4.2.0.1: Written Nutrition Plan

The facility should provide nourishing and appealing food for children according to a written plan developed by a qualified nutritionist/registered dietitian. Caregivers/teachers, directors, and food service personnel should share the responsibility for carrying out the plan. The director is responsible for implementing the plan but may delegate tasks to caregivers/teachers and food service personnel. Where infants and young children are involved, the feeding plan may include special attention to supporting mothers in maintaining their human milk supply. The nutrition plan should include steps to take when problems require rapid response by the staff, such as when a child chokes during mealtime or has an allergic reaction to a food. The completed plan should be on file, easily accessible to staff, and available to parents/guardians on request.

If the facility is large enough to justify employment of a full-time nutritionist/registered dietitian or child care food service manager, the facility should delegate to this person the responsibility for implementing the written plan.
Some children may have medical conditions that require special dietary modifications. A written care plan from the primary health care provider, clearly stating the food(s) to be avoided and food(s) to be substituted, should be on file. This information should be updated annually if the modification is not a lifetime special dietary need. Staff should be educated about a child’s dietary modification to ensure that no child in care ingests or has contact with foods he/she should avoid while at the facility. The proper modifications should be implemented whether the child brings his/her own food or whether it is prepared on site. The facility needs to inform all families and staff if certain foods, such as nut products (e.g., peanut butter, peanut oil), should not be brought from home because of a child’s life-threatening allergy. Staff should also know what procedure to follow if ingestion or contact occurs. In addition to knowing ahead of time what procedures to follow, staff must know their designated roles during an emergency. The emergency plan should be dated and updated biannually.

RATIONALE

Nourishing and appealing food is the cornerstone of children’s health, growth, and development, as well as developmentally appropriate learning experiences (1-3). Nutrition and feeding are fundamental and required in every facility. Because children grow and develop more rapidly during the first few years after birth than at any other time, a child’s home and the facility together must provide food that is adequate in amount and type to meet each child’s growth and nutritional needs. Children can learn healthy eating habits and be better equipped to maintain a healthy weight if they eat nourishing food while attending early care and education settings (4). Children can self-regulate their food intake and are able to determine an appropriate amount of food to eat in any one sitting when allowed to feed themselves. Excessive prompting, feeding in response to emotional distress, and using food as a reward have all been shown to lead to excessive weight gain in children (5,6). The obesity epidemic makes this an important lesson today.

Meals and snacks provide the caregiver/teacher an opportunity to model appropriate mealtime behavior and guide the conversation, which aids in children’s conceptual and sensory language development and eye/hand coordination. In larger facilities, professional nutrition staff must be involved to ensure compliance with nutrition and food service guidelines, including accommodation of children with special health care needs.

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

4.2.0.2 Assessment and Planning of Nutrition for Individual Children
4.2.0.4 Categories of Foods
4.2.0.8 Feeding Plans and Dietary Modifications
4.3.1.2 Responsive Feeding of Infants by a Consistent Caregiver/Teacher
4.4.0.2 Use of Nutritionist/Registered Dietitian
4.5.0.11 Prohibited Uses of Food
4.7.0.1 Nutrition Learning Experiences for Children
9.2.3.11 Food and Nutrition Service Policies and Plans
9.2.4.3 Disaster Planning, Training, and Communication
Appendix C: Nutrition Specialist, Registered Dietitian, Licensed Nutritionist, Consultant, and Food Service Staff Qualifications

REFERENCES

1. US Department of Health and Human Services, Administration for Children and Families, Office of Head Start. Head Start Program Performance Standards. Rev ed. Washington, DC: US Government Printing Office; 2016. https://eclkc.ohs.acf.hhs.gov/policy/45-cfr-chap-xiii. Accessed September 7, 2017
2. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017
3. Holt K, Wooldridge N, Story M, Sofka D. Nutrition Questionnaires/ For: adolescents, early childhood, infants. In: Bright Futures: Nutrition. Chicago, IL: American Academy of Pediatrics; 2011: 223-236
4. Kleinman RE, Greer FR, eds. Pediatric Nutrition. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2014
5. Lally JR, Griffin A, Fenichel E, Segal M, Szanton E, Weissbourd B. Caring for Infants and Toddlers in Groups: Developmentally Appropriate Practice. 2nd ed. Arlington, VA: Zero to Three; 2008

NOTES

Content in the STANDARD was modified on 11/9/2017.