Infant Feeding in the CACFP - Maine.gov · 2020-02-14 · bit later, when the baby is ready for it, then that meal/snack can be claimed for reimbursement. Remember to document! •Practice

Infant Feeding in the CACFP An overview of USDA’s Infant Feeding in the Child and Adult Care Food Program guide, Infant Meal Pattern &

Infant Feeding Documentation

USDA’s Feeding Infants in the Child and Adult Care Food Program

• Covers topics such as:• Infant meal pattern

• Developmental readiness

• Hunger and fullness signs

• Handling/storage of breastmilk & infant formula

• Solid foods

• Creditable items

• Includes:• Parent communication tools• Child care provider handouts• Practice scenarios

Today’s Agenda:• Infant Meal Pattern Overview

• Parents bringing in components

• Breastmilk and Iron-Fortified Infant Formula

• Creditable foods for infants

• Food allergies and intolerances

• Documenting infant feeding

Infant Meal Pattern

Two Age Groups:

Birth – 5 monthsand

6 months – 11 months

Parents may provide one creditable food component to count toward a reimbursable meal or snack!

• Parent: breastmilk or creditable infant formula

• You: all solid food components

• Parent: one creditable solid food component

• You: creditable iron-fortified infant formula

and

all other solid food components

Parent- Provided Food Component

Parent- Provided Food Component:

What if parents want to bring in more than 1

component?

January 7, 2020

To Whom it May Concern,

I do not want my child, Zoe Havens, to

participate in the CACFP.

Sincerely,

Bruce Havens

Why? The American Academy of Pediatrics (AAP)

recommends delaying the introduction of solid foods because most infants are not developmentally ready to consume solid foods until 6 months of age. Also,

introducing solid foods too early can increase the risk of obesity!

Infant Age Group Birth – 5 months:

4-6 fl oz Breast Milk or Formula*

* Minimum amount that must be offered

Breastmilk• Support breastfeeding!

Find the “Breastfed Babies Welcome Here!” guide, poster and message graphic online at https://www.fns.usda.gov/tn/breastfed-babies-welcome-here

• Mom can breastfeed on site: you can claim that meal/snack for reimbursement!

• You may offer less than the required minimum serving size of breastmilk if you know that the infant will only consume a smaller amount at one time. If you offer the remainder of the serving size a bit later, when the baby is ready for it, then that meal/snack can be claimed for reimbursement. Remember to document!

• Practice safe breastmilk handling techniques!

The infant feeding guide has great tips for safe handling and storage of breastmilk.

https://www.fns.usda.gov/tn/breastfed-babies-welcome-here

Iron-Fortified Infant Formula

➢Daycare Homes and Centers MUST offer to provide at least one brand of infant formula!✓Formula must be iron-fortified

✓Formula must be regulated by the FDA (made in the USA)

✓Soy-based, low lactose and lactose-free iron-fortified infant formulas (regulated by the FDA) are allowed! NO doctor’s note is required!

Why Iron-Fortified? Iron supports the baby’s growth and brain development!

➢ You must offer the full minimum serving size of infant formula at every meal service in order to claim reimbursement!

Scenario:Mom is not able to provide you with enough breast milk to meet her infant’s needs and she wants the breast milk to be supplemented with iron fortified infant formula. She doesn’t want to use the brand that you provide, she wants to provide both the breast milk and formula… if she does, is the meal still

reimbursable?

Yes! Because breast milk and formula are the same component, the parent can provide BOTH breast milk and

iron fortified infant formula and you can claim the meal/snack for reimbursement!

Infant Age Group: 6 – 11 Months

Introduce solid foods!• All infants progress at different rates, and providers should work with

parents to determine when an infant is developmentally ready to try solids or new foods.

• American Academy of Pediatrics (AAP) Developmental Readiness Guidelines:

• Able to sit in chair with good head control

• Open’s mouth for food

• Moves food from a spoon into the throat

• When the child has doubled in weight

Infant Age Group: 6 – 11 Months

On the Infant Food Chart, infant cereal, baby food, and solid food serving sizes all start with 0 Tbsp. This provides flexibility when

introducing solids…

Therefore, a child in this age range may have all 3 components or just 1 depending on his/her developmental readiness- and the meal is still

reimbursable!

Scenario:

You have an 8 month old infant at your center or home daycare that you feel is developmentally ready for solid foods; however, the parents/guardians do not want the infant to be introduced to solid foods….what do you do?

Tell the parents/guardians about the signs you’ve seen indicating that the infant is ready to start solid foods; educate them about guidance from the American Academy of Pediatrics; suggest that they consult their pediatrician… if the parents still do not want their infant to be served solid foods while in your care, you should respect their decision and NOT serve solid foods. As long as you continue to serve & document the required amount of breast milk/formula, the meal/snack is reimbursable.

Best practice: have parents write a note stating that they don’t want you to serve solid foods while baby is in your care.

Infant Age Group: 6 Months – 11 Months

Breakfast, Lunch & Supper Meal Pattern-3 Components:

1

2

3


Breakfast, Lunch & Supper Meal Pattern-3 Components:

Scenario:

Little Johnny is 7 1/2 months old. He has been eating iron fortified infant cereal at meal times for about a month now. When his guardian drops him off today, he tells you not to serve Johnny any more iron fortified infant cereal because he says it’s making Johnny constipated. You know that the parent is the “boss” when it comes to offering foods but you also know that, in order to claim infant meals for reimbursement, you must serve iron fortified infant cereal and/or a meat/meat alternate…… What do you do?

You have a few options:

1. Ask his guardian to get a doctor’s note stating that Johnny cannot be served iron fortified infant cereal and what he should be served instead. [Do not claim meals containing an alternate grain product until you have the Doctor’s note on file.]

2. Replace the iron fortified infant cereal with a meat/meat alternate at meal times. This is allowed per the meal pattern. Make sure to communicate with the guardian if/when introducing new foods.

3. If you cannot do option #1 or #2, then do not claim Johnny’s meal for reimbursement.


Snack Meal Pattern- 3 Components:

1

3

Is This Infant Breakfast Reimbursable?

NO! If you serve a creditable grain at meal time for infants, it must be iron fortified infant cereal!

Baby Betsy is 10 months old…

Is This Infant Lunch Reimbursable?

Yes! You may replace the grain component with meat/meat alternate at meal time!

Baby Bob is 8 ½ months old…

NO! The meal pattern for infants contains 3 components-we’re missing the fruit/vegetable component!

Baby Beatrice is 11 months old…

Infant Snack Reimbursable?


Baby Bruce is 11 months old…


Baby Barbara is 6 1/2 months old. Her mom tells you that she does not want Barbara eating iron fortified infant cereal of any kind…

Transition Time: Formula – Unflavored Whole Milk

Breastmilk – Unflavored Whole Milk

CACFP allows a transition time of 1 month (from the date the infant turns 12 months old to the time the child turns 13 months of age) to

help babies get used to unflavored whole cow’s milk.

➢Both unflavored whole milk and infant formula can be served during this 1-month transition period. If the parent requests that you continue to serve formula after the child turns 13 months of age, then a doctor’s note would be required.

➢The parent may request that a child continue to receive breastmilk for as long as the parent wishes- a doctor’s note is never required for serving breastmilk!

Scenario:Susie is 12 months and 13 days old. You’ve been in the process of transitioning her from iron fortified infant formula to whole cow’s milk. However, today Susie refuses to accept anything but iron fortified infant formula. Are her meals and snacks reimbursable today?

Yes! For a period of 1 month, when children are 12-13 months of age, meals containing infant formula may be reimbursed to facilitate the weaning from formula to cow’s milk.

After Susie turns 14 months old, her Dad says she’s been really fussy and asks you to start giving her just the iron fortified infant formula again to see if that will help. Can you do this and claim the meal/snack for reimbursement?

NO! Meals and snacks containing infant formula that are served to children 13 months old and older are only reimbursable when supported by a medical statement signed by a medical authority.

Scenario:

I have a 1 year old child that is still being breastfed. Mom is only able to provide me with 2 fl. ounces of breastmilk…can I serve 2 fl. ounces of whole unflavored cow’s milk as a supplement to meet the minimum milk requirement?

Yes! Remember, mom can choose to breastfeed for as long as she wishes, no doctor’s note required. However, you’re still required to meet the meal pattern requirements for that age group. In this case, breastmilk and cow’s milk are considered the same ”milk” component. The meal pattern requirement for “Milk” for kids ages 1-2 is 4 fl. ounces:

Creditable and Non-Creditable Foods in the Infant Meal Pattern

Creditable Foods in the Infant Meal Pattern:

Grains:• Iron-fortified infant cereal

• Breakfast, lunch and supper, or snack

• Breads

• Snack only

• Crackers

• Snack only

• Ready-to-eat cereals

• Snack only

• Must meet the sugar limit (6 grams per dry ounce)

• Fortified (with vitamins & minerals)

*there is no whole grain requirement for infants!

Iron-Fortified Infant Cereal• Infant cereal must be iron-fortified.

• Single and mixed-grain cereals are creditable.

• Offer single grain first, then mixed-grain.

• How to tell if an infant cereal is “iron-fortified”:

• Look for “Iron-Fortified” on the package.

• Look at the ingredient list for:

• Iron

• Ferric Fumarate

• Electrolytic Iron

• Iron (Electrolytic)

How Can I Tell if a Cereal Has 6 Grams of Sugar or Less? Let’s Practice!

1. Find Serving Size in grams (g).

2. Find amount of Sugars in grams (g).

3. Use the table in Appendix D to find the allowable sugar amount.

Yummy Brand Cereal

Non-Creditable Foods in the Infant Meal Pattern: Grain Items

Grain based desserts:➢Are NOT creditable in CACFP!

➢Baby food desserts e.g. peach cobbler dessert

➢Cake, cookies, etc.

➢Granola bars

➢Nutrigrain® or other cereal bars

Creditable Foods in the Infant Meal Pattern

Meat and Meat Alternates:• Meats and poultry

• Fin fish

• Shellfish

• Whole eggs(yolk and egg white)

• Beans and peas

• Cheese*

• Cottage cheese

• Yogurt

➢ Must meet the sugar limit

(23 grams per 6 ounces)

How Can I Tell if a Yogurt Has 23 Grams of Sugar or Less?Let’s Practice!1. Find Serving Size in grams (g).

2. Find amount of Sugars in grams (g).

3. Use the table in Appendix E to find the allowable sugar amount.

Yummy Brand Yogurt

Non-Creditable Foods in the Infant Meal Pattern: Meat/Meat Alternate Items

➢Soy products:• Soy yogurt• Tofu

➢Cheese Food, cheese spread, “cheese product”

➢Homemade yogurt

➢Yogurt products like freeze dried yogurt snacks, commercial frozen yogurt and yogurt bars are NOT creditable!

Creditable Foods in the Infant Meal Pattern

Vegetables and Fruits:

• All vegetables and fruits can be offered.

Non-Creditable Foods in the Infant Meal Pattern: Fruits and Vegetables

• Fruit and vegetable juices- including 100% juice!• Freeze dried fruit or vegetable snacks• Fruit snacks

Creditable and Non-Creditable Foods in the

Infant Meal Pattern

Commercial, mixed-component, “combination”

baby foods:

➢Label must document how the food credits toward the meal pattern

UDSA’s Infant Feeding Guide contains a list of common

creditable and non-creditable foods in the infant meal

pattern.

Infant Food Allergies and Intolerances

Infant Food Allergies and Intolerances• Communicate with parents about any possible food allergies and

intolerances.

• Known food allergies should be documented with a written care plan developed by the baby’s parents and health care provider. This plan should include the steps to take if the baby has a reaction at meal or snack time.

• Food allergies and intolerances that do not prevent you from meeting the meal pattern should be documented with a parent or doctor note to prevent any appearance of discrimination, for example:

• Allergies to fruits that can be easily substituted to meet meal pattern

• Food allergies and intolerances that prevent you from meeting the meal pattern must be documented with a signed note from a medical professional authorized to write prescriptions, for example:

• Allergies/intolerances to iron fortified infant formula• Allergies/intolerances to iron fortified infant cereal

Infant Formula for Babies with Special Dietary Needs

• Special Dietary needs due to Disabilities:Infant formulas that are not iron-fortified, or have low or no iron, or are FDA exempt are creditable if the substitution is supported by a medical statement from a medical professional licensed to write prescriptions.

*Doctor’s note should specify:-name of formula to be avoided-how the formula affects the infant-specify the formula(s) to substitute-be signed by the doctor

• Special Dietary needs due to Religious Reasons:You or the parent can substitute another compliant, iron-fortified infant formula.

Highly Recommended: keep signed parent’s note on file regarding request

Documenting Infant Feeding

= Federal Requirement for participation in the CACFP!

Proves that you’re following meal pattern requirements = Supports your claim for

reimbursement

Documenting Infant Feeding

Maine’s Requirements:1. Dated Infant Menu posted daily

2. Documentation showing:• Specific foods served to each infant for each meal/snack

component• Amounts of breast milk/formula/foods served (not consumed)

This can be done on a single document OR 2 different documents.

Documenting Infant Feeding: Daily Infant Sheet

Document for CACFP:

• Infant’s first and last name

• Date

• Age group of infant

• Circle whether the infant was served breast milk and/or formula

• The amount of breast milk or formula served

• The specific fruit and/or vegetable served

• The specific grain item and/or meat/meat alternate item served


• Date


Document for CACFP:



Document for CACFP:

• The specific fruit and/or vegetable served


• Date




• The specific grain item and/or meat/meat alternate item served

Maine’s Requirements:

1. Dated Infant Menu posted

2. Documentation showing:• Specific foods served

to each infant for each meal/snack component

• Amounts of breast milk/formula served(not consumed)

Documenting Infant Feeding: Infant Portion Menu for Multiple Infants


Debbie’s Daycare 1/7/2020

Bob T.3 mo.A

Logan R.8 mo.B

Jill W.5 mo.A

Rojan T.7 mo.B

Tiana J.10 mo.B



Bob T.3 mo.A

Logan R.8 mo.B

Jill W.5 mo.A

Rojan T.7 moB

Tiana J.10 mo.B

(B) 4oz (F) 7 oz (F) 6 oz (B) 8 oz (B)3oz @ 8am4 oz @9:30am



Bob T.3 mo.A

Logan R.8 mo.B

Jill W.5 mo.A

Rojan T.7 moB

Tiana J.10 mo.B

(B) 4oz (F) 7 oz (F) 6 oz (B) 8 oz (B)3oz @ 8am4 oz @ 10am

pears applesauce pears

yogurt rice cereal rice cerealyogurt

Documenting Infant Feeding: Infant Portion

Menu

Documenting Infant Feeding: Infant Portion Menu

Debbie’s Daycare

1/6/20 1/7/20 1/8/20 1/9/20 1/10/20

January 2020

Documenting Infant Feeding: Infant Portion Menu

1. Bob Theriault 3 mo.2. Logan Roy 8 mo.3. Jill Wentworth 5 mo.4. Rojan Tarr 7 mo.5. Tiana Janowitz 10 mo.

X BM

Applesauce

Debbie’s Daycare January 2020

1/6/20 1/7/20 1/8/20 1/9/20 1/10/20


A= 1(1) B=2(4,5)

A=1(3) B=1(2)

A= 1 Because there’s one infant in the “A” age groupA= 1 (1) Because the one infant is Bob and he is infant #1

B= 2 Because there are 2 infants in the “B” age groupB= 2 (4,5) Because the older infants who had breast milk were infants #4 and #5


1/6/20 1/7/20 1/8/20 1/9/20 1/10/20

A= 1(1) B=2(4,5)

A=1(3) B=1(2)


B= 3

Pears (2,5)Applesauce (4)


1/6/20 1/7/20 1/8/20 1/9/20 1/10/20

A= 1(1) B=2(4,5)

A=1(3) B=1(2)

B= 3

Pears (2,5)Applesauce (4)


B = 3

Yogurt (2)

Rice Cereal (4,5)

Documenting Infant Feeding:3 State Forms Available for Use:

Q & A: Question: Are foods like chicken nuggets, fish sticks and sausage creditable in the infant meal pattern?

Answer: Yes; however, they are not recommended due to their high sodium content. In addition, a Child Nutrition Label or Product Formulation Statement is required for these products in order to determine the serving size needed to meet meal pattern requirements.

Question: Can solid foods be served to infants younger than 6 months of age? Can I claim those meals/snacks for reimbursement? Is any extra documentation required?

Answer: Yes, meals containing solid foods are reimbursable when served to infants who are developmentally ready to accept them, even if the infant is younger than 6 months of age. Work closely with infants’ parents/guardians regarding developmental readiness for solids. Best practice: obtain written note from parent/guardian indicating that solid foods should be served while in care.

Q & A: Question: Can a provider, or any other staff member of a child care center or day care home, breastfeed her own infant on-site and claim that meal for reimbursement?

Answer: Yes, a center or day care home provider, or any other staff member of a child care center or day care home, may breastfeed her infant on-site and the center or day care home may claim the meal/snack for reimbursement if the infant is enrolled in the CACFP at the center or day care home.

Question: If a center or day care home is unable to provide a private place for mothers to breastfeed and a mother chooses to breastfeed in her car, is that meal still reimbursable?

Answer: Yes, as long as the mother breastfeeds somewhere on the grounds of the daycare center or home, the meal is reimbursable. If the mother chooses to leave the premises, then the meal would NOT be reimbursable.

Resources:

USDA’s Feeding Infants in the Child and Adult Care Food Program guide and CACFP Trainer’s Tools: Feeding Infants (English & Spanish)

https://www.fns.usda.gov/resource/cacfp-trainers-tools-feeding-infants

USDA Memo: Feeding Infants and Meal Pattern Requirements in the Child and Adult Care Food Program; Questions and Answers (CACFP 02-2018)

https://www.fns.usda.gov/cacfp/feeding-infants-and-meal-pattern-requirements-child-and-adult-care-food-program-questions-1

April Taylor

[email protected]

https://nam03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fns.usda.gov%2Fresource%2Fcacfp-trainers-tools-feeding-infants&data=02%7C01%7CApril.Taylor%40maine.gov%7Ca26dfae0b20f49c1d40408d799da5d68%7C413fa8ab207d4b629bcdea1a8f2f864e%7C0%7C0%7C637147035541488661&sdata=UsLIMTVLbEndTSrhP076Py3AmmwlLULiSgPVBNtS930%3D&reserved=0

https://www.fns.usda.gov/cacfp/feeding-infants-and-meal-pattern-requirements-child-and-adult-care-food-program-questions-1

mailto:[email protected]

Documents

Infant Feeding in the CACFP - Maine.gov · 2020-02-14 · bit later, when the baby is ready for it, then that meal/snack can be claimed for reimbursement. Remember to document! •Practice