Policy Memo 120H

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

TO: All CACFP Sponsoring Organizations of Day Care Homes

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

SUBJECT: Obligations of Family Day Care Homes 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 previous CACFP policy memoranda that guided infant menu development for reimbursable meals.

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. The family day care home provider 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

Each provider must:

  1. Select at least one iron-fortified infant formula to offer to infants in care.
  2. Ask the parent or guardian of the enrolled infant to complete an Infant Feeding Statement (CACFP-121). A copy of the Infant Feeding Statement is enclosed. This informs the parent or guardian that meals, including the infant formula that the provider offers, will be served unless the parent declines.
  3. Request the parent or guardian document their preference on the Infant Feeding Statement, even if the parent or guardian declines the provider's offer to provide meals for their infant. Sponsors must keep these statements on file.

IV. Infant Meals Eligible for Reimbursement

  1. For infants from birth to 4 months: Meals and snacks consumed by an infant in care may be claimed for reimbursement whether the infant is fed breast milk, formula, or a combination of both. This applies even if the parent or guardian has chosen to supply the formula or breast milk. If a breastfeeding mother comes to the family day care home to nurse her own child, the meal cannot be reimbursed. However, meals may be claimed if the provider's assistant or employee nurses her infant during working hours.
  2. For infants from 4 months to 7 months: Once the parent or guardian has requested the provider start solid foods for their infant, the meal is reimbursable only if the provider supplies at least one component of the meal pattern requirements. If the infant is not eating solid food, the requirements for infants from birth to 4 months apply until solid foods are begun.
  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 provider supplies at least one component of the meal. If the parent or guardian 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.
  4. Claiming Resident/Own Infant: A provider may claim a resident infant when non-resident children are present and the provider's household is income eligible based upon the completion of the Income Eligibility Application (DOH-4161). If a provider nurses her own infant she may claim the infant's meals and snacks.

V. Recordkeeping for Infant Meals

  1. The provider must keep daily meal counts to record the number of meals and snacks served to infants who are in care during the meal service period.
  2. The provider must complete an infant menu for each infant in care. The Infant Menu for Day Care Homes (CACFP-154 & CACFP-155) is enclosed for that purpose.

VI. Common Questions

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

Q. How many infant formulas does the provider need to offer? Does it matter if it is powdered, concentrated or ready-to-feed?
A. The provider must offer one iron-fortified infant formula that meets the needs of at least one infant in care. It may be of any type. If the provider chooses a powdered or concentrated formula, the provider 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 meal service and must be washed, rinsed and sanitized between uses.

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

Q. Can the provider 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 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 infant formula, breast milk and 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. Does the provider 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 family day care home providers must offer at least one iron-fortified formula that will meet the needs of at least one infant in care. The parent or guardian 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 provider must supply and pay for the formula if the parent or guardian requests. In this case, a medical professional 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 infant enrolled in care. The provider cannot require the parent or guardian to bring the formula because they participate in WIC.

VII. Breastfeeding Friendly Child Care Homes

  1. New York State Department of Health encourages new mothers to breastfeed their infants. CACFP encourages sponsors and family day care home providers to support breastfeeding families.
  2. Sponsors of family day care homes can encourage and support breastfeeding families through CACFP's Breastfeeding Friendly Certification for Day Care Homes.
  3. Participating sponsors will supply the following materials, a sample of which is also enclosed:
    1. Breastfeeding-Friendly Day Care Home (CACFP-151) - This flyer explains how the provider can support breastfeeding mothers.
    2. Is My Day Care Home Breastfeeding Friendly? (CACFP-152) - This 2-page flyer describes the self-assessment process for the provider to complete and return to their sponsor.
    3. Information for Parents (CACFP-153) - This 2-page flyer explains what a breastfeeding friendly day care home is. Page 2 of the flyer allows sponsors to list breastfeeding-friendly family day care homes to use in marketing to parents.
  4. Sponsors will send the provider's completed self-assessment to CACFP and we will recognize the provider with a Breastfeeding-Friendly Family Day Care Home certificate and window cling.
  5. Provider and parent materials can be ordered using the enclosed order form. They are also available to download from CACFP's website at: www.nyhealth.gov/nutrition.

VIII. Summary

Participating CACFP family and group family day care homes are obligated to serve all children in care, including infants. If an infant is in care during mealtime, the provider must offer the infant a meal that complies with the age-appropriate CACFP meal pattern. This policy memo establishes guidelines for providing and claiming infant meals.

For additional questions call CACFP at 1-800-942-3858, ext. 27104, 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 Sponsoring Organizations of Day Care Homes (CACFP-3978) to request them or print them from the web page at www.nyhealth.gov/nutrition.

Enclosures:

Healthy Infant Meal Pattern (CACFP-103)

Infant Feeding Statement (CACFP-121)

Income Eligibility Application (DOH-4161)

Breastfeeding Friendly Day Care Home (CACFP-151)

Is My Day Care Home Breastfeeding Friendly? (CACFP-152)

Information for Parents (CACFP-153)

Infant Menu for Day Care Homes (CACFP-154)

Infant Menu for Day Care Homes (CACFP-155)

Order Form for Sponsoring Organizations of Day Care Homes (CACFP-3978)