables in a food inventory.
3. Explain the nutritional impact of competitive foods.
4. List the eight specific requirements for nutrients as set forth by the NSLP, SBP, and CACFP.
5. What kinds of settings might participate in the CACFP?
6. What are the two types of menu planning typically used with participation in the NSLP?
7. What are the three types of menus commonly used in food service operations and which is most often used by child care and education settings?
8. Describe five tips for promoting allergy food safety in the cafeteria.
9. Explain the major responsibility of the school or child care setting regarding menus and diabetes.
Case Study The following is a lunch menu for 3- to 5-year-olds in a child care setting:
6 ounces low-fat milk: 1 milk serving
Peanut butter (1½ tablespoons) on ½ slice of whole-grain bread: ½ protein serving and 1 grain serving
3 ounces blueberry-flavored yogurt: ½ protein serving
½ cup strawberry slices: 1 vegetable/fruit/juice serving
½ cup steamed green beans: 1 vegetable/fruit/juice serving
1. Billy has Type 1 diabetes, and his mother asks for the carbohydrate content of the menu items. Before getting this information from the food service director, try to identify the menu items that have carbohydrates that will have to be counted for Billy’s insulin.
2. Maria has an allergy to milk that causes hives. Her doctor’s note states that her reactions do not cause anaphylaxis, and she does not have any other food allergies or intolerances.
a. Is her condition considered a disability?
b. Are there menu items she should avoid?
c. Instead of another beverage from child care, Maria’s mom provides Neocate Jr., a hypoallergenic beverage that is designed for children with food allergies, along with a doctor’s note. The school food service director is willing to provide an alternative for Maria’s missing protein serving. Can you think of a potential substitution for Maria?
3. Aidan has lactose intolerance.
a. How does his body react to milk compared to Maria’s?
b. Identify the food(s) that Aidan should avoid within this meal.
c. Based off your answer to part b., can you think of any questions for Aidan’s parent(s)?
Concept Check Chapter 4
Answers: 1. Whole-grain bread (starch), milk (lactose), yogurt (lactose and other sugars), strawberries
(sugars).
2. a. no
b. milk, yogurt
c. soy yogurt, soy cheese, meat, poultry, or fish
3. a. Aidan’s body is missing the enzyme lactase that breaks down the carbohydrate lactose and therefore causes gastrointestinal symptoms. Maria’s body recognizes milk protein as a foreign invader and launches an immune reaction that causes hives.
b. Milk (contains lactose). Yogurt also contains lactose, however is often tolerated if it contains active cultures, which predigest the lactose.
c. Can Aidan tolerate yogurt?
Activity Use the following menu items to put together four menus, keeping in mind the five principles of menu planning
Lean ground beef Grape halves Mashed butternut squash Steamed brown rice
Tuna salad Veggie stir fry (broccoli and cauliflower)
Shredded lettuce Whole-grain bread
Barbeque pulled turkey Pineapple rings Green bell pepper slices Whole-wheat pita
Sweet and sour chicken (not fried)
Carrot sticks Diced tomatoes Baked taco shell
Peanut butter Apple slices Watermelon chunks Whole-wheat multigrain roll
Concept Check 1. Menus are averaged over what time period to determine if they meet nutrition requirements?
a. 3 days
b. 5 days
c. 7 days
d. 10 days
2. Which of the following is not a restricted competitive food of minimal nutritional value (FMNV)?
a. soda pop
b. chewing gum
c. candy
d. lemonade
Key Terms Chapter 4
3. Tips for encouraging cultural competency include offering ethnically diverse food items, conducting taste tests in the classroom, bridging the familiar with the unfamiliar, offering menu items in the child’s native language, providing hands-on learning opportunities, and
a. reading children’s books on other countries’ customs and foods
b. only providing children with the new food to ensure that they try it
c. requesting that families bring food from home to share
d. taking the children to a restaurant that serves only ethnic food
4. Three religions that may have dietary considerations are Islam, Judaism, and
a. Presbyterian
b. Seventh Day Adventist
c. Catholic
d. Mormon
5. Nutrients that may need special attention in various vegetarian diets are iron, calcium, vitamin D, zinc, B12, vitamin A, and
a. omega-3 fatty acids
b. uric acids
c. saturated fat
d. trans fat
Answers: 1. c; 2. d; 3. a; 4. b; 5. a
Key Terms competitive foods Foods that are sold at school that are not part of the National School Lunch Program or School Breakfast Program and are therefore not held to federal nutrition standards.
cultural competence A demonstration on the part of child care teachers and adminis- trators of knowledge, behaviors, and policies that promote effective communication with people of different backgrounds.
cycle menu The type of menu most often utilized in school or child care settings, with a rotation of weeks’ or months’ food items.
entitlement foods Commodity foods provided to schools or child care programs partici- pating in National School Lunch Program or Child & Adult Care Food Program that are pro- vided at a certain amount per meal served.
food components The major categories of food, by which regulating agencies guide menu planning to meet nutritional requirements. They are meat/meat alternatives, vegeta- bles/fruits, grains/breads, and milk.
halal The set of Islamic laws that governs food practices, cosmetics, personal care, and pharmaceuticals.
kosher Acceptable food practices that are part of Jewish laws and traditions.
Key Terms Chapter 4
lacto-ovo-vegetarian Primarily plant-based diet but includes eggs and milk (avoids meat, fish, and poultry).
lacto-vegetarian Primarily plant-based diet but includes milk (avoids meat, fish, poultry, and eggs).
major life activities The ability to eat, see, hear, speak, breathe, walk, care for one’s self, perform manual tasks, work or learn.
ovo-vegetarian Primarily plant-based diet but includes eggs (avoids meat, fish, poultry, and milk).
person with a disability An individual who has an impairment (physical or mental) that significantly restricts at least one major life activity.
semivegetarian Primarily plant-based diet but includes eggs, meat, fish, and poultry on occasion.
single-use menu A type of menu that is not repeated in its entirety and is often used for a particular day, such as a catered event or to break up the monotony of a regular menu.
static menu A type of menu where the same offerings are available every day, commonly used in restaurants.
vegan All plant-based diet. Does not include any food that contains an ingredient that comes from an animal. This includes ingredients such as gelatin in Jell-O, cream in creamy salad dressings, eggs and milk in baked goods or pasta, etc.
