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Healthy
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Special Dietary Concerns
In the Childcare Setting
Ordinarily, as children come together at meal or snack time, everyone should be eating the same foods. However, there are special circumstances in which a child or teacher cannot eat the same foods. Some examples of special dietary needs include:
- Children with chewing or digestive difficulties may need meats chopped and vegetables cooked until soft.
- Sugar in all forms may be limited for a diabetic child.
- Fats and cholesterol may be limited for overweight children.
- Specific foods or additives may cause allergic reactions in some children.
- Cultural or religious preferences may restrict specific foods, either as a general rule, or at certain times or holidays.
- An underweight or hypoglycemic child may require several snacks a day or special liquid supplements.
Any special dietary needs of children or adults should be clearly identified and documented and it is essential that staff be trained in the importance of adhering to these needs or restrictions. Some food allergies, for example, can be life-threatening. All staff should know the specific food or ingredient restrictions, possible consequences and symptoms of food reactions, and recommended first aid and treatment if needed.
Ask the Parents
When a child is first enrolled, parents should be asked if their child has any special dietary requirements and this information should be recorded. If there is a medical reason for special dietary requirements, such as food or chemical allergies, documentation should be requested from the child's physician.
For addressing religious or cultural dietary concerns, policies should be in place before the situation arises to determine if and how much the program can accommodate these preferences. Food restrictions may be for a limited time, such as during religious holidays. Requests to restrict a particular category of food, such as to omit all meats and substitute other proteins, may not be feasible for your program but you may want to try to accommodate the parents on their request, if at all possible.
It may not be appropriate to limit a child's foods based only on a parent's recommendation. For example, a parent may feel that a low-fat diet is essential. While that may be adequate for an adult, young children need a certain amount of fat in their diet to promote healthy development, including healthy brain development. Requests to limit a child to a particular type of diet such as a low-fat diet, should be discussed with the parents. For instance, skim or reduced fat milk is not appropriate for children.
Unless there is a medical reason to limit fat intake, a well-balanced diet of nutritious foods served at the childcare center should be sufficient for the child. Likewise, a request to substitute foods because "my child doesn't like that" may be inappropriate. Part of the childcare experience should be exploration and experiencing new things, including new foods.
Childcare programs that receive meal subsidies from the U.S. Department of Agriculture are responsible for assuring that meals and snacks are nutritious and that serving sizes are appropriate for young children.
Medical Restrictions
Children with dietary needs based on medical restrictions should have the following information provided by a physician:
- Specific dietary restrictions or needs. For example, a physician treating a diabetic child should state the number of calories or amount of food needed and if the child is taking insulin.
- Specific food allergies, severity of the allergy, and if the food is to be totally avoided, or only restricted. For example, a child allergic to milk may be able to have some products with cooked milk, while a child allergic to peanuts may need to completely avoid all foods with peanuts or peanut oil.
- Possible physical reactions and symptoms. Staff should be aware of symptoms of a diabetic reaction, either to not enough sugar or too much sugar. An allergic reaction may cause anaphylactic shock, which causes breathing difficulties and is life-threatening.
- Specific instructions on how to take care of the child until the parent or paramedic arrives are very important. Insulin shock or allergic reactions can be life-threatening and require immediate medical attention.
Food Allergies
The most common offending foods for allergic reactions are milk, eggs, wheat, corn, legumes, nuts, and seafood. Allergic reactions to fish, shellfish and nuts are usually the most serious. Reactions to other foods are usually less severe and may range from headaches to mood swings to rashes.
If a child in your center has a food allergy, it is essential that you know the specific food or ingredient to avoid and you should have this information provided by the child's physician. Here are some types of food allergies:
Cows' milk is the most common food allergen that can produce a variety of symptoms, including vomiting, diarrhea, nasal stuffiness, headache, hives, severe asthma attacks, or even bed-wetting. An allergy to cows' milk and lactose intolerance are not the same and the incidence of actually being unable to handle lactose is much less frequent than a dairy allergy.
Reading the label of packaged foods should let you know if the child can have the product. Terms indicate the presence of milk or milk-containing substances include: calcium caseinate, casein, caseinate, casein hydrolysate, creamed foods, dried milk solids (DMS), lactalbumin, lactate solids, milk solid pastes, sweetened condensed milk, whey, or whey solids.
When limiting milk, you may need to avoid: any foods that contain sauces or gravies because these frequently contain cheese, milk, or butter as a main ingredient (i.e., potato au gratin); milk-based drinks like hot chocolate or chocolate drinks; all types of cheese and cheese foods; and ice cream and sherbet.
Similar to milk, egg has several protein substances that may cause a severe allergic reaction. Egg-containing foods to avoid may include baking powder, breaded foods, breads with a glazed crust, cakes and cookies, marshmallows, creamed candies and doughnuts, mayonnaise and salad dressings, ice cream and sherbet, pancakes and waffles, French toast, custard, cream pies, and soups made with eggs. Key words on labels that may indicate the presence of egg or egg products include albumin, dried egg solids, egg solids, ovomucin, and vitellin.
Certain grain products such as wheat, corn, oats, rye barley, and rice are known to cause allergic reactions. Buckwheat, although not a cereal grain, also can be an allergen. If a child is allergic to wheat, it may be difficult to avoid because wheat contains gluten, which is used in a wide variety of baked products. Be cautious of labels that include "other flours" as they will likely contain wheat flour.
Foods that commonly contain wheat include baked beans, breads, bread crumbs, biscuits, muffins, pretzels, dry or cooked cereals, crackers, breaded meats and fish, jams (if wheat is used as a thickener), macaroni products, creamed soups and vegetables, potato and rice mixes, and processed meats. Key words that indicate the presence of wheat include modified food starch, flour, enriched flour, and self-rising flour.
Corn is another common allergy-producing food. It is found in cereals, oils, sweeteners, and starches. It is used as a filler, extender, and thickener in many foods. People vary as to the type of corn they are allergic to. Some cannot eat corn in any form but pure corn sugar. Others can eat corn-on-the-cob, canned corn, and popcorn, but cannot tolerate corn syrup. Generally, corn oil is the least offensive food, while corn syrup is the most offensive. Foods commonly containing corn are carbonated beverages, instant coffee and tea, breads, pastries, muffins, marshmallows and marshmallow creme, cream puffs, instant pudding mixes, cereals, salad dressings, deep fat frying mixtures and breading, and cooking oils.
Just to give you an idea of how many foods can cause reactions, here are other foods that may contain corn: canned and frozen fruits, gelatin capsules, ice creams and sherbets, jellies and preserves, margarine, gravies, ham, luncheon meats, chili mix, chop suey, cream pies, pie crusts, canned pie fillings, pancake mix, custard, sauces, seasoning salts, MSG, pretzels, corn chips, vegetable soups, powdered sugar, syrups, tortillas, Harvard beets, canned peas, and frozen string beans. Vitamin capsules may also contain corn products. Key words that indicate the presence of corn are corn solids, corn syrup, corn starch, and vegetable starch.
Legume allergies include foods such as peas, beans, and peanuts. There are many types of legumes, such as acacia, alfalfa, Arabic, beans (green, kidney, lima wax, mung, navy), soybean (including soya flour and oil), carob (chocolate substitute) cassia, karaya, lentils, licorice, locust bean gum, peas (black-eyed, chic, green, split), and peanuts (including peanut oil). A child may react to a single legume, such as peanuts and peanut products, and still be able to eat other legumes such as green beans. Another child may react to any of the legumes.
Foods containing legumes may include breakfast cereals and pastries, breads, candies, cheese spreads, crackers, salad dressings, ice cream, margarine, flavored potato chips, noodles, shortening, salad oils, peanut butter and peanut spread, potato and rice mixes, steak sauces, seasoning sauces, soups, "non-dairy" toppings, and baking chocolate substitutes. Key words that indicate presence of legumes include leguminosae, hydrolyzed vegetable protein, soya flour, soy concentrate, textured vegetable protein (TVP), and vegetable protein concentrate.
The term "nut" is given to a variety of seeds, not all of which are true nuts. Those must likely to act as allergens are peanut (which is actually a legume), walnut, pecan, Brazil nut, hazelnut (filbert), and coconut. Less common offenders are pistachio, macadamia nut, cashew, pinyon nut, and almond. Check ingredients carefully. For example, a child allergic to peanuts would also need to avoid many other real "nuts" such as cashews, because they are often processed using peanut oil.
Children with these allergies also need to avoid nut toppings and crumbs on cookies and ice cream, candies containing nuts or nut oil, and oils from nuts used in salad oils, lard substitutes, and margarine. Sometimes a child allergic to nuts will also be allergic to cottonseed oil and meal.
Religions and Food Beliefs
Children and their families come from many countries and cultures, with various religious and food beliefs. As childcare providers, it is important to understand the relationship between religion and food. There are many religious rituals or customs associated with food. Many religions have decreed what foods can or cannot be eaten; how certain foods are to be prepared; and what foods may or may not be eaten on certain days or certain occasions.
Childcare providers should be sensitive to the importance of food beliefs and religious, cultural, and also ethnic preferences. There should be an effort to address these concerns whenever possible. This can also provide an excellent opportunity to educate children about other cultures and customs.
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