Accommodating Special Diets
In section two, we will be discussing accommodating special diet requests.
First off, when might a substitute might be needed? The case of an allergy or intolerance is a very common reason for a diet substitute request. An allergy is when there is an immune system reaction to a specific protein. An intolerance is when there is difficulty in digesting a particular food or nutrient. Allergies and intolerances can range from severe to mild and it is important that you as a child care provider be aware of possible life threatening responses that could occur in children with allergies. Another reason for a substitute request would be a parent preference and/or a religious preference.
When discussing this topic, it’s important to address the topic of disabilities. This will play an important role as to how you handle special dietary requests. The definition of a disability according to the Americans with Disabilities Act Amendments Act of 2008 is: any person who has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment. The term “Major Life Activities” includes the category “Major Bodily Functions” which encompasses functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, cardiovascular, endocrine, and reproductive functions. This is important to know because allergies or intolerances often affect one or more of the major bodily functions. If there is a special dietary request from a child who’s need for a substitution is diagnosed as a disability, you MUST comply with the request. If you think accommodating this request would create an undue hardship on your organization, contact our office.
When determining if the substitution request is a result of a disability, it’s important to know who made the determination. In order to be valid, the form needs to have been signed by a licensed physician, which is an individual who has the authority to write medical prescriptions. In Utah, this includes medical doctors, physicians assistants, osteopathic physicians, advance practice registered nurses, and naturopathic physicians. In some situations, the medical authority might have not stated that the child has a disability, but did describe the symptoms. If the symptoms described meet the definition of a disability, meaning that they substantially limit a major life activity, you could treat it as if the medical authority had diagnosed a disability and serve whatever was instructed to serve.
If the child’s condition is not considered a disability, the sponsor MAY honor the request, but is not required to. Only school sponsors are allowed to offer non-dairy beverage substitutions—juice or water—based on non-disability requests, such as though made by parents.
Now let’s move on to the documentation that is needed. You are welcome to use the USBE special diet form, but you don’t have to as long as we have information that states the child’s disability and an explanation of why the disability restricts the child’s diet, the major life activity affected by the disability, the food or foods to be omitted from the child’s diet, and the appropriate substitutions.
This is the state form that you are welcome to use at your center. This form can be found on our website at www.schools.Utah.gov/cnp. We will got over each of the sections and describe what is needed. At the top of the form, there is basic information to fill out such as the name of the child and parent and telephone number. Directly under that is where the individual will fill out what to NOT serve and what to serve instead, these boxes must be filled out. Underneath, there is a spot to put the diagnosis. Not all children will have a diagnosis, so it only needs to be filled out if it’s applicable. Directly below the diagnosis box is the symptoms and severity box. As you can see, the first option is “not applicable, lifestyle or religious preference”. An example where this box would be marked is if the family was vegetarian or vegan and requesting substitutions for animal products. Underneath that option, there are a variety of common symptoms related to food allergies/intolerances, with the option of writing in different symptoms. Have the medical authority or parent filling it out check as many of the symptoms as apply and if they check “other” encourage them to write in the specifics. The severity of symptoms can be helpful in determining if the issue could be classified as a disability. Have the individual filling out the form be as accurate as they can. The general comments box is for any additional details that they want to provide. Every case is different and the more information that is provided, the easier it is on you.
The next box that we will talk about must be completed by a licensed physician. In this box, the licensed physician can mark whether the child’s need for a substitution is related to a disability or not related to a disability. As we discussed previously, if it is marked as a disability, or if the licensed physician described the symptoms in such a way that it can be classified as a disability, you are required to accommodate the request. If it’s not a disability, you have the choice whether to accommodate the request or not. If it is a medical authority filling out the form, they need to sign it and write their title. The medical authority’s telephone number will be good in case you need to contact them. Make sure that the date is filled out and that you have the parent or guardian sign.
The back of the form has definitions and information as well as a place for you as a center to document how you’re handling the request. As we already discussed, a licensed physician is defined as an individual who has the authority to write a medical prescription and the details are specified here. The next table is helpful information for you to know who can fill out the form in different situations. If the substitution is due to a disability, then it must be completed by a licensed physician. If the substitution is NOT due to a disability, there are a few more options as to who can fill out the form. A licensed physician can fill out the form, as well as a registered nurse or registered dietitian. A parent/guardian can also fill out the form, but remember in this case, that the meal must still meet the meal pattern in order to be claimed.
Next, we have the definition of a disability. This can be helpful for the licensed physician because they might have a different understanding of what a disability is. As we discussed before, you can define a disability as a physical or mental impairment which substantially limits one or more major life activities, with the more specific definitions detailed below. Beneath the definitions, there is also another reminder of what you need to do as far as accommodating the request in different situations. Underneath this box is the space for you to document how you’re accommodating this request. If the substitution request is marked as a disability or you’re treating it as a disability based on the symptoms described meeting the definition of a disability, you would check that first box and you would be required to accommodate the request. The next option is that it’s NOT a disability. In this case, you have the option to accommodate the request or not accommodate the request. It is helpful for the state agency on reviews and for you as a center to have this documented. Check whichever box is applicable and then date the form. This is a food program document, so make sure to keep it for at least three years plus the current year, longer if needed.
For special diet substitutions the action that you would take depends on who signs the form. If the documentation is signed by the parent, the substitution must meet the meal pattern and the alternate menu options must be made available to everyone. If the documentation is signed by a recognized medical authority, which includes registered nurses and dietitians, you would follow the medical authority’s orders, but the meal still needs to follow the meal pattern. These actions would be taken whether or not it is determined that the child has a disability.
If you have any questions about the topics discussed in this section, please contact our office.
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