Ray Hawkins, Unit Head
Special Nutrition Programs

Arnette Cowan, MS, RD, LDN
Nutrition Program Consultant

The new USDA policy requiring child care facilities on the Child and Adult Care Food Program (CACFP) to offer formula has raised many questions about the NC child day care sanitation requirements. The purpose of this memo is to clarify for CACFP sponsors the North Carolina sanitation rules about preparing formula. We have worked with staff of the Environmental Health Branch, Department of Environment and Natural Resources who oversee child day care sanitation. This memo updates any previous correspondence on these issues.

PREPARING FORMULA

Current North Carolina sanitation rules allow all licensed child day care facilities to prepare and serve formula on-site. Therefore, all CACFP sponsors may begin preparing formula upon receipt of this memo. In accordance with 15A NCAC 18A .2804(e), the minimum sanitation rules listed below must be followed in all centers and large day care homes.

• The formula must be prepared in a designated kitchen area with at least a two-compartment sink, a refrigerator, and a separate handwashing area. If this equipment is not located in the area where infants are cared for, an additional staff person is needed who can go to the kitchen and prepare the formula so that infants are not left unattended.
• Written permission from a parent or guardian or a prescription from the child's physician is required whenever formula that is not pre-packaged and ready-to-feed is provided by the facility to an infant. Facilities preparing bottles on-site and offering concentrated or powdered formula or ready-to-feed formula in a can must get permission from the parents of infants using that formula. The Provision of Iron-Fortified Infant Formula or Breastmilk form provides a place for parents to give their permission for this when they sign to accept the formula. This form may be used as is or may be added to the infant's enrollment form, and will count as the required written permission.
• Facilities using re-usable bottles must have either a dishwasher or a three-compartment sink and must sanitize bottles and nipples between uses.  
• Facilities who do not have a dishwasher or three-compartment sink for sanitizing bottles / nipples may still prepare formula but must use single-service bottles.

Sponsors with questions about the child day care sanitation rules may call their local health department environmental health specialist or the special nutrition programs consultant assigned to their county.

cc: Alice Lenihan
Auditors
Ed Norman, Division of Environmental Health