Individualized Education Plan (IEP) | 504 Accommodation Plan | Diet Order Form (PDF) | Diet Order Form Instructions | Special Diet Needs

This section assists parents or guardians with children who have special dietary needs. Children with special diet needs can have school breakfast and lunch made for them. By law, changes can be made to your child's school lunch breakfast and lunch at no extra charge, if he or she has special needs or a medical condition.

• Is your child eligible?
• What kind of condition would make your child eligible?
• What kind of meal changes can be made?
• How can you get special school meals for your child?

Is your child eligible?

If your child needs diet changes to do major life activities, he or she is eligible. A major life activity is defined as caring for one's self, doing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working.

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Here are some examples of developmental disabilities or medical conditions which effect major life activities:

Diabetes Seizure Disorder Spina Bifida Severe Obesity Cerebral Palsy

Severe Food Allergy Down Syndrome PKU (Phenylketonuria) Metabolic Disorders Juvenile Rheumatoid Arthritis

Cystic Fibrosis Feeding Difficulties Prader Willi Syndrome Conditions requiring tube feedings

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What kind of meal changes can be made?

Here are some examples:

• Texture Changes (pureed, ground, chopped, thickened liquids)
• Increased Calories
• Weight Management (calorie controlled)
• Tube Feeding
• Food Restriction (milk & milk products, eggs, other)

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Follow the steps below:

1. Obtain the "Diet Order Form" from one of the following sources:
   
   • Download the Diet Order Form (PDF) from this web site
   • The child nutrition director for your child's school
   • The schools principal's office
   • Your local health department nutritionist
   • A Developmental Evaluation Center nutritionist

   The Diet Order Form can be downloaded as an Acrobat Portable Document (PDF) file and then printed out. Adobe's Acrobat Reader is a freely distributed program which allows documents, such as this form, to keep their official format. Below is the address to order a hard copy if you prefer.

   Additional forms may be ordered from:

   Division of School Services
   Child Nutrition Services Section
   301 North Wilmington Street
   Raleigh, NC 27601-282

2. Fill out Part I of the Diet Order Form. Have your child's pediatrician, the family physician, or the health department's physician fill out Part II and sign the form.
3. Take the form to the principal's office at your child's school. Copies will be given to you, your child's teacher, and the school food service manager.
4. If your child has an Individual Education Plan (IEP) or a 504 Accommodation Plan, ask that a statement about the dietary change be put in the plan.
5. Help the school make the dietary changes by answering any questions and working with them to meet your child's needs. In some cases, it may be necessary for you to meet with the school food service manager and a dietitian to plan your child's menus. If you have a meal plan from a dietitian, you can attach it to the form.

If you have any questions about the special school meals for your child, call the Child Nutrition Program at 1-800-662-7030 extension 5-1920.

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