Nutrition Services Nebraska Department of Education Feeding Infants Nutrition Services Nebraska Department of Education Welcome to this workshop on Feeding Infants.

Definition of Infant in the CACFP Birth through 11 months Up to the child’s first birthday An infant is a child who has not had his or her first birthday.

Infant Meals CACFP Centers caring for infants must offer meals to them. All centers must offer iron-fortified infant formula to infants under one year of age.

Feeding Infants Book This is a very important resource when feeding infants. You can download it from Nutrition Services Web-site. If you were participating in CACFP in 2002 and claiming infants, you should find a copy at your center. I will be referring chapters in this guide throughout this presentation. http://www.education.ne.gov/ns/CACFP/feeding_infants.pdf

Nutrition Services web site http://www.education.ne.gov/ns Another important resource is the Nutrition Services Web Site. There is a special section on Infant Feeding. Click on Child and Adult Care Food Program

Scroll down and click on Infant Feeding

Infant Formula Selection Box Our Enrollment Form has this area to ask the question about formula provided by the center. Be sure to write in the name of the formula you offer prior to copying multiples of this form.

Infant Formula/Feeding Selection Form This form is for the same purpose if you don’t use the enrollment form provided by our office. One or the other must be used.

Breast Milk Credited the same as formula Chapter 3 provides information on handling breast milk As I said before, breast milk is the best food for babies. Women are encouraged to continue breast feeding after they return to work. If mothers can visit their infant’s center, a comfortable place for breast feeding should be provided. It is more and more common for women to express breast milk and provide it for their infants in centers. If your center is feeding an infant breast milk, their meals can be claimed just the same as formula provided by the center. It is important to handle breast milk correctly. Labeling and dating bottles is very important.

CACFP Meal Pattern Birth through 3 months Breakfast Lunch or Supper Snack Breast Milk or 4-6 oz Formula

Reimbursable meals for Birth through 3 months Center provided formula Parent provided breast milk Parent provided formula Staff mother breast feeding during work hours Only exception is when visiting mother (non-staff) breastfeeds infant Meals that are reimbursable for infants from birth through 3 months are those that contain parent provided breast milk, parent provided formula or center provided formula. The center is reimbursed for feeding infants aged birth through 3 months regardless of the source of the formula. If the mother comes to breastfeed her child, the meal is not reimbursable when no other foods are required. If an employee of the center breastfeeds her own child, that meal is reimbursable.

0-3 Tbsp. Fruit and/or Vegetable CACFP Meal Pattern 4 through 7 months Breakfast Lunch or Supper Snack Breast Milk or 4-8 oz. Formula or 4-6 oz. Formula 0-3 Tbsp. Infant Cereal 0-3 Tbsp. Fruit and/or Vegetable Please note that the snack amount for 4-7 months old infants is 4-6 ounces of formula or breast milk. Please correct your hand-out.

Reimbursable meals for 4 through 7 month olds Center provided formula Parent provided formula Parent provided breast milk Foods added, as appropriate per infant, provided by Center Meals for infants 4-7 months old are reimbursable if the parent provides breast milk, the center provides formula or parent provides the formula. As foods are added, these must be provided by the center.

Reminders Ages 4-7 months: 0-3 T cereal or veg./fruit means that the meal component is optional dependent on the infant’s needs. Portion size not listing zero as a measurement indicates the component must be offered, i.e. formula. On ages 4-7 months, if a component is listed as 0-3 Tablespoons, that component is optional.

CACFP Meal Pattern 8 through 11 months Breakfast All 3 components must be offered Lunch or Supper Snack Breast Milk or 6-8 oz. Formula or 2-4 oz. Formula 2-4 Tbsp. Infant Cereal 2-4 Tbsp. Infant Cereal Or 1-4 Tbsp. Meat Or 2 - 4 oz. Fruit Juice 1-4 Tbsp. Fruit and/or Vegetable 0-1/2 Crackers/ Bread Please note that the snack amount for 8-11 months old infants is 2-4 ounces of formula or breast milk or 2-4 oz of full strength fruit juice. Zero to ½ cracker is also included as an optional component. Please correct your hand-out.

Reimbursable meals for 8 through 11 month olds Center must offer meal components with either breast milk or formula For infants ages 8 through 11 months, the center must provide required meal components with either breast milk or formula.

Meat Portions for 8 - 11 Month Olds Lunch and Suppers 1 - 4 tablespoons of meat, poultry, egg yolk, cooked dry beans or peas or 1/2 - 2 ounces of cheese 1 - 4 ounces (volume) of cottage cheese or 1 - 4 ounces (weight) of cheese food or cheese spread

Reminders Ages 8-11 months: Breakfast - infant cereal is required to be offered Lunch & Supper: infant cereal and/or meat/meat alternate must be offered For ages 8-11 months, At breakfast iron fortified infant cereal must be served. At lunch and supper, iron fortified infant cereal and/or meat must be served. Iron intake in very important for infants.

Reminders Full strength (100%) juice is reimbursable only at snack for 8 through 11 month old infants Juice must be pasteurized Full strength juice, which is 100% juice, can only be considered a fruit/vegetable component at snack. Juice cannot be diluted or watered down for infants. While there is no current regulation requirement for pasteurized juice, it is strongly recommended. Pasteurized juice is generally identified as such on the product label. Unpasteurized juice, such as apple juice and orange juice, can contain pathogenic microorganisms and infants are at particular risk for serious illness and even death from these pathogens.

Reimbursement Requirements Infant must be enrolled Infant Formula Selection Form/box must be completed/filled out Infant Meal Record must be completed Reimbursement Requirements: Infant must be enrolled The Infant Formula/Feeding Selection Form must be completed and on file The Infant Meal Record must be completed and document meal pattern was met Meals must be counted at the point of service. Meals are claimed as paid unless an IEF is completed and on file.

Reimbursement Requirements Meal must be offered to all ages Claim as “Paid” unless IEF is on file Point of service meal count sheets must be completed

Infant Meal Records Weekly Record One per individual per week OR Daily Record One per day for multiple infants of the same age group Infant meal records are required for claiming infant meals in CACFP. Your center can choose to complete weekly record for each infant for each week or you can do a daily record that lists multiple infants. Choose one or the other. The Infant Meal Records are best completed by the persons feeding the infants. However, if the foods are prepared in a central location, they can be completed there.

Infant Meal Records Write in the date, infant’s name, date of birth (DOB) and claim code. List what food and the amount of food offered at each meal immediately after feeding the child. Mark the meals on a point-of-service meal sheet (blue & white) – Only infants’ meal counts can be done at the end of the day (from infant meal production records) The Weekly Meal Record is designed to allow one record per infant per week. There are three weekly meal records, one for each age group. Record the infant’s name and Date of Birth. Record the amount of food offered at each meal for each infant. Again, the specific food and the amount must be recorded. Use the meal count section at the bottom of the page to count the meals served.

Iron Fortified Infant Cereal Mix with breast milk or formula – you can mix in fruit Feed with a spoon; not from a bottle After measuring the cereal, mix it with breast milk or formula to the consistency that is appropriate for the infant. Always feed cereal from a spoon, not from a bottle.

Iron Fortified Infant Cereal Not creditable: Cereal in jars Infant Cereal with fruit flakes Regular family breakfast cereals (hot or cold) Some cereals are not creditable and meals including these cannot be reimbursed: Cereal in jars-sometimes called “wet” infant cereals. Cereal designed for older children and adults, “regular cereal”. These cereals are not recommended for babies because: These often contain mixed grains. These are often higher in salt and sugar than infant cereals. These may contain vitamins and minerals in forms or amounts that are not suitable for babies. These may contain small hard pieces of food that could cause choking. Even regular oatmeal is not acceptable as infant cereal.

Vegetables and Fruits Commercially Prepared Center Prepared Commercially Prepared is often called Baby Food. Beginning vegetables and fruits include: Commercially prepared baby foods: Green beans, green peas, squash, sweet potatoes, carrots, beets, spinach, applesauce, apricots bananas, peaches, pears and plums. Center prepared vegetables that have been cooked and processed to the proper texture: Asparagus, broccoli, cabbage, cauliflower, green beans, green peas, kohlrabi, plantain, potatoes, squash,and sweet potatoes. Center prepared fruits that have been cooked and pureed or mashed: Apples, pears, and dried fruit. Ripe fruits that can be mashed: Apricots, avocado, bananas, cantaloupe, mango, melon, nectarines, papaya, peaches and plums. Avoid citrus fruits until after 6 months of age.

Commercial Fruits and Vegetables Vegetable or fruit must be listed as first ingredient (no sugar) Plain vegetables and fruits are preferred In order to be creditable a commercially prepared fruit/vegetable must list a fruit or vegetable as the first ingredient on the label. Plain vegetables and fruits are best because they contain more nutrient and do not usually contain sweeteners and salt.

Center Prepared Fruits and Vegetables Texture must be appropriate; usually cooked Avoid canned vegetables that are high in sodium Avoid canned or frozen fruits with added sugar Babies between 6 and 12 months of age may be served soft-cooked vegetables and fruits. Ripe bananas do not need to be cooked. It is best to begin with pureed fruits and vegetables and as the infant becomes more adept at handling solid foods, you can progress to ground and then fork mashed items. Do not add salt, sugar, fat, or other seasonings to the fruits and vegetables being prepared for a baby.

Center Prepared Fruits and Vegetables Choking dangers: Raw vegetables Corn kernels Hard fruits: apples, etc. Whole fruits: grapes, etc. Uncooked dried fruits Due to the risk of choking, there are various fruits and vegetables that should not be fed to infants.

Meat and Meat Alternates Eggs Egg yolks at 8 months Yolk must be hard cooked Avoid egg whites until after 1 year. Egg yolk can be introduced at or after 8 months of age. The yolk must be hard cooked to avoid harmful bacteria. Salmonella can cause severe illness in infants. Egg whites should not be fed to infants under 1 year of age because it may cause allergic reactions.

Meat and Meat Alternates Cheese Introduced at 8 months or older Natural cheese rather than processed cheese Cheese and yogurt can be in introduced at 8 months or older. Cheese should be cut into thin strips not chunks to make choking less likely. Use regular cheese such as natural cheddar, Colby or mozzarella, not cheese food, cheese spread or processed cheese. Cheese food, cheese spread or processed cheese are higher in salt than regular cheese. Cheese in cooked foods, such as pizza, will not have a texture appropriate for infants.

Meat and Meat Alternates Avoid: Peanut butter, seeds, nuts Fish and shell fish Processed meats (chicken nuggets) Peanuts and nuts are likely to cause a reaction in infants. Peanut butter is not reimbursable in infant meals for CACFP. Fish and shellfish may contain higher levels of mercury or cause severe allergic reactions. Processed meats are higher in fat and sodium and lower in protein that plain meats.

Meat and Meat Alternates Not creditable: Fish sticks Hot dogs “Baby Food” meat sticks Commercial or home made: casseroles/combination dinners: Macaroni & cheese, turkey & noodles, spaghetti & meat sauce These foods should not be fed to infants and are not reimbursable under CACFP. Fish sticks may contain bones. Hot dogs are higher in fat and sodium and can cause choking. Baby food meat sticks are meant for children over 1 year old. Home canned meats may contain harmful bacteria. In commercially prepared combination dinners the amount of meat, fruits, vegetables etc. cannot be determined.

Grains/Breads Bread or crackers Strips of dry bread, toast, tortillas Plain crackers Teething biscuits Bread or crackers may be served with snack or with meals. Again consult with the parents to determine which breads and crackers have been introduced at home. At 8 or 9 months of age, children enjoy having finger foods. Also, at that age, the risk of a reaction to wheat decreases. These are examples of the kinds of bread or crackers that are acceptable. Remember that the breads and crackers must be made from whole grain or enriched flour. Choose crackers that are lower in salt. Do not use graham crackers made with honey.

Grains/Breads Avoid: Snacks such as pretzels or chips Cookies or granola bars Crackers with seeds, nuts, etc. Whole kernels, such as rice. Avoid forms that can cause choking. Mash cooked rice if it is used.

Foods to Avoid Sweeteners and Sweetened Foods: “Baby Food” Desserts Cakes, cookies, candy Chocolate Added sugar, syrup, etc. Avoid highly sweetened foods.

Infant Records Infant meal records must be complete if the meal is to be claimed. Creditable meals must also be marked on the Record of Meals and Supplement Served forms (meal count sheet).

Question A parent mixes cereal and formula in a bottle and brings it to the center. Can we claim this as a creditable formula for a meal? ? +

Answer A parent mixes cereal and formula in a bottle and brings it to the center. Can we claim this as a creditable formula for a meal? NO. A doctor’s statement is needed to claim formula mixed with cereal in a bottle. 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 the center could provide the cereal and then feed the infant the cereal from a spoon. If there is no doctor’s statement and the parent will not provide the formula without the cereal, the meal is not reimbursable.

Question If a parent wants an infant to have more than three meals during the day, who should furnish the formula for the meals that cannot be claimed?

Answer If a parent wants an infant to have more than three meals during the day, who should furnish the formula for the meals that cannot be claimed? The parent because the center is not required to provide formula for more than three meals per infant per day.

Question If a parent wants an infant to have only a limited number of bottles/formula, which is less than the infant wants, what are you to do?

Answer If a parent wants an infant to have only a limited number of bottles/formula, which is less than the infant wants, what are you to do? Since infants are “fed on demand” and unless there is a medical statement, honor your responsibility to the infant.

Question Is yogurt a creditable food for infants?

Answer Is yogurt a creditable food for infants? No. Commercially prepared, plain yogurt can be served as an extra to infants 8 months and older, but it is not creditable as a meat/meat alternate. The same would go for mixed dinners.

Question Are meals served to a child who just turned one year old reimbursable if they contain infant formula?

Answer Are meals served to a child who just turned one year old reimbursable if they contain infant formula? Yes, for a period of one month. After the 13th month, a doctor’s statement will be needed for formula to continue in place of fluid milk.

Question If a physician prescribes whole cow’s milk as a substitute for breast milk or formula for an infant under 12 months of age, are meals reimbursable?

Answer If a physician prescribes whole cow’s milk as a substitute for breast milk or formula for an infant under 12 months of age, are meals reimbursable? Yes, with a doctor’s statement, the meal pattern can be amended.

Question Must all infants be fed during the period identified as meal time on the center agreement with NDE?

Answer Must all infants be fed during the period identified as meal time in the center agreement with NDE? No, infants are “fed on demand”. vs. Infants, especially younger ones, do not always have a specific feeding schedule. If lunch for the older children is identified at 12:00 to 1:00, but the infant is hungry at 11:00, you may serve a reimbursable lunch and claim the meal. For some infants, the meal may also be split. For example, the 8 month old my be fed the required food components at one time and then have the formula in the bottle a little later.

Infant Meal Records

Infant Meal Records Supply all the information as indicated on the top of each form. Write specific kinds and amounts of food offered to the infant based on meal pattern requirements; i.e., “6 oz. formula”, “4 T. plums”, “2 T. chicken”.

Infant Meal Records Use in combination with a point of service meal count sheet. All records must be kept for 4 years

Questions? Please pick up your certificate Call us at 800-731-2233 in Nebraska or 402-471-2488 in Lincoln.