Frequently Asked Question about Feeding Infants on the CACFP
Feeding infants – frequently asked questions
Do you have a question regarding feeding infants on the CACFP? Email us. Answers to your questions will be posted on this page.
Q: What do we do if a parent mixes cereal with infant formula and brings that to the center in a bottle? Can/should we serve this?
If a parent brings their own formula mixed with cereal, the center should request a medical statement in order for that formula to meet meal pattern requirements.
If there is no medical reason for the cereal to be added to the formula, the center could request that the parent bring the formula and cereal separately and then feed the infant the cereal from a spoon.
Q: If the child’s formula is not on the approved list of formulas and it is brought to the center by the parent, is a medical statement needed to claim the child’s meals for reimbursement?
According to page 23 of Feeding Infants “Iron-fortified infant formula is required to meet the meal pattern.” If the parents furnish a formula that is not on the approved list, the parents must also furnish a medical statement for the formula they choose.
Q: A parent has accepted the formula provided by the center. The center provides the formula to the infant for three reimbursable meals. Can the parent provide the formula for non-reimbursed meals at the center? This could occur if the child has five meals at the center.
A: The center needs to provide the formula for meals which will be claimed for reimbursement. The parents would be responsible for providing the formula for the non-reimbursable meals. Centers may choose to provide formula for the non-CACFP meals if they want to.
USDA has issued the following answers to these questions regarding feeding infants on the CACFP
Source: U.S. Department of Agriculture, January 7, 2000
Q: When an infant is transitioning from breast milk to formula, it is common to provide the infant with both foods, to gradually ease the infant into consuming formula in place of breast milk. During this transition period, when an infant is receiving both breast milk and formula, is the meal reimbursable?
A: Yes. From birth through 7 months, any one meal which contains some quantity of breast milk is reimbursable. Similarly, meals containing only infant formula are also reimbursable.
Q: If the mother comes into the day care home or center where her child is in care and breastfeeds her infant, is the meal reimbursable?
A: No. While we support all efforts for mothers to breastfeed their infants, it is our intention that the provider must provide some type of “service” in order to be reimbursed for a meal. The interim rule authorizes meals as reimbursable if the provider bottle feeds an infant breast milk that has been previously expressed by the mother, as it takes effort to prepare the bottle and feed the baby.
Q: Is the meal reimbursable if a provider breastfeeds her own infant?
A: Yes, as long as the infant is otherwise eligible to receive reimbursement (i.e., the provider is income eligible).
More answers from USDA
Source: U.S. Department of Agriculture, April 20, 2000
Q: When an infant receives both breast milk and formula, is the meal eligible for reimbursement?
A: Yes, a meal served to an infant under 12 months of age and under which contains some amount of breast milk (and some amount of formula ) is reimbursable as long as the total number of ounces offered to the infant meets, or exceeds, the minimum amount for the milk component as specified in the CACFP infant meal pattern.
Q: Are meals served to children, 12 months and older, reimbursable if they contain infant formula?
A: Yes, for a period of one month, when a child is weaning from infant formula to whole cow’s milk (i.e., transitioning), meals that contain infant formula may be reimbursable. When a child is weaned from formula (or breast milk) to cow’s milk, it is a common practice to provide the infant with both foods at the same meal service, to gradually ease the infant to accept some of the new food. However, unlike breast milk, infant formula is not an alternative type of milk which can be substituted to meet the fluid milk requirement for the CACFP meal pattern for children over the age of one year. (See FNS Instruction 783-7, rev. 1, Milk Requirement—Child Nutrition Programs.) Thus, for a child 13 months of age and older who is not in this transitional stage, a statement from a recognized medical authority is needed for a meal containing infant formula to be eligible for reimbursement (See FNS Instruction 783-2, rev 2, Meal Substitutions for Medical or Other Special Dietary Reasons).
Q: If a physician prescribes whole cow’s milk as a substitute for breast milk for an infant under 12 months of age, is the meal reimbursable?
A: Yes, a meal or snack containing whole fluid cow’s milk and served to an infant under 12 months of age is eligible for reimbursement if the substitution is authorized, in writing, by a recognized medical authority. Similarly, if a recognized medical authority prescribes a formula such as low-iron formula, which is not currently listed as a formula for CACFP, the meal is eligible for reimbursement.
We have always recognized the unique dietary needs of infants and that decisions concerning diet, during this first year of life, are for the infant’s health care provider and parents or guardians to make together. Therefore, to support the request, a medical statement which explains the food substitution or modification is needed. The statement must be submitted and kept on file by the facility or institution.
Q: A mother would like her 5-month old infant to receive breast milk which she provides and solid foods, which are listed as options in the meal pattern. Because the infant is developmentally ready for solid foods, whose responsibility is it to provide them?
A: If an infant is developmentally ready for one or more solid food items and the parent or guardian requests that the infant be served solid foods, the center or provider is responsible for purchasing and serving them to the infant.
The CACFP infant meal pattern takes into consideration that infants develop at different paces. Some food items such as fruit and cereal are listed as options in the infant meal pattern to account for an infant’s “readiness” to accept these foods (i.e., some infants are developmentally ready for solid foods earlier than others). This occurs in the breakfast and lunch/supper meal service for infants 4-7 months of age, and for the snack meal service for infants 8-11 months of age. A child care center or provider must serve a complete meal to every infant or child enrolled in the meal service. Therefore, if a child is developmentally ready for these solid foods, and the parent or guardian requests that the infant is served solid foods, the components are no longer considered as options and should be served to the infant to provide her with the optimal nutrition she needs to develop and grow.
Q: Is a meal reimbursable if the parent or guardian provides the majority of the meal components for infants older than three months?
In addition to medical or special dietary needs, parents may choose to provide one or several of the meal components under the CACFP infant meal pattern for infants older than three months, as long as this is in compliance with local health codes. Because we recognize that parents or guardians are often most in touch with their child’s individual dietary preferences, we believe the CACFP infant meal pattern can accommodate these preferences. In such a case, the center or provider would still be required to provide at least one of the components in at least the minimum quantities specified in the meal pattern in order for the meal to be reimbursable. Centers and sponsoring organizations also need to ensure that the parent or guardian is truly choosing to provide the preferred component(s), and that the center or provider has not solicited (requested or required) the parent or guardian to provide the components in order to complete the meal and reduce cost to the center or provider.
Q: If a mother comes to the day care home or center to nurse her infant, is the meal reimbursable?
No. Although we strongly support all efforts for mothers to breastfeed their infants, we believe that the caregiver must provide some type of service in order to be reimbursed for a meal. CACFP reimburses child care facilities for the cost of preparing and serving nutritious meals and snacks to infants and children receiving day care. In the case of breastfed infants, CACFP reimburses the facility for the cost of preparing the bottle and feeding the infant. When a parent nurses her own child, the services for which the center or the provider would receive reimbursement are not being performed.
However, the meal would be reimbursable for infants over 3 months of age who are developmentally ready for solid foods, if at least one other component is furnished by the center or provider. For example, if a mother comes to the day care home for lunch meal service to breastfeed her 5 month old infant and the provider supplies a serving of vegetables (listed as options in infant meal pattern for lunch for infants aged 4-7 months), the meal is reimbursable.
Q: If a day care home provider breastfeeds her own infant, is the meal eligible for reimbursement?
Yes, a day care provider who nurses her own infant may claim reimbursement for the meal as long as she is eligible to claim reimbursement for meals and snacks served to her own child. In this case, the meal is reimbursable because the mother (provider) is actively engaged with the child. Thus, unlike a mother who comes into a center or home to breastfeed an infant, the provider is being reimbursed for her services – the time and effort she expends breastfeeding her own infant.
Q: Cottage cheese is a meat alternate in the lunch and supper meal pattern for infants aged 8 through 11 months. How much cottage cheese must be offered to fulfill the meat/meat alternate meal pattern requirement?
Cottage cheese, cheese food, and cheese spread are acceptable meat alternates in the CACFP infant meal pattern. An error in the meal pattern tables in sections 210.10(m)(2)(iii)(C), 210.10a(h)(3), and 226.20(b)(4) incorrectly measures the amount of cheese in tablespoons. The correct amount which may be offered as a meat alternate to infants, aged 8 through 11 months, is 1 to 4 ounces.
Q: Is yogurt an allowable meat alternate in the infant meal pattern?
The Office of Analysis, Nutrition and Evaluation plans to issue a memorandum on the use of yogurt in the CACFP infant meal pattern in the future.