Policy Memo 120C

DOH-CACFP: Number 120C (2/08) - Revised (05/09), Supersedes Numbers 83, 84C, 86 and 37

TO: All CACFP Center Sponsors

FROM: Lynne Oudekerk, Acting State Director, Child and Adult Care Food Program

SUBJECT: Obligations of Child Care Centers to Offer CACFP Meals to all Infants Enrolled in Care: Requirements and Recordkeeping

I. Purpose and Scope

CACFP-participating facilities are required to serve developmentally-appropriate meals and snacks to all children in care, including infants. This policy memorandum summarizes the guidelines issued in three previous CACFP policy memos for programs to use in developing menus and claiming reimbursement for meals served to infants.

II. Background Information

  1. For CACFP, an infant refers to a child from birth to their first birthday.
  2. CACFP regulations require that each enrolled child must be offered a meal if they are in care during the meal service period. This applies to children of all ages, including infants.
  3. The CACFP Healthy Infant Meal Pattern (CACFP-103) requires infant formula or breast milk. Child care centers must offer age-appropriate solid foods and at least one iron-fortified formula that would satisfy the needs of one or more infants in care.
  4. The infant's parent or guardian may decline the formula and/or food being offered and supply all or part of the infant's meals.

III. Steps for Providing Infant Meals

  1. Select at least one iron-fortified infant formula that will meet the needs of at least one infant in care.
  2. Develop an infant menu that specifies the infant formula that you have selected and includes other age appropriate solid foods, as outlined in the CACFP Healthy Infant Meal Pattern.
  3. Provide the Infant Feeding Statement (CACFP-121) to the parents of enrolled infants. A sample is enclosed. This informs the parent that infant meals, including the infant formula that you have selected, will be provided to their child.
  4. Request all parents complete the Infant Feeding Statement to document their preferences. Keep these statements on file.

IV. Infant Meals Eligible for Reimbursement

  1. For infants from birth to 4 months -All meals and snacks consumed by an infant while in care may be claimed for reimbursement whether the infant is fed breast milk or formula. This applies even if the parent has declined the center's offer to supply meals to the infant. The only exception is a breastfeeding mother who nurses her own child at the center.
  2. For infants from 4 months to 7 months - All meals and snacks can continue to be claimed even if the infant is only fed breast milk or formula. Once a parent has requested that the center also provide solid foods for their infant, the meal is reimbursable only if the center supplies at least one component of the meal.
  3. For infants from 8 months to their first birthday - Solid foods are a required part of the CACFP Healthy Infant Meal Pattern for children of this age. The meal is reimbursable only if the center supplies at least one component of the meal. If the parent is supplying formula or breast milk and all solid foods for their infant age 8 months and older, the meal cannot be claimed for reimbursement.

V. Recordkeeping for Infant Meals

  1. Keep meal counts to record the number of meals served to infants who are in care during the meal service period.

VI. Common Questions

Q. Are there any centers that are exempt from providing formula and foods to infants?
A. No. This memo applies to all CACFP centers that care for infants from birth until their first birthday.

Q. We don't have a commercial kitchen at our day care center. Are we exempt from providing formula?
A. No. A commercial kitchen is not needed. Ready-to-feed formula does not require mixing. If it is not possible to sterilize bottle and nipples, you may use disposable bottle inserts and nipples.

Q. How many infant formulas do we need to offer? Does it matter if it is powdered, concentrated or ready-to-feed?
A. You must offer one iron-fortified infant formula that will meet the needs of at least one infant in care. It may be of any type. If you choose a powdered or concentrated formula your staff will be responsible for mixing the formula with water in the correct amounts.

Q. Is there a list of approved formulas?
A. No. All iron-fortified infant formulas are acceptable.

Q. Do bottles and nipples need to be sanitized?
A. Yes. Bottles and nipples are considered to be like other dishes and utensils used in food service and must be washed, rinsed and sanitized between uses.

Q. Can we ask parents to supply the bottles for infant feeding?
A. No. As with other items needed for meal service, parents cannot be asked to supply these items.

Q. Can we use a microwave to heat formula, breast milk and food for the infants?
A. No. The New York State Office of Children and Family Services and New York City Department of Health and Mental Hygiene regulations prohibit the heating of any food for infants in a microwave because some spots in the food or liquid may become superheated and burn the infant's mouth. The recommended method for heating food is to heat it under warm running water or heat it in a saucepan of water that has already been warmed. Test the temperature of all foods and fluids before serving any to an infant.

Q. Do we have to buy commercial baby food?
A. No. It is acceptable to serve foods that have been mashed or pureed to the correct texture for infants. Do not feed home-prepared spinach, beets, turnips, carrots or collard greens to infants under 6 months of age. Never provide honey or egg white to infants.

Q. Whose responsibility is it to pay for special, more expensive formulas?
A. All child care centers must offer at least one iron-fortified formula that will meet the needs of at least one infant in care. The parent may decline that formula and supply a different one. If the infant requires a special formula and the infant meets the definition of a person with a disability, the center must supply and pay for the formula. In this case, a medical provider would need to document the infant's disability and indicate the type of formula needed.

Q. What are the guidelines for infants who receive benefits through the WIC Program?
A. Children from families who participate in the Special Supplemental Food Program for Women, Infants and Children (WIC) must be offered infant meals just like any other child enrolled in care. The center cannot require the parent to provide formula due to their participation in WIC.

VII. Breastfeeding Friendly Child Care Centers

New York State Department of Health's Obesity Prevention Program encourages new mothers to breastfeed their infants. CACFP encourages child care centers to support breastfeeding families and recognizes these centers with Breastfeeding Friendly Child Care Center certificates. Enclosed is a Is Your Center Breastfeeding Friendly? (CACFP-177) self-assessment to help you determine if your center is Breastfeeding Friendly and may qualify for a certificate.

VIII. Summary

CACFP-participating facilities are obligated to serve all children in care, including infants. If an enrolled child is in care during mealtime, the center must offer the infant a meal that complies with the age-appropriate CACFP meal pattern. This policy memo established guidelines for providing and claiming infant meals.

For additional questions call CACFP at 1-800-942-3858 and ask to speak to a nutritionist. Also refer to the current Crediting Foods in CACFP and the United States Department of Agriculture (USDA) publication FNS-258 Feeding Infants - A Guide for Use in the Child Nutrition Programs. If you do not have these publications, use the Order Form for Center Sponsors (CACFP-3718), to request them, or print them from the CACFP website at www.nyhealth.gov/nutrition.

Enclosures:

Healthy Infant Meal Pattern (CACFP-103)

Infant Feeding Statement (CACFP-121)

Is Your Center Breastfeeding Friendly? (CACFP-177)

Order Form for Center Sponsors (CACFP-3718)