Meeting the New Meal Patterns without losing your mind Whole Grains as Simple as Possible Easy Babies Know the Choking Food Rules Sources: Massachusetts Department of Elementary & Secondary Education- Office for Food and Nutrition Programs United States Department of Agriculture National CACFP Sponsors Association
Congratulations! Together we have made the transition to the new meal patterns! You have improved your menus by serving more whole grains, fruits, and vegetables. You have reduced the amount of sugar in children s diets by following the new guidelines for cereals, yogurt, and grain-based desserts. The CACFP has aligned the infant meal pattern to follow the best practices of infant development and gives you and parents more input on the individual baby s readiness for solid foods. The Office for Food and Nutrition Programs (FNP) has also clarified the Choking Prevention Policy for children under the age of four and we have included that information in this training. The positive impacts of these changes will help children develop healthy eating habits that will follow them all their lives. We have had this past year to transition to the new meal patterns without any fiscal disallowances assessed on your monthly claims for errors in serving or recording foods. Starting October 1, 2018, menus that are not in compliance with the new meal patterns will be assessed fiscal disallowances. This home study addresses the changes that have had the largest impact on your participation on the CACFP and may still be confusing. To avoid costly errors on your menus, we encourage you to serve meals that meet the meal pattern and record foods carefully. Thank you for your continued participation in the CACFP 2.
At least one serving of grains per day must be whole grain rich For CACFP compliance: Creditable breads or grains must be made with enriched or whole grains. Enriched grains are refined grains that have been processed to remove the bran and germ and then have necessary nutrients added back in. Enriched grain products are creditable, but do not meet the whole grain criteria unless identified as such. How do you know that a grain is whole grain rich? Here are 4 approved ways that work for family child care providers: #1 The product is found on the Massachusetts WIC food list for approved whole grains. This is a separate list from the WIC cereal list. Go to www.yoursforchildren.com for WIC information or WIC flyer at the end of this training. #2. The product is labeled as whole wheat and has a Standard of Identity issued by the U.S. Food and Drug Administration (FDA). This applies only to certain bread and pasta products that are allowed the label whole grain. This does not apply to crackers and cereal products. See Appendix A. #3. The product includes one of the following FDA approved whole grain health claims on its package, exactly written: Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat, and cholesterol may reduce the risk of heart disease and some cancers. OR Diets rich in whole grain foods and other plant foods, and low in saturated fat and cholesterol, may help reduce the risk of heart disease. #4 The food meets the Food and Nutrition Service s Rule of Three, a 3 step process for identifying whole grain rich products in the CACFP. To meet the Rule of Three as a whole grain rich product, the first ingredient (or second if first is water) must be whole grain and the next two grain ingredients (if any) must be whole grains, enriched grains, bran, or germ.* When applying the Rule of Three for ready-to-eat breakfast cereals, if the first ingredient is a whole grain and the cereal is fortified, the product meets the whole grain rich criteria. In this situation, the second and third grain ingredients, if any, do not need to be considered. *See lists in appendix B for whole and other grain ingredients. 3.
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Wondering if your food is WHOLE GRAIN-RICH? Is it a cereal? STOP T CACFP CREDITABLE Is it a bread or pasta labeled WHOLE WHEAT and does it meet the Standard of Identity? Does it meet the sugar limit requirements? Is the product found on ANY State agency s WIC approved lists? Is the 1st ingredient (2nd after water) a WHOLE GRAIN? DOES T MEET THE WHOLE GRAIN-RICH REQUIREMENTS Does the product packaging list either of the FDA statements? Do you have proper documentation from manufacturer proving WGR? Does it meet the whole grain-rich criteria under the NSLP? Is it fortified with Vitamins & Minerals? Are the next two grain ingredients whole grain, enriched, bran, or germ? Is the 1st ingredient (2nd after water) a WHOLE GRAIN? Do they follow the statement, contains less than 2%...? Do you have proper documentation from manufacturer proving WGR? Identifying Whole Grain-Rich Visit us at www.cacfp.org for more information. This institution is an equal opportunity provider. DOES T MEET THE WHOLE GRAIN-RICH REQUIREMENTS
What is the easiest way to meet whole grain requirement? Grain is a required component in breakfast*, lunch, and supper meals, and is an option at snack. Pick a meal that you serve daily and always serve a whole grain at that meal. Breakfast is the easy choice and then you have met the meal pattern requirement for whole grains for the day! It doesn t matter if all the children participate in breakfast. The requirement is that you serve a whole grain rich food in at least one meal in the day that you claim. *You have the option of replacing the grain component in breakfast with a meat/meat alternate up to three (3) times per week. If you chose that option, serve a whole grain at another meal those days. Examples of whole grain rich meals for CACFP: (Remember to code WG in Kidkare or write WG on paper menus) Breakfast 1% low-fat Milk* Skim Milk* 1% low-fat Milk* Banana Clementine Strawberries Cheerios Whole Wheat Bread Oatmeal 1% low-fat Milk* 1% low-fat Milk* Skim Milk* Baked Apple Steamed Carrots Plums Whole Grain Pancakes Brown Rice Whole Wheat French Toast Lunch/Supper Skim Milk* 1% low-fat Milk* 1% low-fat Milk* Garden Salad Sliced Red Peppers Zucchini sticks Potato Wedges Cantaloupe Orange Slices Hamburger Fish Fillet Roast Chicken Whole Wheat Rolls Corn Tortilla (W.G.) Whole Grain Pasta Snack Cheddar Cheese Yogurt Tuna Whole Wheat Mini-bagels Rice Cakes (W.G.) Whole Wheat Rolls Triscuits Mini-wheat Cereal Snap Peas Hummus 1% or Fat-free Milk* Quinoa * Serve whole milk to children age 1-2 years 6.
Highlights of the New Infant Meal Patterns Two infant age groups now: 0-5 months, 6-11 months Only breastmilk or iron fortified infant formula are to be served through 0-5 months Solid food should be introduced around 6 months, when the child is developmentally ready* Fruits/Vegetables are a new required meal component at snack If a mother breastfeeds her child at the family child care home this meal is reimbursable note directly breastfed on infant s menu 100% juice, and cheese food/spread are no longer creditable infant foods Whole eggs and yogurt are now creditable infant foods Yogurt must contain no more than 23g of sugar per 6 ounces Ready to eat breakfast cereals containing no more than 6 grams of sugar per ounce may be served at snack Animal crackers are not creditable infant foods Parents can provide only one meal component to a reimbursable meal *When the infant is developmentally ready for solid foods, they should be slowly introduced. As infants may have different preferences each day, a solid food does not need to be offered as part of every meal pattern until the infant has developed a tolerance for it. Meals are not going to be disallowed simply because a food was offered one day and not the next if that is consistent with the infant s eating habits. It is important for the provider and parents to have very good communication about when and what solid foods to serve the infant while the infant is in the provider s care. Each item offered to an infant should be recorded and documented daily even if they do not consume all of it or even any of it. Per FNP email guidance 2/2/2018 Infant Solid Food Checklist: Iron fortified infant formula and dry infant cereal, do not combine in bottle Record the amount of food served not the amount consumed Communicate with parents regularly about new foods they have introduced. General Rule of Thumb: only offer foods that have been introduced in the infant s home. Creditable solid foods are single component foods (apple and banana in a jar is ok). Commercially mixed and combination foods of different components (such as mixed apple and chicken or any mixed dinner) are not creditable for infants 7.
Infant Meal Pattern Meal Components 0-5 6-11 Breakfast/Lunch/Supper Breast Milk or Formula Fruit/Vegetable Iron Fortified Infant Cereal (IFIC) AND/OR Meat/Meat Alternate Required X X X Required Only if ready Only if ready Only if ready Snack Breast Milk or Formula Fruit/Vegetable AND Bread, Cracker, Ready-toeat cereal or Infant Cereal Required X X Required Only if ready Only if ready Amounts you must serve. Breakfast/Lunch/Supper Breast Milk or Formula Fruit/Vegetable * Iron Fortified Infant Cereal (IFIC), or Meat/Meat Alternate** Meat, Poultry, Fish, Whole Egg, Beans/ Peas, or Cheese, or Cottage Cheese, or Yogurt Snack Breast Milk or Formula Fruit/Vegetable* Grain: Bread Cracker IFIC or ready to eat cereal 4-6 fl oz 6-8 fl. oz 0-2 Tbsp 0-4 Tbsp 0-4 Tbsp 0-2 oz 0-4 oz 0-4oz 4-6 fl oz 2-4 fl. oz 0-2 Tbsp 0-1/2 slice OR 0-2 crackers OR 0-4 Tbsp X: Gradually introduce solid food when infant is around 6 months old, and is developmentally ready. * A combination of fruit and vegetable may be served. ** A combination of IFIC and Meat/meat alternate may be served. 8.
Feeding the Baby For the First Year Babies grow quickly during the first year of life and make many changes in the types of food and textures of foods they are able to eat. As babies grow and develop, watch for the flowing signs which will tell you when they are ready for a new food. Babies Age: When Babies Can: Serve: Birth through 5 months * Only suck and swallow LIQUIDS ONLY * Breastmilk * Iron Fortified Infant Formula 6 months through 11 months When Babies Can: Serve; * Draw in upper or lower lip as spoon is removed from mouth * Move tongue up and down * Sit up * Open the mouth when they see food * Drink from cup with help, spills expected * Move tongue from side to side * Begin feeding themselves * Begin to hold food and use fingers to feed themselves *Drink from a cup with help, less spilling SEMISOLID FOODS Such as: *Strained fruits/ vegetables *yogurt *Iron fortified infant cereals MODIFIED TABLE FOOD Such as: *Mashed or diced soft fruits/vegetables *Scrambled eggs *Strained cooked meat/poultry *Pieces of soft bread *Crackers 9.
Prevent Choking! Children under 4 years of age are at the greatest risk of choking. Almost 90% of children who die from choking are under 4 years old. Children this age are still learning how to chew, often have not developed the grinding motion with molars, and may swallow foods whole. As we know, they like to put things in their mouth, but have small airways that may become easily blocked. Based on guidance from the USDA, foods that pose the highest risk for choking are foods that "are round, tube-shaped, small, hard, thick and sticky, smooth, slippery, or easily molded to stick to the airway." In order to align with Massachusetts state licensing and USDA's recommendations, Massachusetts Office for Food and Nutrition Programs (FNP) policy restricts the serving of the following foods to children under 4 years of age: Hot dogs, sausages, sausage links or similar shaped processed food items Grapes, cherries, melon balls (melon is ok as long as it is not in ball form ), or cherry and grape tomatoes Specific berries kiwi berries, raspberries, blackberries, goji berries Peanuts, nuts, and seeds (for example sunflower or pumpkin seeds) Peanut butter and nut butters Dried fruit such as raisins or cranberries There are many other items that are not included in the above list which may still pose a choking hazard due to their shape (tube-shaped, round, small) or texture (hard, thick and sticky, smooth, slippery, or easily molded). OFNP asks that providers consider these characteristics when feeding children under the age of 4 years, and recommends altering any food item which may pose a risk. Providers should consider altering food items so that they can be served in manageable bites. The information about alternate food preparation methods relates only to other foods not specifically identified in the above list. The foods listed above are not to be served to children under the age of 4 years. If the foods specifically identified above are served to children under the age of 4 years by a provider, in lieu of a financial disallowance, technical assistance and additional training will be provided by Yours for Children as per FNP guidance. Minimize choking risks by: Making sure children are seated upright when eating Sit with children and always actively supervise them while eating Encourage children to eat slowly Keep mealtimes calm and away from noise and distractions Avoid eating on the run Make sure children are not eating while walking, running, or playing 10.
Overview of Meal Pattern Changes 1. 100% full strength fruit or vegetable juice is reimbursed only once per day 2. Fruits and vegetables are now separate meal components 3. Grain based desserts are no longer creditable 4. Breakfast cereals contain no more than 6 grams of sugar per ounce 5. Meat/Meat Alternate can replace a grain in breakfast up to 3x/week 6. New 2 infant age groups: 0-5 months and 6-11 months 7. 100% juice is never creditable for infants 8. Firm/Extra firm tofu can be credited as a meal alternate when it contains at least 6g of protein per ounce. Tofu must be served in a recognizable form, not blended into other foods 9. Yogurt is limited to 23g of sugar per 6 ounce serving 10. Lunch must contain at least one serving of vegetables 11. At least one serving of bread/grains per day must be whole grain 12. Fluid milk served to children age 1 2 years old must be whole, unflavored milk. Fluid milk served to children age 2 and older must be 1% low fat, or fat-free skim. See Milk Policy Serving Meals 1. Deep fat frying is prohibited as a way of preparing food onsite 2. Food can not be used as a punishment or reward 3. Drinking water must be offered to young children using visual cues 4. Parent/guardian can supply ONE meal component as part of a reimbursable meal 5. For medical condition/allergy child care provider may substitute within the same meal component 6. For a disability the child care provider MUST have a medical statement on file, submit copy of medical statement to YFCI, and MUST make the substitution 7. Family style is a meal service option for your child care home 8. Child care providers MUST offer the minimum required amounts of each food served 9. Providers are to limit servings of graham crackers (any shape) and animal crackers to snacks no more than two (2) times per week for children over 1 year. Not creditable for infants Best Practices (not required) 1. Serve fruit or vegetable at snack for children older than 1 year 2. Serve a variety of whole fruit. Provide at least one serving of dark green vegetables, red and orange vegetables, beans and peas, starchy vegetables, and other vegetables weekly 3. Serve at least two servings of whole grain rich grains daily 4. Serve only lean meats 5. Limit serving processed meats to not more than once a week 6. Serve only natural cheeses and choose low fat or reduced fat cheeses 7. Incorporate seasonal and locally produced foods into meals 8. Limit serving pre-purchased pre-fried foods to no more than one serving per week 9. Avoid serving non-creditable foods that are sources of added sugar 11.
Appendix A: FDA Standard of Identity Whole Grains An FDA Standard of Identity is a set of rules for what a certain product (like whole wheat bread) must contain or may contain to legally be labeled with that product name. FDA provides Standards of Identity for certain whole wheat bread products (21 CFR 136.180) and certain whole wheat pasta products (21 CFR 139.138). Only breads with these exact product names conform to an FDA Standard of Identity and can be considered whole grain-rich using this method: whole wheat bread entire wheat bread graham bread whole wheat rolls entire wheat rolls graham rolls whole wheat buns entire wheat buns graham buns Only pastas with these exact product names conform to an FDA Standard of Identity and can be considered whole grain-rich using this method: whole wheat macaroni product whole wheat macaroni whole wheat spaghetti whole wheat vermicelli Other grain products labeled as whole wheat that do not have an FDA Standard of Identity, such as crackers, tortillas, bagels, and biscuits, must be evaluated for whole grain-rich creditability for CACFP using one of the other methods described on page 3. Please be aware that manufacturers may label their products with terms that are similar to, but slightly different from, FDA Standard of Identity terms defined above. Some frequently encountered terms include whole grain, made with whole grains, made with whole wheat, or contains whole grains. These terms do not indicate an FDA Standard of Identity for whole wheat products. Foods labeled with these terms must be evaluated for whole grain-rich creditability for CACFP using one of the methods described on page 3, such as the Rule of Three. USDA Memo CACFP 09-2018 12.
Appendix B: Ingredients Whole Grains for Rule of Three Whole Grains (must be the first grain ingredient; may be the second or third grain Corn Whole Corn Whole Grain Corn Whole Grain Corn Flour Oats Instant Oatmeal Oat Groats Old Fashion Oats Quick Cooking Oats Steel Cut Oats Whole Grain Oat Flour Rice Brown Rice Sprouted Rice Wild Rice Rye Rye Groats Sprouted Whole Rye Whole Rye Flour Brans and Germs (may be the second or third grain ingredient) Wheat bran Oat bran Corn bran Rice bran Rye bran Wheat germ Enriched Grains (may be the second or third grain ingredient) Enriched wheat flour Enriched white flour Enriched durum flour Enriched rye flour Enriched rice flour Enriched corn flour Enriched bromated flour Enriched durum wheat flour Enriched rice Disregarded Ingredients (may be ignored as not included in Rule of Three ) Wheat Bulgur Cracked Wheat Graham Flour Sprouted Whole Wheat Wheat Berries Wheat Groats Whole Durum Flour Whole Grain Wheat Flakes Whole Wheat Flour Other Whole Grain Amaranth Amaranth Flour Buckwheat Buckwheat Flour Buckwheat Groats Millet Millet Flour Any grain derivatives which are generally presented in only small amounts, such as: Wheat gluten, wheat starch, wheat dextrin, corn starch, corn dextrin, rice starch, tapioca starch, and modified food starch Non-creditable Grains or Flours (The following ingredients are not whole or enriched grains and cannot be one of the first 3 grain ingredients) Quinoa Sorghum Sorghum Flour Spelt Berries Sprouted Buckwheat Sprouted Einkorn Sprouted Spelt Teff Teff Flour Triticale Triticale Flour Whole Einkorn Berries Whole Grain Einkorn Flour Whole Grain Spelt Flour Bromated flour Wheat flour White flour Durum flour Oat fiber Corn fiber Malted barley flour Barley malt Corn 13. Yellow corn meal Yellow corn flour Degerminated corn meal Semolina Farina Rice flour Potato flour Any bean flour Any nut flour USDA Memo CACFP 09-2018
Milk Policy The 2017 New USDA Meal Pattern for Children modifies the requirements for fluid milk in the Child and Adult Care Food Program (CACFP). Milk served in the CACFP must meet the following, which includes changes that come with the implementation of the new Meal Pattern for Children as of October 1, 2017: Unflavored, whole milk must be served to children one (1) year of age. Unflavored* low-fat (1%) milk or fat-free (skim) milk must be served to children two (2) years of age and older. Non-dairy milk substitutes that are nutritionally equivalent to milk may be served in place of milk to children with medical or special dietary needs. Parents must supply the provider with medical documentation for any substitutions. Milk served must be pasteurized fluid milk that meets state and local standards and contains vitamin A and D as specified by the Food and Drug Administration. Evaporated milk does not meet the definition of milk. Milk may be lactose-free milk, lactose reduced milk, cultured buttermilk, or acidified milk. * Yours for Children policy omits the serving of flavored milk to children age six (6) and older to limit the amount of sugar consumed. Meeting the New Meal Patterns 2018 This is a REQUIRED TRAINING for 2 hours of Child and Adult Care Food Program (CACFP) Training credit. Successful completion meets your Nutrition training requirement for fiscal year 2018. Complete all the home study questions. SUBMIT to the YFCI office WITHIN (2) WEEKS of RECEIPT One hundred percent of the funding for this program and publication is provided by USDA and, therefore, any publications may be freely copied by USDA, the Massachusetts Department of Elementary and Secondary Education, and by any other institutions under the Child and Adult Care Food Program. Please credit the listed source when given or Yours for Children, Inc. when not given. This institution is an equal opportunity provider. 15.