Policy Memo 171H

DOH-CACFP: Number 171H (12/13), Supersedes Number 120H (05/09)

TO: All CACFP Sponsors of Day Care Homes

FROM: Sandra J Rhoades, Director of Homes Administration Unit, Child and Adult Care Food Program

SUBJECT: Obligations of Day Care Homes to Offer CACFP Meals to all Infants Enrolled in Care: Recordkeeping Changes

I. Purpose and Scope

CACFP-participating day care homes are required to serve developmentally appropriate meals and snacks to all children in care, including infants. USDA issued guidance to State Agencies permitting certain flexibilities to simplify and improve the delivery of nutrition assistance to low-income children through CACFP. This policy memorandum modifies the recordkeeping requirements described in CACFP Policy Memorandum Number 120H issued in May 2009. All other requirements in Number 120H remain unchanged and are incorporated into this memo.

II. Background Information

  1. Day care homes serving infants must offer to serve infant meals that include breast milk or an infant formula that meets CACFP requirements [7 CFR 226.20(b)].
    1. For CACFP, an infant refers to a child from birth to their first birthday.
    2. CACFP regulations require day care homes to offer meals to all enrolled children, including infants.
  2. Day care homes must develop an infant menu that includes the infant formula (or breast milk) being offered and other age appropriate solid foods for children 8-12 months of age, as outlined in the CACFP Healthy Infant Meal Pattern. Sample Infant Lunch Menus (CACFP-109) are enclosed and can be downloaded from: http://www.health.ny.gov/prevention/nutrition/cacfp/docs/cacfp-109.pdf
  3. The Infant Feeding Statement is now included on the Child Enrollment Form (DOH-4419), which must be given to the parents of enrolled infants for completion. A sample is enclosed. The Infant Feeding Statement documents who will supply the formula, if the infant is not breastfed, and/or who will supply solid foods for the infant while in care. Sponsors must enter the parent's infant feeding choices in Child Information Form in CIPS.

III. 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 provider's offer to supply meals to the infant. The only exception is a breastfeeding mother who nurses her own child at the day care home.
  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. All infants under 8 months are eligible to be claimed regardless of who supplies the formula or breast milk, or whether any of the optional solid foods are supplied by the provider.
  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 day care home 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.
  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 day care home provider nurses her own infant she may claim the infant's meals and snacks.

IV. Revised Recordkeeping Requirements for Infant Meals

  1. Infant menus are no longer required for infants under 8 months of age. Instead one infant menu is used for all infants ages 8 through 12 months. Instead of completing an infant menu for each infant in care,
    1. infant menus are only required for infants age 8 through 12 months.
    2. the same infant menu should be used for all children age 8 months to their first birthday. A sample is enclosed.
  2. Keep meal counts to record the number of meals served to all infants who are in care during the meal service period.

V. Common Questions

Q. How will providers know what to feed infants under 8 months in their day care homes if there is no written menu?

A. Solid foods are not required for infants under 8 months of age, so the only menu item is breast milk or iron fortified formula. Day care home providers will follow the parent's instructions for feeding their infants under 8 months of age, in addition to the Healthy Infant Meal Pattern.

Q. Are there any day care homes that are exempt from offering to provide formula and foods to infants?

A. No. All CACFP participating day care homes that care for infants from birth until their first birthday.

Q. How many infant formulas does a provider need to offer? Does it matter if it is powdered, concentrated or ready-to-feed?

A. The day care home 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 a powdered or concentrated formula is chosen, the provider will be responsible for mixing the formula with clean water in the correct amounts.

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 providers 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. However, they may voluntarily bring them.

Q. Can a microwave be used 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. Does the day care home 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. However, remind providers not to feed home-prepared spinach, beets, turnips, carrots or collard greens to infants under 6 months of age because they are high in nitrates. Providers should also never give honey or egg whites to infants.

Q. Whose responsibility is it to pay for special, more expensive formulas?

A. If the infant requires a special formula and a medical provider documents that the infant meets the definition of a person with a disability, the day care home must supply and pay for the formula that the medical provider prescribes. If the infant is not identified as a person with a disability, the provider is not required to supply and pay for the special formula.

Q. What are the guidelines for infants who receive benefits through the WIC Program?

A. The day care home cannot require the parent to provide formula due to their participation in WIC. If the parent chooses to bring their WIC formula to the day care home, the infant meals are still reimbursable as discussed in III above.

VI. Breastfeeding Friendly Day Care Homes

CACFP encourages Sponsoring Organizations and day care homes to support breastfeeding families and recognizes these homes with Breastfeeding Friendly Day Care Home certificates. We are revising our process for conferring Breastfeeding Friendly designations to incorporate minimum training standards. More information will be coming soon. In the meantime, you can visit CACFP's website for more information on how your organization can promote Breastfeeding Friendly Day Care Homes under your sponsorship: http://www.health.ny.gov/prevention/nutrition/cacfp/breastfeedingspon.htm

VII. Summary

CACFP-participating day care homes are obligated to serve all children in care, including infants. If an enrolled child is in care during mealtime, the day care home 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 Day Care Home Sponsors (CACFP-3718), to request them, or print them from the CACFP website at: http://www.health.ny.gov/prevention/nutrition/cacfp/docs/cacfp-3978.pdf

Enclosures

Child Enrollment Form (DOH-4419)

Sample Infant Lunch Menus (CACFP-109)

Optional Infant Menu Forms (CACFP-154, CACFP-155, CACFP-199)