Accommodating Children with
SPECIAL DIETARY NEEDS
What Is a Special Diet?
Any change or modification to the
site’s basic menu
Accommodating Individuals with Special
Dietary Needs
• Disability
Any individual who has a physical or mental
impairment which substantially limits 1 or
more major life activity
• Other Medical Need
Any individual that does not have a disability
but is medically certified as having a special
medical or dietary need
USDA Regulations
Regulations governing Child Nutrition Programs make
it clear that substitutions to the regular meal must be
made for program participants who are unable to eat
meals because of their disabilities, when that need is
certified by a licensed physician
What are Disabilities?
• Disability is defined in:
– Section 504 of the Rehabilitation Act of 1973
– Americans with Disabilities Act of 1990
– Part B of the Individuals with Disabilities
Education Act (IDEA)
• IEP
Disabilities-Rehabilitation Act of 1973 and the
Americans with Disabilities Act-1990
• Orthopedic, Visual, Speech, and
Hearing Impairments
• Cerebral Palsy
• Epilepsy
• Muscular Dystrophy
• Multiple Sclerosis
• Cancer
• Heart Disease
• Metabolic Diseases
• Food Anaphylaxis
(Severe Food Allergy)
• Mental Retardation
• Emotional Illness
• Drug Addiction and Alcoholism
• Specific Learning Disabilities
• HIV Disease
• Tuberculosis
Medical Statement For Children
With Disabilities Must Reveal:
 What the disability is
 How it restricts diet
 Major life activity affected
 Foods to be omitted
 Foods to be substituted
Disability
• Accommodation MUST be made
• No extra charge
• A disability determination can ONLY be made by a
licensed physician (MD or DO)
Other Special Dietary Needs
• For individuals who may not have a disability
but who may have a medical condition that
warrants a diet prescription
• Must have a signed medical statement from an
approved recognized medical authority
Regulations:Non-disability
Schools/sponsors may make substitutions in foods for nondisabled students who are unable to consume the regular
meal because of medical or other special dietary need
Children Who Are Not Disabled But Have Other
Special Dietary Needs
 Food allergies or intolerances
◦ NOT generally disabilities UNLESS anaphylactic
 Accommodation MAY be made BUT is NOT Required
 In many cases, allergies can be dealt with through
“Offer-Versus-Serve” or by providing additional
selections
In West Virginia a Recognized Medical
Authority is:
• MD
• DO
• CNP
• PA
Special Dietary Needs
Disability or Medical Condition
• The documentation must be in writing from a licensed
physician or a recognized medical authority.
• The documentation must contain specific, detailed
instructions containing any substitutions or
appropriate food texture.
Special Dietary Needs
It is important that all recommendations for accommodations
or changes requesting a special diet be documented in writing
to protect the child, facility and to minimize
misunderstandings
Special Dietary Needs
• Sponsors should retain copies of special, non-meal pattern
diets on file
• Diet orders need to be renewed on a yearly basis
• Sponsors are encouraged to ensure that the diet orders reflect
the current dietary needs of the child
Communication
• Maintain communication among parents/guardians,
teachers, medical staff, child nutrition director, food service
staff, and consultant if applicable
• Understand the dietary restrictions prescribed in the plan
kept on file with the school nurse/medical staff
• Obtain and serve special formula or foods
• Follow prescribed portion sizes
• Keep information confidential
Special Dietary Needs
• To avoid confusion and misunderstandings all involved
parties should be included in a scheduled meeting when
the special need is first identified
• A team approach will help to better meet the participant’s
needs
Team Approach
• When a family notifies the school about a student’s
special diet, a team should be quickly established to
create a management plan
• Key team members – Administrator, nurse, food
service director, teacher
• Others should be educated and informed – lunch room
monitors, other faculty, janitors, bus drivers, coaches
Team Members May Include:
•
•
•
•
Physician
Nurse
Administrator
Food Service Staff
•
•
•
•
Parent
Child
Dietitian
Other Staff
Education is the Key
Education and Communication
• Food service staff may require special training
• Sponsor may require the help of a registered
dietitian
• State agencies may be of assistance
QUESTIONS???????