1. 1 Infant Meals Component of the Child and Adult Care Food Program -CACFP Ann-Marie Martin CACFP Coordinator Alaska Department of Education & Early Development

2. Definition of Infant in the CACFP 2 Birth through 11 Months Up to the child’s first birthday

3. Infant Meals CACFP Centers/Providers caring for infants must offer meals to them 3 All centers/providers must offer iron- fortified formula to infants under one year of age

4. To claim infant meals for reimbursement To Claim Reimbursement for Infant Meals: Parents complete CACFP Enrollment form that includes infant section or complete an Infant Formula/Feeding Selection form Include infants in your One Month Enrollment Report (OMER) Follow the CACFP Infant Meal Pattern Take point of service meal counts Maintain Infant Menus/Meal Count records 4

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7. One Month Enrollment Report (OMER Infants must be listed on the Center’s One Month Enrollment Report (OMER) that is completed each year 7 Center administrators complete the OMER annually for documenting family income which is directly associated with reimbursement for the center. For more information on completing the OMER please contact EED.

8. USDA Infant Meal Pattern Meal pattern is grouped into three age categories: birth-3 mo 4-7 mo 8-11 mo 8

9. Required Components May offer either: Breast Milk and/or Iron-fortified Infant Formula (IFIF) Solids when infants are developmentally ready: 4-7 months optional (only if not developmentally ready) 8-11 months required 9

10. Must provide at least one infant formula Parents may decline infant formula Bring their own iron-fortified infant formula Bring their own pumped breast milk 10

11. When parents provide non- creditable infant formulas 11 Provide a Specialty Formula That does not meet CACFP Requirements Need: Signed Medical Statement Diagnosis must be identified and authorized Example: Low-iron formulas <1 mg iron per 100 kcals

12. Breast Milk Credited the same as formula Chapter 3 provides information on handling breast milk 12

13. AgeBreakfastLunch and SupperSnack Birth through 3 months 4-6 fluid ounces formula 1 and/or breast milk 4 through 7 months 4-8 fluid ounces formula 1 and/or breast milk 0-3 Tbsp infant cereal 2 (ready) 4-8 fluid ounces formula 1 and/or breast milk 0-3 Tbsp infant cereal 2 (ready) 0-3 Tbsp fruit and/or vegetable (ready) 4-6 fluid ounces formula 1 and/or breast milk 8 through 11 months 6-8 fluid ounces formula 1 and/or breast milk and 2-4 Tbsp infant cereal 2 and 1-4 Tbsp fruit and/or vegetable 6-8 fluid ounces formula 1 and/or breast milk and 2-4 Tbsp infant cereal 2 and/or 1-4 Tbsp lean meat, fish, poultry, egg yolk, cooked dry beans or cooked dry peas 5 or ½-2 ounces (weight) cheese or 1-4 ounces (volume) cottage cheese or 1-4 ounces (weight) of cheese food or cheese spread and 1-4 Tbsp fruit and/or vegetable 2-4 fluid ounces formula 1 and/or breast milk or fruit juice 3 0 to ½ slice of crusty bread 4 (optional) or 0 to 2 crackers 4 (optional) CACFP Infant Meal Pattern 13

14. Birth through 3 months Required at all meals and snacks: Iron-fortified formula and/or Breast milk OK to offer less than the minimum amount of breast milk 14 BreakfastLunch or SupperSnack Breast Milk or 4-6 oz Formula Breast Milk or 4-6 oz Formula Breast Milk or 4-6 oz Formula

15. Reimbursable meals for Birth through 3 months Center provided formula Parent provided breast milk Parent provided formula Staff mother breast feeding during work hours (not on break) Only exception is when visiting mother (non-staff) breastfeeds infant (not reimbursable) 15

16. 4 through 7 months Required at all meals and snacks: Iron-fortified formula and/or Breast milk Solid foods when developmentally ready 16 BreakfastLunch or SupperSnack Breast Milk or 4-8 oz. Formula Breast Milk or 4-8 oz. Formula Breast Milk or 4-6 oz. Formula 0-3 Tbsp. Infant Cereal 0-3 Tbsp. Fruit and/or Vegetable

17. 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 17

18. Reminders Ag es 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. 18

19. 8 through 11 months 19 Breakfast All 3 components must be offered Lunch or Supper All 3 components must be offered Snack Breast Milk or 6-8 oz. Formula Breast Milk or 6-8 oz. Formula Breast Milk or 2-4 oz. Formula 2-4 Tbsp. Infant Cereal2-4 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

20. Reimbursable meals for 8 through 11 month olds Center must offer meal components with either breast milk or formula 20

21. 8 through 11 months Required at Breakfast: Iron-fortified formula and/or breast milk Iron-fortified infant cereal (IFIC) Fruit and/or vegetable (not juice) 21

22. 8 through 11 months Required at Lunch and Supper: Iron-fortified formula and/or breast milk Fruit and/or vegetable (not juice) Iron-fortified infant cereal (IFIC) and/or Meat/meat alternate Lean meat, fish, poultry, egg yolk, cheeses, and beans or peas 22

23. 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 or 1 - 4 ounces (volume) of cottage cheese 23

24. 8 through 11 months Required at Snacks: Iron-fortified formula and/or Breast milk or Fruit Juice (full strength) 24 When developmentally ready: Crusty bread or Crackers

25. Reminders Ages 8-11 months: Breakfast - infant cereal is required to be offered (you can add fruit to the cereal & you can make with formula vs. water) Lunch & Supper: infant cereal and/or meat/meat alternate must be offered 25

26. Introducing Solids Introduce new food one at a time: Allow 3 to 5 days between each new food Observe infant closely for any reaction to new food items Serve appropriate textures in small amounts Do not add sugar, salt, fat, or spices to food 26

27. Table food for older infants You can serve table food to older infants & claim meal if … You have checked with parents on items you can serve to the infant from the “big kids” menu The infant still gets all required components of the Infant Meal Pattern 27 Big kids menu: hamburger so you To serve/claim for Infants: Cut it up write “hamburger” on the infant menu in the meat/meat alternate column You still need to serve infant formula/breast milk and vegetable/fruit

28. Infant Formula Center must supply at least one creditable infant formula USDA is no longer keeping an approved infant formula list on their website Ensure formula is not an FDA exempt Infant Formula Look for the statement “Infant Formula with Iron” Use the nutrition facts label as a guide Must have 100 mg of iron or more per 100 calories of formula 28

29. Parent Provided Food & Formula A parent may choose to provide food and/or formula for their own child. Must be an iron-fortified infant formula Maintain documentation that the parent declined offered food and/or formula (CACFP enrollment form or the infant formula/feeding selection form) 29

30. Food Provided by Parents Parents may provide breast milk, formula, and/or foods, However, the center/provider must: -Supply at least one required component when two or more components are offered (not earlier than 4 months), in order to claim the meal for reimbursement. 30

31. Food Provided by Parents When mom comes to the site and nurses their child… the meal is not reimbursable… UNLESS the center or provider supplies an additional required component. 31

32. When staff member nurses their own child 32 the meal is reimbursable if they are working If on break you will treat as if they are a mom coming in to breastfeed their infant

33. Is this infant meal reimbursable? 33

34. Is this infant meal reimbursable? 34

35. Infant Menu/Meal Count Records Weekly or Monthly Record One per individual per week OR Daily Record One per day for multiple infants of the same age group 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 menu/meal sheet 35

36. Individual Infant Menu/Meal Count 36 Pont of service (POS) – write food offered at time of service & include count

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38. Infant menus must contain the following information: Food components offered. Names of infant. Infant’s age and date of birth. Meal type. Date of meal service. 38

39. Common Menu Documentation Errors Non-creditable foods Missing required components Breast fed infants are included in the meal counts (and no other component supplied by the site). 39

40. Not moving to next set of meal pattern requirements at start of their 4 th and 8 th months. Infants are moved to the Toddler Room and their meals are no longer recorded on individual daily infant meal records or are fed the child meal pattern. Children over age 1 are still in the infant room and fed infant meal pattern. Common Menu Documentation Errors 40

41. Transitional Period After the 1 st Birthday Between the 12 th and 13 th month Transition from IFIF to cows milk Offer as a mixture 41

42. Happy 1 st Birthday! After the 1 st Birthday Use the 1 through 2 year old meal pattern Cows milk – full fat for 1 to 2 yr. olds Medical statements required: Infants not ready to be served the1-2 year old meal pattern 42

43. Medical Statements Also required for serving: Cows milk to children under 1 year Formula to children over 13 months An alternate meal pattern 43

44. Creditable Foods for Infants Foods prepared at the center, with appropriate modifications Commercially prepared foods must be plain fruits, vegetables, and meats Infant cereal must be iron fortified 44

45. Iron Fortified Infant Cereal Iron-fortified (45 mg. of iron for every 100 g. of dry cereal) Mix with breast milk or formula Feed with a spoon; not from a bottle Many older infants don’t like infant cereal for breakfast, but it is required to claim the meal – mix in fruit and they like it 45

46. Iron Fortified Infant Cereal Not creditable: Cereal in jars Infant Cereal with fruit flakes Regular family breakfast cereals (hot or cold) 46

47. Vegetables and Fruits Commercially Prepared Center Prepared 47

48. Commercially Prepared Infant Food Fruits and Vegetables Creditable The fruit or vegetable is the first ingredient Contain multiple fruits or vegetables Water is not the first ingredient Non-Creditable Baby dinners Jarred cereal with fruit Desserts Water is the first ingredient 48

49. Commercial Fruits and Vegetables Vegetable or fruit must be listed as first ingredient (no sugar) Plain vegetables and fruits are preferred 49

50. Pasta Vegetable Medley 4 oz. Vegetables Ingredients: water, tomato paste, pear concentrate, carrots, dried egg yolks, enriched macaroni product (durum wheat semolina, niacin, ferrous sulfate, thiamine mononitrate, riboflavin and folic acid), romano cheese (made from partially skimmed cow's milk, cheese cultures, salt and enzymes) and zinc sulfate. Rice Cereal with Apples Beech-Nut Naturals First Advantage 4 oz. Cereals Ingredients: apples, apple juice from concentrate (water and apple juice concentrate), water, dried egg yolks, rice flour, cinnamon, ascorbic acid (vitamin c), ferrous sulfate (source of iron), citric acid, zinc sulfate (source of zinc), niacinamide, calcium pantothenate, thiamine mononitrate (vitamin b1), riboflavin (vitamin b2), pyridoxine hydrochloride (vitamin b6), vitamin b12 and folic acid. Not Creditable - Water 1 st ingredient. - Has 2 food components, making it a dinner. Not Creditable Cereals with fruit not creditable. 50

51. 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 Do not add sugar or salt 51

52. Center Prepared Fruits and Vegetables Choking dangers: Raw vegetables Corn kernels Hard fruits: apples, etc. Whole fruits: grapes, etc. Uncooked dried fruits 52

53. Meat and Meat Alternates 53 Eggs Egg yolks at 8 months Yolk must be hard cooked Avoid egg whites until after 1 year.

54. Cheese Introduced at 8 months or older Natural cheese rather than processed cheese 54 Meat and Meat Alternates

55. Avoid: Peanut butter, seeds, nuts Fish and shell fish Processed meats (chicken nuggets) 55 Meat and Meat Alternates

56. Commercially Prepared Infant Food Meat & Meat Alternates Creditable Plain strained baby food meats - Including those with beef, chicken, turkey, lamb, veal, and ham. Non-Creditable Combination dinners. Meat sticks. Breaded/battered seafood and canned fish with bones. Yogurt. Nuts, seeds, and nut/seed butters. 56

57. Chicken Lasagna Beech-Nut Naturals Stage 3 6 oz Dinners Ingredients: water, tomato paste, finely ground chicken, carrots, pear puree concentrate, enriched macaroni product (durum wheat semolina, niacin, ferrous sulfate, thiamine mononitrate, riboflavin and folic acid) and romano cheese (made from partially skimmed cow's milk, cheese cultures, salt and enzymes). Vegetables & Beef Beech-Nut Naturals Stage 2 4 oz. Dinners Ingredients: vegetables (carrots, rehydrated potatoes, peas), water and beef Not Creditable - Has more than 1 food component. - Considered a “Dinner”. Not Creditable - Water 1 st ingredient - More than 1 food component. Making it a “dinner”. 57

58. Grains/Breads (1 st ingredient is whole or enriched grain) Strips of dry bread, toast, tortillas Plain crackers - saltines Teething biscuits English muffins Pita bread Animal crackers Graham crackers (without honey) 58

59. Grains/Breads Avoid: Snacks such as pretzels or chips Cookies or granola bars Crackers with seeds, nuts, etc. Whole kernels, such as rice. 59

60. Non-Creditable Breads and Crackers for Infants Allergies (whole eggs): pancakes waffles muffins Calories: brownies cakes doughnuts Choking: hard pretzels breadsticks tortilla chips granola bars some ready to eat cereals 60

61. Meal Times for Infants No specified meal time May offer meal at more than one sitting Claim if around “normal” meal time Breakfast not claimed at 11 a.m. Complete one meal before serving the next 61

62. Meal Times for Infants On-Demand Infant Feeding Feed when hungry Only approved meal types can be claimed 62

63. Division of Responsibility Whether breast or formula fed and make baby feel comfortable/secure Help baby feel calm & alert Learn cues of baby Don’t push or continue to feed if baby is not interested Introduce solid foods when baby is interested and able to eat, versus by their age 63 Caregiver/Parent

64. Division of Responsibility How much How often What level of capability How fast 64 Baby

65. Solid Foods Studies show solid foods do not help with sleep patterns Do not add solids to bottle Don’t pressure – pressure sets up feeding problems and children don’t grow as well Look for clear feeding signals Leaning forward Opens mouth - 65

66. 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? 66

67. 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. 67

68. 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? 68

69. 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. 69

70. Question Is yogurt a creditable food for infants? 70

71. 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. 71

72. Question Are meals served to a child who just turned one year old reimbursable if they contain infant formula? 72

73. 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. 73

74. 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? 74

75. 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 medical statement, the meal pattern can be amended. 75

76. State of Alaska CACFP web site http://education.alaska.gov/tls/cnp/CACFP1.html 76

77. WIC Breastfeeding Information 77 http://www.hss.state.ak.us/dpa/p rograms/nutri/WIC/default.htm

78. Want more on infant feeding? www.fns.usda.gov/tn/Resources/feeding_infants.html 78

79. Ellyn Satter’s Feeding with Love and Good Sense II DVD The Infant The Transitional Child The Toddler The Preschooler 79 www.ellynsatter.com Or www.ellynsatterinstitute.org

80. Special thank you to the Washington State CACFP & Nebraska State CACFP for some of the training materials. 80