infant meals component of the child and adult care food program -cacfp

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Infant Meals Component of the Child and Adult Care Food Program -CACFP

Ann-Marie Martin

CACFP Coordinator

Alaska Department of Education & Early Development

Definition of Infant in the CACFP

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Birth through 11 Months

Up to the child’s first birthday

Infant Meals

CACFP Centers/Providers caring for infants must offer meals to them

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All centers/providers must offer iron-fortified formula to infants under one year of age

To claim infant meals for reimbursement

To Claim Reimbursement for Infant Meals:

• Parents complete CACFP Enrollment form that includes infant section or complete an Infant Formula/Feeding Selection form

• Include infants in your One Month Enrollment Report (OMER)

• Follow the CACFP Infant Meal Pattern

• Take point of service meal counts

• Maintain Infant Menus/Meal Count records

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One Month Enrollment Report (OMER

Infants must be listed on the Center’s One Month Enrollment Report (OMER) that is completed each year

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Center administrators complete the OMER annually for documenting family income which is directly associated with reimbursement for the center.For more information on completing the OMER please contact EED.

USDA Infant Meal PatternMeal pattern is grouped into three

age categories:

birth-3 mo

4-7 mo

8-11 mo

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Required Components

May offer either:

• Breast Milk and/or

Iron-fortified Infant Formula (IFIF)

Solids when infants are developmentally ready:

• 4-7 months optional (only if not developmentally ready)

• 8-11 months required

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• Must provide at least one infant formula

• Parents may decline infant formula

• Bring their own iron-fortified infant formula

• Bring their own pumped breast milk

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When parents provide non-creditable infant formulas

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• Provide a Specialty Formula• That does not meet CACFP

Requirements

• Need:• Signed Medical Statement• Diagnosis must be identified

and authorized

Example:

Low-iron formulas<1 mg iron per 100 kcals

Breast Milk

Credited the same as formula

Chapter 3 provides information on handling breast milk

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Age Breakfast Lunch and Supper Snack

Birththrough

3 months

4-6 fluid ounces formula1 and/or breast milk

4-6 fluid ounces formula1 and/or breast milk

4-6 fluid ounces formula1 and/or breast milk

4through

7months

4-8 fluid ounces formula1 and/or breast milk

0-3 Tbsp infant cereal2 (ready)

4-8 fluid ounces formula1 and/or breast milk

0-3 Tbsp infant cereal2 (ready)

0-3 Tbsp fruit and/or vegetable (ready)

4-6 fluid ounces formula1 and/or breast milk

8through

11 months

6-8 fluid ounces formula1 and/or breast milkand2-4 Tbsp infant cereal2

and1-4 Tbsp fruit and/or vegetable

6-8 fluid ounces formula1 and/or breast milkand2-4 Tbsp infant cereal2

and/or1-4 Tbsp lean meat, fish, poultry, egg yolk, cooked dry beans or cooked dry peas5

or ½-2 ounces (weight) cheeseor1-4 ounces (volume) cottage cheese or1-4 ounces (weight) of cheese food or cheese spreadand1-4 Tbsp fruit and/or vegetable

2-4 fluid ounces formula1 and/or breast milk or fruit juice3

0 to ½ slice of crusty bread4

(optional)or 0 to 2 crackers4 (optional)

CACFP Infant Meal Pattern

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Birth through 3 months

Required at all meals and snacks:

• Iron-fortified formula and/or

• Breast milk

OK to offer less than the minimum amount of breast milk 14

Breakfast Lunch or Supper

Snack

Breast Milkor 4-6 ozFormula

Breast Milkor 4-6 ozFormula

Breast Milkor 4-6 ozFormula

Reimbursable meals forBirth through 3 months

Center provided formula

Parent provided breast milk

Parent provided formula

Staff mother breast feeding during work hours (not on break)

Only exception is when visiting mother (non-staff) breastfeeds infant (not reimbursable)

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4 through 7 months

Required at all meals and snacks:

• Iron-fortified formula and/or

• Breast milk

Solid foods when developmentally ready16

Breakfast Lunch or Supper Snack

Breast Milk

or 4-8 oz. Formula

Breast Milk

or 4-8 oz. Formula

Breast Milk

or 4-6 oz. Formula

0-3 Tbsp. Infant Cereal

0-3 Tbsp. Infant Cereal

0-3 Tbsp. Fruit and/or Vegetable

Reimbursable meals for4 through 7 month olds

Center provided formula

Parent provided formula

Parent provided breast milk

Foods added, as appropriate per infant, provided by Center

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Reminders

Ages 4-7 months:

• 0-3 T cereal or veg./fruit means that the meal component is optional dependent on the infant’s needs.

• Portion size not listing zero as a measurement indicates the component must be offered, i.e. formula.

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8 through 11 months

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Breakfast

All 3 components must be offered

Lunch or Supper

All 3 components must be offered

Snack

Breast Milk

or 6-8 oz. Formula

Breast Milk

or 6-8 oz. Formula

Breast Milk

or 2-4 oz. Formula

2-4 Tbsp. Infant Cereal 2-4 Tbsp. Infant Cereal Or

1-4 Tbsp. Meat

Or

2 - 4 oz. Fruit Juice

1-4 Tbsp. Fruit and/or Vegetable

1-4 Tbsp. Fruit and/or Vegetable

0-1/2 Crackers/

Bread

Reimbursable meals for 8 through 11 month olds

Center must offer meal components with either breast milk or formula

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8 through 11 months

Required at Breakfast:• Iron-fortified formula and/or

breast milk

• Iron-fortified infant cereal (IFIC)

• Fruit and/or vegetable (not juice)

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8 through 11 months

Required at Lunch and Supper:• Iron-fortified formula and/or breast

milk

• Fruit and/or vegetable (not juice)

• Iron-fortified infant cereal (IFIC) and/or

• Meat/meat alternate

Lean meat, fish, poultry, egg yolk, cheeses, and beans or peas

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Meat Portions for 8 - 11 Month OldsLunch and Suppers

1 - 4 tablespoons of meat, poultry, egg yolk, cooked dry beans or peas

or

1/2 - 2 ounces of cheese

or

1 - 4 ounces (volume) of cottage cheese

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8 through 11 months

Required at Snacks:• Iron-fortified formula and/or

• Breast milk or

• Fruit Juice (full strength)

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When developmentallyready:

•Crusty bread or •Crackers

RemindersAges 8-11 months:

• Breakfast - infant cereal

is required to be offered

(you can add fruit to the cereal & you can make with formula vs. water)

• Lunch & Supper:

infant cereal and/or meat/meat alternate must be offered

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Introducing Solids

Introduce new food one at a time:

• Allow 3 to 5 days between each new food

• Observe infant closely for any reaction to new food items

• Serve appropriate textures in small amounts

Do not add sugar, salt, fat,

or spices to food26

Table food for older infantsYou can serve table food to older infants & claim meal if …

You have checked with parents on items you can serve to the infant from the “big kids” menu

The infant still gets all required components of the Infant Meal Pattern

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Big kids menu: hamburger so you

To serve/claim for Infants: •Cut it up •write “hamburger” on the infant menu in the meat/meat alternate column•You still need to serve infant formula/breast milk and vegetable/fruit

Infant FormulaCenter must supply at least one creditable infant formula

• USDA is no longer keeping an approved infant formula list on their website

• Ensure formula is not an FDA exempt Infant Formula

• Look for the statement “Infant Formula with Iron”

• Use the nutrition facts label as a guide

• Must have 100 mg of iron or more per 100 calories of formula

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Parent Provided Food & Formula

A parent may choose to provide food and/or formula for their own child.

• Must be an iron-fortified infant formula

• Maintain documentation that the parent declined offered food and/or formula (CACFP enrollment form or the infant formula/feeding selection form)

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Food Provided by Parents

Parents may provide breast milk, formula, and/or foods,

However, the center/provider must:

-Supply at least one required component when two or more components are offered (not earlier than 4 months) , in order to claim the meal for reimbursement.

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Food Provided by Parents

When mom comes to the site and nurses their child…

the meal is not reimbursable…

UNLESS

the center or provider supplies an additional required component.

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When staff member nurses their own child

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the meal is reimbursable if they are working

If on break you will treat as if they are a mom coming in to breastfeed their infant

Is this infant meal reimbursable?

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Is this infant meal reimbursable?

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Infant Menu/Meal Count RecordsWeekly or Monthly Record

One per individual per weekOR

Daily Record

One per day for multiple infants of the same age group

• List what food and the amount of food OFFERED at each meal immediately after feeding the child.

• Mark the meals on a point-of-service menu/meal sheet

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Individual Infant Menu/Meal Count

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Pont of service (POS) – write food offered at time of service & include count

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Infant menus must contain the following information:

• Food components offered.

• Names of infant.

• Infant’s age and date of birth.

• Meal type.

• Date of meal service.

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Common MenuDocumentation Errors

Non-creditable foods

Missing required components

Breast fed infants are included in the meal counts (and no other component supplied by the site).

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• Not moving to next set of meal pattern requirements at start of their 4th and 8th months.

• Infants are moved to the Toddler Room and their meals are no longer recorded on individual daily infant meal records or are fed the child meal pattern.

• Children over age 1 are still in the infant room and fed infant meal pattern.

Common MenuDocumentation Errors

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Transitional Period

After the 1st Birthday

• Between the 12th and 13th month

Transition from IFIF to cows milk

• Offer as a mixture 41

Happy 1st Birthday!After the 1st Birthday

• Use the 1 through 2 year old meal pattern

• Cows milk – full fat for 1 to 2 yr. olds

Medical statements required:

• Infants not ready to be served the1-2 year old meal pattern

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Medical Statements

Also required for serving:

• Cows milk to children under 1 year

• Formula to children over 13 months

• An alternate meal pattern

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Creditable Foods for Infants

Foods prepared at the center, with appropriate modifications

Commercially prepared foods must be plain fruits, vegetables, and meats

Infant cereal must be iron fortified

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Iron Fortified Infant Cereal

Iron-fortified (45 mg. of iron for every 100 g. of dry cereal)

Mix with breast milk or formula

Feed with a spoon; not from a bottle

Many older infants don’t like infant cereal for breakfast, but it is required to claim the meal – mix in fruit and they like it

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Iron Fortified Infant Cereal

Not creditable:

• Cereal in jars

• Infant Cereal with fruit flakes

• Regular family breakfast cereals (hot or cold)

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Vegetables and Fruits

Commercially Prepared

Center Prepared47

Commercially Prepared Infant Food

Fruits and Vegetables

CreditableThe fruit or vegetable

is the first ingredient

Contain multiple fruits or vegetables

Water is not the first ingredient

Non-CreditableBaby dinners

Jarred cereal with fruit

Desserts

Water is the first ingredient

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Commercial Fruits and Vegetables

Vegetable or fruit must be listed as first ingredient (no sugar)

Plain vegetables and fruits are preferred

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Pasta Vegetable Medley4 oz.Vegetables

Ingredients:water, tomato paste, pear concentrate, carrots, dried egg yolks, enriched macaroni product (durum wheat semolina, niacin, ferrous

sulfate, thiamine mononitrate, riboflavin and folic acid), romano cheese (made from partially skimmed cow's milk, cheese cultures,

salt and enzymes) and zinc sulfate.

Rice Cereal with ApplesBeech-Nut Naturals First Advantage4 oz.Cereals

Ingredients:apples, apple juice from concentrate (water and apple juice concentrate), water, dried egg yolks, rice flour, cinnamon, ascorbic acid (vitamin c), ferrous sulfate (source of iron), citric acid, zinc sulfate (source of zinc), niacinamide, calcium pantothenate, thiamine mononitrate (vitamin b1), riboflavin (vitamin b2), pyridoxine hydrochloride (vitamin b6), vitamin b12 and folic acid.

Not Creditable

- Water 1st ingredient. - Has 2 food components,

making it a dinner.

Not Creditable

Cereals with fruit not creditable.

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Center Prepared Fruits and Vegetables

Texture must be appropriate;

usually cooked

Avoid canned vegetables that are high in sodium

Avoid canned or frozen fruits with added sugar

Do not add sugar or salt

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Center Prepared Fruits and Vegetables

Choking dangers:

• Raw vegetables

• Corn kernels

• Hard fruits: apples, etc.

• Whole fruits: grapes, etc.

• Uncooked dried fruits

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Meat and Meat Alternates

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Eggs

•Egg yolks at 8 months•Yolk must be hard cooked•Avoid egg whites until after 1 year.

Cheese

• Introduced at 8 months or older

• Natural cheese rather than processed cheese

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Meat and Meat Alternates

Avoid:

• Peanut butter, seeds, nuts

• Fish and shell fish

• Processed meats

(chicken nuggets)

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Meat and Meat Alternates

Commercially Prepared Infant Food

Meat & Meat Alternates

Creditable

Plain strained baby foodmeats - Including those with beef, chicken,

turkey, lamb, veal, and ham.

Non-Creditable

Combination dinners.

Meat sticks.

Breaded/battered seafood and canned fish with bones.

Yogurt.

Nuts, seeds, and nut/seed butters.

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Chicken Lasagna

Beech-Nut Naturals Stage 3 6 oz   Dinners

Ingredients: water, tomato paste, finely ground chicken, carrots, pear puree concentrate, enriched macaroni product (durum wheat semolina, niacin, ferrous sulfate, thiamine mononitrate, riboflavin and folic acid) and romano cheese (made from partially skimmed cow's milk, cheese cultures, salt and enzymes).  

Vegetables & Beef

Beech-Nut Naturals Stage 2  4 oz. Dinners

Ingredients:vegetables (carrots, rehydrated potatoes, peas), water and beef

Not Creditable

- Has more than 1 food component. - Considered a “Dinner”.

Not Creditable

- Water 1st ingredient - More than 1 food component.

Making it a “dinner”.

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Grains/Breads

(1st ingredient is whole or enriched grain)

• Strips of dry bread, toast, tortillas

• Plain crackers - saltines

• Teething biscuits

• English muffins

• Pita bread

• Animal crackers

• Graham crackers (without honey)

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Grains/Breads

Avoid:

• Snacks such as pretzels or

chips

• Cookies or granola bars

• Crackers with seeds, nuts, etc.

• Whole kernels, such as rice.

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Non-Creditable Breads and Crackers for Infants

Allergies (whole eggs):

• pancakes• waffles• muffins

Calories: • brownies• cakes• doughnuts

Choking: • hard pretzels• breadsticks• tortilla chips• granola bars• some ready to

eat cereals

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Meal Times for Infants• No specified meal time

• May offer meal at more than one sitting

• Claim if around “normal” meal time

• Breakfast not claimed at 11 a.m.

• Complete one meal before serving the next

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Meal Times for Infants

•On-Demand Infant Feeding

•Feed when hungry

•Only approved meal types can be claimed

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Division of Responsibility

Whether breast or formula fed and make baby feel comfortable/secure

Help baby feel calm & alert

Learn cues of baby

Don’t push or continue to feed if baby is not interested

Introduce solid foods when baby is interested and able to eat, versus by their age

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Caregiver/Parent

Division of Responsibility

How much

How often

What level of capability

How fast

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Baby

Solid Foods

Studies show solid foods do not help with sleep patterns

Do not add solids to bottle

Don’t pressure – pressure sets up feeding problems and children don’t grow as well

Look for clear feeding signals

Leaning forward

Opens mouth -

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Question

If a parent wants an infant to have more than three meals during the day, who should furnish the formula for the meals that cannot be claimed?

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Answer

If a parent wants an infant to have more than three meals during the day, who should furnish the formula for the meals that cannot be claimed?

The parent because the center is not required to provide formula for more than three meals per infant per day.

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Question

If a parent wants an infant to have only a

limited number of bottles/formula, which

is less than the infant wants, what are

you to do?

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Answer

If a parent wants an infant to have only a

limited number of bottles/formula,

which is less than the infant wants,

what are you to do?

Since infants are “fed on demand” and

unless there is a medical statement,

honor your responsibility to the infant.

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Question

Is yogurt a creditable food for infants?

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Answer

Is yogurt a creditable food for infants?

No. Commercially prepared, plain yogurt can be served as an extra to infants 8 months and older, but it is not creditable as a meat/meat alternate. The same would go for mixed dinners.

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Question

Are meals served to a child who just turned one year old reimbursable if they contain infant formula?

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Answer

Are meals served to a child who just turned one year old reimbursable if they contain infant formula?

Yes, for a period of one month. After the 13th month, a doctor’s statement will be needed for formula to continue in place of fluid milk.

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Question

If a physician prescribes whole cow’s milk as a substitute for breast milk or formula for an infant under 12 months of age, are meals reimbursable?

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Answer

If a physician prescribes whole cow’s milk as a substitute for breast milk or formula for an infant under 12 months of age, are meals reimbursable?

Yes, with a medical statement, the meal pattern can be amended.

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State of Alaska CACFP web site

http://education.alaska.gov/tls/cnp/CACFP1.html

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WIC Breastfeeding Information

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http://www.hss.state.ak.us/dpa/programs/nutri/WIC/default.htm

Want more on infant feeding?

www.fns.usda.gov/tn/Resources/feeding_infants.html78

Ellyn Satter’s Feeding with Love and Good Sense II DVD

The Infant

The Transitional Child

The Toddler

The Preschooler

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www.ellynsatter.comOr

www.ellynsatterinstitute.org

Special thank you to the Washington State CACFP & Nebraska State CACFP for some of the training materials.

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