Optional Best Practices to Further Improve Nutrition in the CACFP

The Healthy, Hunger-Free Kids Act of 2010 (the Act), PL 111-296, amended section 17 of the Richard B. Russell National School Lunch Act (NSLA), 42 USC 1766, to require the U.S. Department of Agriculture (USDA) to update the Child and Adult Care Food Program (CACFP) meal pattern requirements to make them consistent with (a) the most recent version of the Dietary Guidelines for Americans (Dietary Guidelines), (b) the most recent relevant nutrition science, and (c) appropriate authoritative scientific agency and organization recommendations. Subsequently, on April 25, 2016, USDA's Food and Nutrition Service (FNS) published the final rule “Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act” (81 FR 24348) (the “Final Rule”) to update the CACFP meal patterns in 7 CFR 226.20.

Along with updating the meal requirements for the CACFP, the Final Rule preamble outlined optional best practices that center and day care homes may choose to adopt to further improve the nutritional value of the meals they offer. This memorandum outlines those optional best practices and resources to help centers and day care homes implement the best practices in Attachment A. The best practices are a vital tool to encourage centers and day care homes to voluntarily go beyond the regulatory requirements to further strengthen the nutritional quality of the meals they serve.

Best Practices

Many of the best practices are recommendations from the Dietary Guidelines and the National Academy of Medicine that FNS did not adopt as requirements for reasons of cost or complexity. As the Dietary Guidelines and nutrition science evolve, FNS will adjust the best practices to support the CACFP's nutrition and wellness goals.

FNS would like to emphasize that these best practices are optional. The best practices are suggestions only and are not required to be followed in order to receive reimbursement for the meal. The best practices will not be monitored and non-compliance with them cannot result in a meal disallowance or a serious deficiency finding. FNS highly encourages implementing the best practices and applauds those centers and day care homes that find ways to incorporate them into their meal service.

The best practices, as provided in the Final Rule preamble, are as follows:

Infants

• Support mothers who choose to breastfeed their infants by encouraging mothers to supply breastmilk for their infants while in day care and offering a quiet, private area that is comfortable and sanitary for mothers who come to the center or day care home to breastfeed.

Vegetables and Fruit

• Make at least one of the two required components of snack a vegetable or a fruit.
• Serve a variety of fruits and choose whole fruits (fresh, canned, frozen, or dried) more often than juice.
• Provide at least one serving each of dark green vegetables, red and orange vegetables, beans and peas (legumes), starchy vegetables, and other vegetables once per week.

Grains

• Provide at least two servings of whole grain-rich grains per day.

Meat and Meat Alternates

• Serve only lean meats, nuts, and legumes.
• Limit serving processed meats to no more than one serving per week.
• Serve only natural cheeses and choose low-fat or reduced-fat cheeses.

Milk

• Serve only unflavored milk to all participants. If flavored milk is served to children 6 years old and older, or adults, use the Nutrition Facts Label to select and serve flavored milk that contains no more than 22 grams of sugar per 8 fluid ounces, or the flavored milk with the lowest amount of sugar if flavored milk within this sugar limit is not available.
• Serve water as a beverage when serving yogurt in place of milk for adults.

Additional Best Practices

• Incorporate seasonal and locally produced foods into meals.
• Limit serving purchased pre-fried foods to no more than one serving per week.
• Avoid serving non-creditable foods that are sources of added sugars, such as sweet toppings (e.g., honey, jam, syrup), mix-in ingredients sold with yogurt (e.g., honey, candy or cookie pieces), and sugar-sweetened beverages (e.g., fruit drinks or sodas).
• In adult day care centers, offer and make water available to adults upon their request throughout the day.

Infants

• Support mothers who choose to breastfeed their infants by encouraging mothers to supply breastmilk for their infants while in day care and offering a quiet, private area that is comfortable and sanitary for mothers who come to the center or day care home to breastfeed. Breastfeeding provides numerous benefits to the mother and infant, and the American Academy of Pediatrics recommends breastmilk as the optimal source of nutrients through the first year of life. In an effort to support breastfeeding, the updated meal patterns allow centers and day care homes to be reimbursed for meals when a mother directly breastfeeds her infant on-site. The best practice listed above reinforces FNS' efforts to promote breastfeeding and encourages centers and day care homes to provide a supportive environment for breastfeeding mothers. Providing a quiet, private area that is comfortable and sanitary for breastfeeding mothers will help them continue breastfeeding after their infant enters day care.

Vegetables and Fruit

• Make at least one of the two required components of snack a vegetable or a fruit.
• Serve a variety of fruits and choose whole fruits (fresh, canned, frozen, or dried) more often than juice.
• Provide at least one serving each of dark green vegetables, red and orange vegetables, beans and peas (legumes), starchy vegetables, and other vegetables once per week.

The Dietary Guidelines indicates that most Americans do not consume enough vegetables and fruits. The Dietary Guidelines recommends an increased consumption of a wide variety of whole vegetables and fruit, as each type of vegetable or fruit provides a different array of nutrients. Centers and day care homes can help bring children's and adults' vegetable and fruit intake closer to the recommended amounts and increase the variety of vegetables and fruits they consume by following these best practices.

Grains

• Provide at least two servings of whole grain-rich grains per day. The Dietary Guidelines recommends that all individuals consume half of all their grains in the form of whole grains. Whole grains offer a variety of vitamin and minerals, including magnesium, selenium, iron, zinc, B vitamins, and dietary fiber. However, most Americans currently do not consume enough whole grains. This best practice recommends serving one more whole grain-rich food per day than is required in the updated CACFP meal patterns. Whole grain-rich foods are foods that contain 100 percent whole-grains, or that contain at least 50 percent whole-grains and the remaining grains in the food are enriched.

Meat and Meat Alternates

• Serve only lean meats, nuts, and legumes.
• Limit serving processed meats* to no more than one serving per week.
• Serve only natural cheeses and choose low-fat or reduced-fat cheeses.

Meat and meat alternates are good sources of protein and a host of vitamins and minerals, including B vitamins, vitamin E, calcium, phosphorus, zinc, magnesium and iron. These nutrients are essential to healthy growth and development in young children and the continued health of adults. In order for participants to gain the most nutritional benefit from the meat and meat alternates they are served, FNS recommends centers and day care homes implement the best practices listed above.

*The Dietary Guidelines define processed meat as all meat or poultry products preserved by smoking, curing, salting, and/or the addition of chemical preservatives, including bologna, luncheon meats, pepperoni, bacon, and smoked turkey products, among others (http://health.gov/dietaryguidelines/2015/guidelines/appendix-6/#m).

Milk

• Serve only unflavored milk to all participants. If flavored milk is served to children 6 years old and older, or adults, use the Nutrition Facts Label to select and serve flavored milk that contains no more than 22 grams of sugar per 8 fluid ounces, or the flavored milk with the lowest amount of sugar if flavored milk within this sugar limit is not available. Milk is a critical component of the CACFP meal pattern because it provides children with vital nutrients for growth and wellness, such as protein, calcium, vitamin D, and potassium. Flavored milk contains added sugars, and the Dietary Guidelines recommend that all Americans reduce their consumption of added sugars and found that added sugar consumption is particularly high in children. While more research is needed to examine the impact of flavored milk on added sugar consumption, the current science supported changing the CACFP meal pattern to prohibit flavored milk for children 1 through 5 years old. As an additional best practice, FNS encourages centers and day care homes to serve only unflavored milk to all children and adults in their care. If a center or day care home decides to serve flavored milk to children 6 years and older and adults, centers and day care homes can use the Nutrition Facts Label to select flavored milk that has no more than 22 grams of sugar per 8 fluid ounces, or the lowest amount of sugar available. FNS will adjust this best practice as nutrition science evolves and the market availability of lower-sugar flavored milks improves.
• Serve water as a beverage when serving yogurt in place of milk for adults. This combination will help ensure that adults in care consume a calcium rich food and stay hydrated.

Additional Best Practices

• Incorporate seasonal and locally produced foods into meals. A growing body of research demonstrates several positive impacts of serving local foods and providing food education through CACFP, including increased participation and engagement in meal programs; consumption of healthier options, such as whole foods; and support of local economies.
• Limit serving purchased pre-fried foods to no more than one serving per week. The updated CACFP meal pattern requirements prohibit deep-fat frying as way of preparing food onsite, but continue to allow centers and day care homes to serve pre-fried purchased foods. As a best practice, FNS strongly recommends limiting the service of pre-fried foods that are purchased from a store, caterer, or vendor because they can contribute large amounts of saturated fat and calories to a meal.
• Avoid serving non-creditable foods that are sources of added sugars, such as sweet toppings (e.g., honey, jam, syrup), mix-in ingredients sold with yogurt (e.g., honey, candy or cookie pieces), and sugar-sweetened beverages (e.g., fruit drinks or sodas).

Centers and day care homes can help further reduce children's and adults' consumption of added sugars by limiting the service of non-creditable foods that are high in added sugars.

• In adult day care centers, offer and make water available to adults upon their request throughout the day.

As required in the Act, the updated CACFP meal pattern requires centers and day care homes to offer drinking water to children throughout the day. While this requirement does not apply to adult day care centers, FNS encourages adult day care centers to help keep adults healthy and hydrated throughout the day by making water available to them upon request as well.

State agencies are reminded to distribute this information to program operators immediately. Program operators should direct any questions regarding this memorandum to the appropriate state agency. State agency contact information is available at http://www.fns.usda.gov/cnd/Contacts/StateDirectory.htm. State agencies should direct questions to the appropriate FNS regional office.

Angela Kline
Director
Policy and Program Development Division
Child Nutrition Programs

Attachment

• Resources