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Special Diets: Your Role in Feeding Students with Special Dietary Needs Megan Fogarty, Registered Licensed Dietitian Wichita Public Schools Wichita, KS July 15, 2015 1:30-2:30pm
Special Diets: Your Role in Feeding Students with
Special Dietary Needs Megan Fogarty, Registered Licensed Dietitian
Wichita Public Schools Wichita, KS
July 15, 2015 1:30-2:30pm
About me:
BS in Nutrition and Food Science, Colorado State University
Hometown: Kansas City, MO
Favorite School Lunch: Cheesy Fish Melt
Objectives
USDA Definition of Disability
The Medical Form
Common Conditions
Best Practices
Menus
Resources
USDA Definitions of Disability
Definitions of a Disability
Rehabilitation Act (1973) and the Americans with Disabilities Act (1990):
Falls under section 504
Physical or Mental Impairments which affect a student’s ability to care for themselves, eating, performing manual tasks, seeing, learning.
Orthopedic, visual, speech, hearing impairments Cerebral Palsy- modified texture meals Muscular Dystrophy- modified texture meals Multiple Sclerosis Metabolic Diseases: PKU (low protein meals), Diabetes Severe Food Allergy- Anaphylaxis risk Intellectual Disability- texture aversion Specific Learning Disability
Definitions of a Disability
Individuals with Disabilities Education Act (IDEA)
Individualized Education Program (IEP) Recognizes 13 disability categories:
Autism- texture aversion
Asthma- increased risk of food allergy and anaphylaxis
Sickle Cell Anemia
ADHD- texture aversion, medications decrease appetite
IEP vs. 504 Plan
IEP 504 Plan
Special education law for children with disabilities
Civil rights law to stop discrimination against people with disabilities
Specific disabilities are covered, must affect the child’s educational performance or ability to learn.
Covers any disability, more broad definition than IEP. The disability must interfere with the child’s ability to learn in a general classroom.
Sets goals for child and must have a specific plan
No standard plan, and does not have to be a written document
Created by parent, Spec. Ed Teacher, other specialists
Created by parent, principal, teachers
Services to student are financed through the school
Services to student are financed through the school
http://www.understood.org/en/school-learning/special-services/504-plan/the-difference-between-ieps-and-504-plans
For more information…
http://www.fns.usda.gov/sites/default/files/special_dietary_needs.pdf
The Medical Statement for Modified Meals
Medical Statement for Modified Meals
Required by USDA to ensure meals are reimbursable and meet nutrition standards.
Must be signed by a recognized medical authority as listed on form
Identify the medical or special dietary condition which restricts the diet
Food/s to be omitted from diet
Food/s to be substituted
Feeding Students with Disability
School food service is required to provide special meals to students with disabilities at no extra cost to the student.
Do not need to be renewed on yearly basis, but
may be recommended or required by your state agency.
For modified textures (soft, ground, pureed) a
licensed physician’s written instruction are recommended, but not required. (may be required by your state agency however)
Student Without Disability
School food service is not required to make meal modifications for students w/o a disability.
Make decisions on a case-by-case basis Medical statement should be provided for
students with and without a disability Not required to make modifications for
preference, lifestyle choices (vegan, vegetarian), or religious beliefs.
Modify the Medical Statement to your advantage
Commonly Seen Conditions
Diabetes- ◦ Type 1- pancreas does not produce insulin ◦ Type 2- insulin resistance
Dysphagia- difficulty swallowing ◦ Soft, Ground, Pureed Foods
Food Allergies ◦ May or not be a disability
Students with Diabetes
Students with Diabetes
Need to consume consistent carbohydrate (CHO) at each meal
Sugar is included in CHO on nutrition facts panel
Focus should be on portion control
Avoid over-limiting sweeter food items
Avoid concentrated forms of sugar such as juice
Students may not need alternate meal
Recommended Carbohydrate Intake from the Academy of Nutrition and Dietetics
Menu with CHO Counts
Stricter Menu
Students with Dysphagia (difficulty swallowing)
Students with Dysphagia
Follow National Dysphagia Diet
• Level 1: Pureed- foods of pudding consistency, no coarse textures or chunks.
• Level 2: Mechanically Altered or Ground- moist foods
that are soft-textured with some cohesion, foods no larger than 1-quarter inch pieces.
• Level 3: Advanced or Soft- Nearly regular textures, no
hard, sticky, or crunchy foods. Foods should be moist and in bite-size pieces.
Students with Dysphagia
Use proper equipment May need to add fluid with sauces, broths,
juices, milk, salsas Serve with additional sauces at correct
consistency Utilize regular menu items
Resources for Dysphagia
American Speech-Language Assoc.: ◦ http://www.asha.org/SLP/clinical/dysphagia/Dysphagia-
Diets/
Dysphagia Divas: ◦ http://www.dysphagia-diet.com/t-dysphagiadivas.aspx
Nutrition411: ◦ http://www.nutrition411.com/articles/dysphagia-level-3-
diet
Students with Food Allergies and Intolerances
Food Allergy?
Food Allergy: “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food”
NAID Guidelines
Not Food Allergy: ◦ Intolerance ◦ Sensitivity ◦ Celiac Disease ◦ Irritable Bowl Syndrome ◦ Food Aversions
Food Allergy Facts
Coconut- is a fruit, but declared a tree nut by the FDA. Most persons with tree nut allergy can safely consume coconut. If coconut needs to be avoided, it should be listed separately on the medical form.
Corn Allergy-corn syrup, HFCS, dextrose safe for individuals
with corn allergy. Corn starch? (information from Dr. Steve Taylor, co-founder and director of the Food Allergy Research and Resource Program (FARRP) University of Nebraska- Lincoln and Via Christi Health Allergy Clinic in Wichita, KS). Soy Allergy- soy lecithin and highly refined soy oil is safe for
most persons with soy allergy. Children will most likely grow out of milk, soy, and egg allergies. Rice allergy is extremely rare
Milk Allergy vs. Lactose Intolerance (LI)
Milk Allergy involves the immune
system. It generally requires that student avoid milk as an ingredient in all types of foods.
Persons with LI lack the enzyme lactase,
the enzyme that breaks down the milk sugar lactose.
LI varies with each individual. Natural Cheeses contain very low levels of lactose per ounce.
Wheat Allergy vs. Gluten Intolerance or Celiac Disease
Wheat Allergy involves the immune system Celiac Disease is an autoimmune disease,
students must avoid barley, rye, contaminated oats, wheat.
Gluten Intolerance is a sensitivity All require a medical diagnosis
So I have a form, now what?
So I have a form, now what?
Make sure the form is completed correctly.
Do you have all the information
you need to make a menu? Do you need to call the parent? Do you need to call the
physician? Do you know what ingredients
are in the foods your serve?
Get Prepared!
How do I prepare myself for this?
Take photos of all ingredient lists on packaging that come into your facility. Save them to a file on your computer for accessibility.
Make yourself a spreadsheet ◦ List all foods you offer listed with common allergens Keep track of other problem ingredients too:
• corn byproducts • oats • barley • food dyes • sodium benzoate • fruits and vegetables • yeast
• sulfites • Rice • sesame • honey • cinnamon • gelatin • citric acid
Example Spreadsheet
What do I feed them?
What do I feed them?
Offer as many of the regular menu foods as possible
Use what you have on hand, get creative Beans offer inexpensive flexibility Offer corn tortillas, corn chips, Rice Chex Puree or ground regular school foods with
broths, tomato-based sauces, or cheese sauces for more flavor and calories
Menu Ideas:
Got Chicken? ◦ Zesty Chicken Salad w/ vinegar-based dressing ◦ BBQ Chicken ◦ Salsa chicken with rice
Got Beans? ◦ Refried Beans w/salsa and rice ◦ Black beans served over a baked potato w/ salsa ◦ Puree for bean dip ◦ Hummus
SunButter ◦ A protein source for students w/ several allergens ◦ Add honey and/or cinnamon for variation ◦ Can purchase in bulk form, portion how you need to.
Communication is key
Communication is key…
Make lists of foods that you offer that contain nuts, tree nuts
Make lists of food that you offer that contain fish, shellfish
Send out information as early in the school year as possible
Identify the school-based team
School Nurse
Food Service Staff
Students Parents
Custodial
Principals
Point of Sale Person
Teachers
Paras
School-based team
Menu Design
Flowchart for School Nurse
Organize your Students
Excel Spreadsheet to Organize Students with Form on File
Excel Spreadsheet to Organize Students with Form on File
Date form was submitted
Name of student
Allergy or disability
Meal modification needed
Meals taken at school (breakfast, lunch, snack, latchkey,
pre-K)
School
Grade level
Comments/notes
Use Consistent Language
“No Fluid Milk”- Needs milk substitute only, tolerates other dairy products
“No Fluid Milk, No Dairy Products”- Lactose
intolerance, tolerates milk cooked in to foods, sometimes cheese crackers
“No Milk as ingredient”- Milk allergy, avoids
any food with milk listed in the ingredients
Use Consistent Language
“No Nut”- Nut allergy, combines allergy to peanuts and tree nuts ◦ Can separate to provide more variety of foods to student ◦ May be confusing to food servers or school-based
employees
“No Fish”- Fish and Shellfish Allergy ◦ Can separate as well
Use Consistent Language
“No Wheat”- Wheat allergy, gluten intolerance, celiac disease ◦ Avoid all food items with wheat listed on package
Use Consistent Language
“No Egg Entrée”- Egg sensitivity, tolerates eggs cooked into foods, avoids eggs as main entrée (omelet, boiled egg, etc.)
“No Egg as Ingredient”- Egg allergy, avoids
all foods with egg as an ingredient
Know Your Resources
Resources for you
Summary
Ensure you have a completed form
Stay Organized
Have ingredient lists easy to reach
Keep it simple, but creative
Communicate
Use your resources
Questions?
