Meeting the Nutritional Needs of Children with Special Dietary Requestsby Linda Fischer, RD, LDNEducational SpecialistTel. #781-338-6456E-mail: lfischer@doe.mass.edu

Agenda

• Child Nutrition Program Regulations

• American with Disabilities Act Amendments Act (ADAAA)

• Types of Dietary Medical Issues• Massachusetts Allergen Awareness

Regulation• Resources

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Child Nutrition Program Regulations

Section 9(a) of the Richard B. Russell National School Lunch Act, 42 USC 1758(a), states those schools, institutions, facilities, sites, and sponsors participating in the Child Nutrition Programs must make dietary accommodations for children with disabilities.

What Qualifies as a Disability?3

Americans with Disabilities Act Amendments Act (ADAAA) of 2008

The ADAAA (P.L. 110-325) amended the Federal definition of disability, broadening it to cover additional individuals.

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What Does the Amendment Mean for Child Nutrition Program

Operators?Because of the broader definition of disability, it is reasonable that Child Nutrition Program operators may see more children identified by their licensed physician as having a food related disability than were identified previously.

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The ADAAA Broadened Definition

There are now two categories (instead of one) to consider when identifying individuals with disabilities.

These include:

1) Major Life Activities (was part of the original Americans with Disabilities Act)

2) Major Bodily Functions (new)

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Major Life Activities Include:

• Caring for oneself

• Performing manual tasks

• Seeing

• Hearing

• Eating

• Sleeping

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• Walking

• Standing

• Lifting

• Bending

• Speaking

• Breathing

• Learning

• Reading

• Concentrating

• Thinking

• Communicating

• Working

Major Bodily Functions Include:

• Functions of the immune system

• Normal cell growth

• Digestive

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• Bowel

• Bladder

• Brain

• Respiratory

• Circulatory

• Neurological

• Cardiovascular

• Endocrine

• Reproductive functions

The ADAAA Broadened Definition

It’s Important to Note…

• Individuals who take mitigating measures to improve or control any of the conditions recognized as a disability, are still considered to have a disability and require an accommodation.

•However, the process for identifying children with disabilities requiring an accommodation has not changed.

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Familiar Disabilities Impacting Child Nutrition Programs

• Food anaphylaxis (severe food allergy)

• Metabolic diseases, such as diabetes or phenylketonuria (PKU)

• Celiac disease

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Eight Major Food

Allergens

Milk

Eggs

Peanuts

Tree Nuts

Wheat

Soybeans

Fish

Shellfish

Food Allergy vs. Food Intolerance

Food Allergy• An overreaction of the immune system

to certain proteins in foods. Some food allergies can be life threatening.

Food Intolerance• Does not involve the immune system.

Food intolerances can cause great discomfort but are not life threatening. Lactose intolerance is one of the most common.

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Types of Dietary Medical Issues

1)Severe

Includes children with:

- A life-threatening food allergy (i.e. food anaphylaxis)

2)Non-Severe

Includes children with:

- Non life-threatening food allergies

- Special dietary needs

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Severe Food Allergy Considerations

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YES

YES

YES

Non-Severe Food Allergy Considerations

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NO

NO

YES

Reimbursable Meal Considerations

1) In order for a meal to be claimed for reimbursement it must contain all required components.

2) Refer to individual medical statements for children who require food substitutions.

3) If substitutions are not provided as documented in the medical statement then the meal CAN NOT be claimed for reimbursement.

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Massachusetts Food Allergen Awareness Regulation

Section 105 CMR 590.009 established Food Allergy Awareness Requirements

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Exemptions

Exemptions for public and private schools, educational institutions, summer camps, childcare facilities, and other child care programs approved to participate in USDA Child nutrition Programs are exempt from 105 CMR 590.009(H), with the exception of 105 CMR 590.009(H)(3)(b)2,

Provided that they have…

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Exemptions1) Written policies and procedures

(effective October 1, 2010) for identifying, documenting, and accommodating students with food allergies, and

2) Documentation verifying participation in food allergen training recognized by the MA Department of Elementary and Secondary Education (ESE) and the Department of Public Health (DPH).

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What Will Satisfy the Food Allergen Training

Requirement?

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1) Food Allergen training provided by the John C. Stalker Institute (JSI) of Food and Nutrition.

2) Food allergy awareness certification from a MA Department of Public Health (MDPH) approved vendor.

Enforcement

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• The Act gives the authority for enforcement of the regulations to local boards of health.

• Health inspectors may question the Person in Charge (PIC) to ensure knowledge of allergens and symptoms of an allergic reaction.

Enforcement

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What Happens if Compliance With the Regulations are Not Met?

1) Failure to comply will result in a critical item on the inspection report requiring corrective action within 10 days.

2) Local boards of health may use fines and other enforcement actions available under 105 CMR 590.000 and state law to achieve compliance.

Resources for Districts/Schools

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Accommodating Children with

Special Dietary Need in theSchool Nutrition Programs

Guidance for School Food Service Staff

United States Department of Agriculture

Food and Nutrition Service

ResourcesAccommodating Children with Special Dietary Needs in the School Nutrition Programs http://www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf

Asthma and Allergy Foundation of Americahttp://www.aafa.org/display.cfm?id=9&sub=30#over

John C. Stalker Institute of Food and Nutrition http://www.johnstalkerinstitute.org/

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ResourcesMA Food Protection Programhttp://www.mass.gov/eohhs/gov/departments/dph/programs/environmental-health/food-safety/retail-food/policies/special-operations.html

Managing Life Threatening Food Allergies in Schoolshttp://www.doe.mass.edu/cnp/allergy.pdf

USDA Guidance Related to the ADA Amendments Act(Policy Memo SP 36-2013) http://www.fns.usda.gov/cnd/governance/Policy-Memos/2013/SP36-2013os.pdf

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Questions??

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