Q: I am not sure about preparing infant formula in my center. Can you help me with this?

Yes. Day care centers can prepare formula as long as they have written permission from the parent/guardian or instructions from the physician. Please refer to memo CACFP 00-01: North Carolina Sanitation Requirements for Preparing Infant Formula. (7/00)

Q: If centers must prepare bottles and serve baby foods, can a disclaimer such as this center will not be held liable for illness due to formula preparation, inadequate sanitation, etc be used?

The CACFP has no requirements for using a disclaimer. You may want to check with your licensing consultant on this. (7/00)

Q: When an infant receives both breast milk and formula, is the meal eligible for reimbursement?

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 for each meal time as specified in the CACFP infant meal pattern. (7/00)

Q: Are meals served to children, 12 months and older, reimbursable if they contain infant formula?

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. 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. (7/00)

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?

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 fortified formula, which is not currently listed as a creditable 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. (7/00)

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?

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 patterns 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. (7/00)

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. (7/00)

Q: If a mother comes to the day care home or center to nurse her infant, is the meal reimbursable?

No. 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 an option in the infant meal pattern for lunch for infants aged 4-7 months), the meal is reimbursable.

Although we strongly support all efforts for mothers to breastfeed their infants, the caregiver must provide some type of service in order to be reimbursed for a meal. When a parent nurses her own child, the services for which the center or the provider would receive reimbursement are not being performed. (7/00)

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.

As with any other claim for meals served to the provider’s own child, the infant must be eligible for free and reduced price meals, enrolled in the day care program, and participating in the program during the time of the meal service. At least one other nonresident child must also be enrolled in the day care program and present during meal service. (7/00)

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. (7/00)

Q: Beech Nut has a product called a "dessert" which contains only apples, apple concentrate with water added, cinnamon, and Vitamin C. There is no added sugar. Since this product does not contain pudding, cereal, or some other type of an extender, would this be an exception?

The Beech Nut product labeled as a "dessert" is NOT reimbursable in the Infant Meal Pattern. Commercial baby foods in the dessert category (these generally have "dessert" or pudding" as part of the product name on the front of the label) which list a fruit as the first ingredient in their ingredient listing are NOT reimbursable meal components in the Infant Meal Pattern". (2/00)

Q: Carnation has a new product which is infant cereal and formula mixed together. Is this a creditable food item?

All infant cereals which contain formula ingredients added to them by the manufacturer are not reimbursable. The CACFP Infant Meal Pattern will allow only infant cereal that meets the definition "any iron fortified dry cereal specially formulated for and generally recognized as cereal for infants that is routinely mixed with formula or milk prior to consumption" and does not contain additional ingredients such as fruit or infant formula ingredients. (2/00)

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?

Yes. From birth through 7 months, any one meal which contains some quantity of breast milk is reimbursable. Similarly, meals containing only infant formula provided by the provider are also reimbursable. However, meals containing only parent-provided formula, and no other meal components, may not be reimbursed. (2/00)

Q: The new regulation requires providers to offer iron-fortified formula to infants less than one year of age. Child care providers cannot mix infant formula at the facilities. How can providers be sure that the parents are bringing iron-fortified formula for their infant?

Formula provided by child care centers can be mixed by the provider as long as there is written permission from a physician or the parent and kept on file (see enclosed memo). The Provision of Iron-fortified Infant Formula or Breastmilk form, that was mailed with memo 99-32 (Federal Regulation Changes) has a space for the parent to give the provider that permission. This form should be kept on file for each infant. (2/00)

Q: How can I claim breastfed infants if our facility does not claim infants on the CACFP?

If you have an agreement with the State Agency to receive reimbursement from the CACFP, all enrolled participants should be offered the benefits of the program. Therefore, if you have infants enrolled in your center, the center must at least offer iron-fortified formula. If the parent brings the breastmilk for their infant, the breastfed infant may also be claimed.

Q: With the new alternate protein regulations in effect, is tofu now a creditable food item?

Based on the guidance we now have, tofu is still not a creditable food item. We will keep you informed if this guidance changes. (7/00)

Q: Are bamboo shoots and water chestnuts approvable as vegetables?

Yes, they both are creditable vegetables. (7/00)

Q: Is there an approved meal pattern for families following Jewish dietary laws with no meat and milk in the same meal?

There is not a written meal pattern, but the regulations do allow for ethnic/religious preferences. Milk must be served at breakfast, lunch, and supper, but vegetable proteins, cheese, nuts, etc. can be substituted for meat. Then the participants can have meat at snack with another component. (7/00)